High Availability and Unified Data Management in a High-Demand Environment

In a survey whose results were released on March 4, HIMSS Media, a division of the Chicago-based Healthcare Information and Management Systems Society (HIMSS), polled 416 healthcare professionals on major IT strategic issues facing patient care organizations right now. The survey was commissioned by the Oceanport, N.J.-based CommVault. It found that the rapid implementation of electronic health records (EHRs) and picture archiving and communications systems (PACS) was most strongly driving the growth in data-access demands in U.S. patient care organizations.

The rapid universalization of EHRs and PACS, combined with the widespread adoption of mobile devices by physicians and clinicians for use in patient care delivery, are creating new data management and security challenges, the survey found. Indeed, nearly 61 percent of those healthcare leaders surveyed cited a concern about managing, protecting, and securing unstructured protected health information (PHI), such as e-mails, stored on laptops, tablets, and smartphones within patient care environments.

Asked whether they had a solution in place to support eDiscovery (the initial process of providing a court with electronic records during a legal case) or an enterprise search solution to support regulatory compliance around HIPAA (the Health Insurance Portability and Accountability Act of 1996), only 26 percent reported having such a solution in place, a sign of compliance risk exposure.  Survey respondents included CIOs, IT managers and directors, clinical informaticists, CEOs, CFOs, and other healthcare leaders.

Shortly after the release of the survey results in March, HCI Editor-in-Chief Mark Hagland spoke with Rick Haverty, director of infrastructure at the University of Rochester (N.Y.) Medical Center (URMC) regarding some of the survey’s results, and his interpretation of those results. URMC—which encompasses three hospitals, Strong Memorial, a 900-bed teaching hospital, as well as two community hospitals, the 250-bed Highland Hospital and the 120-bed F.F. Thompson Hospital (an affiliated facility), plus approximately 170 outpatient care sites—is using CommVault’s unified data management solution to accelerate critical backups of large amounts of data and to support compliance. Below are excerpts from that interview.

Let’s talk about some of the elements in the landscape that are motivating broader data management strategies right now. The meaningful use process under the HITECH (Health Information Technology for economic and Clinical Health) Act, and the Affordable Care Act (ACA), are both setting the pace for change, are they not?

Yes, but also changes within the healthcare system in general. For instance, we’re moving towards becoming an accountable care organization, which means that historical data is becoming more important to us in terms of our ability to support accountable care.

Rick Haverty

Which parts of your overall organization are moving towards accountable care first?

The medical faculty group will lead the way, but the entire three-hospital organization will be moving in that direction.

So, generally speaking moving towards accountable care has been a driving factor?

Right. And meaningful use, too, is a driving factor. We moved from an old Siemens EMR to an Epic, HIMSS level 7 EMR. And we have about 170 ambulatory care sites, with the hospital and ambulatory care sites on Epic, except for the smaller affiliated hospital, which is still on McKesson, but which will migrate over to Epic in the next couple of years. We’ve attested to Stage 1 of meaningful use, last year. Our investment in our EHR [electronic health record] has been $80 million.

What have been your top infrastructure investments in the past year?

Our top one has been the EHR, absolutely. A close second is our new PACS system and VNA [vendor-neutral archive]. The VNA went live last fall, and the new PACS is going live in May. It takes a while for the migration; it will take 18 months for all the PACS data to migrate to the new system.

Which vendors are providing those systems for your organization?

The back-end software for our VNA is from Accuo; we’re migrating to a new PACS system, from Philips.

What are the most pressing demands on you and your team right now?

The number-one demand is high availability. Clinically, we’ve gone from a situation in which we had downtime procedures that were non-computerized, and it wasn’t a critical disaster if we went down for a little bit. But with a HIMSS Level 7 EHR, where so much information is sitting inside computers at this point, there’s no possibility of getting that information on paper. We’ve had two data centers built in the last three years, and we’ve decommissioned the old one that one had been built in 1958, and was originally a motel, and the university bought it in the 1970s. And the back end became our data center, which was below 52 flushing toilets. But back then, that was good enough for a medical center, believe it or not. Not anymore, obviously: high availability is absolutely needed. And everything in the medical center is becoming computerized and digitized, which means we have more projects than ever. Right now, I’m running 900 virtual servers, whereas about five years ago, I was running 300. And the demand just keeps going; there’s no control point for that.

In your role, you are essentially the organization’s CTO, then, correct?

I do make technology decisions for the organizations, and I report to the CIO.

What would your advice be to colleagues nationwide around data availability and unified data management?  What do CIOs and CTOs have to do in order to support these demands?

Part of the challenge is that we have to become as efficient as possible. And we have to archive the right amount of data, in the right types of media. I run three tiers of storage; and can we start to leverage file storage, which can be very cost-effective? At the same time, it’s outside the firewall. That’s why I’ve turned to CommVault to help us. HIPAA recommends that you store this data in the right amount of time, and that it be accessible, which means that you have to be able to bring it up in a reasonable amount of time and read it. And now you’ve got the phenomenon of big data; and how you do you mine that, and do something useful with it?

So people have to strategize on using and storing big data, correct?

Well, the reality is that everyone already is overwhelmed; and if we’re honest about it, we’ll have to admit that we’re not handling this strategically yet. The reality is that right now, we’re storing everything right now, forever, in terms of the diagnostic images. Mammography you still have to keep forever, and pediatric data has to be kept until they’re the age of the majority, which in New York is 21. And the radiologists want information and images going back as far as they exist. And who am I as an IT guy to question that? And as a research institution, we have that entire element as well.

So all this data use has to be rationalized at some point, right?

Yes, because the cost structure won’t otherwise support it. What we’re trying to do is to rationalize all this, and to find a happy medium between just meeting compliance requirements and meeting everybody’s perceived requirements. And until very recently, our answer was, just save everything forever. Meanwhile, our Office of Counsel, the lawyers, want a great deal of information—they want historic information—and, as with anything else for lawyers, some information is useful for them, and some isn’t. And they never tell us what’s particularly useful or not. And we’re involved in clinical trials, and a lot of patient care and PHI [protected health information] situations, and inevitably, legal cases, and we’re the ones who have that information sitting on a tape somewhere. And eDiscovery has become important, and more difficult. The truth is that we’re swimming in data; and now, going to look for something specific for one of our lawyers, becomes much more of a needle in a haystack. And without specific tools, it’s like looking for a needle in a haystack.

Is there anything else you’d like to add?

It’s a really interesting business to be in these days. I’ve been in IT for my entire career, but in healthcare just for the past eight years. And when I first got into healthcare, I was amazed at how backward it was, but things have changed dramatically. And part of the change has come about because of the stimulus package, which got people to think about making investments to provide better care, more efficiently. And that transformation has really happened in the last four or five years. So I have more projects than I can handle, and more data than I want to have; at the same time, it’s a very exciting place to be. And you don’t get a better mission anywhere else. It’s a very exciting time to be in this field right now.