Service and Speed in the HIT Cloud

“Imagine the day when H1N1 detection is automated because it’s passively discovered in the cloud,” says John D. Halamka, MD and CIO at Beth Israel Deaconess Medical Center (BIDMC). A respected leader in the healthcare technology, Halamka sees great potential for the cloud to play a vital role in improving healthcare delivery through shared resources and information. For now, many challenges remain including helping facilities navigate the process of implementation.

BIDMC turned to the cloud as a way of addressing “local insurance payers’ and federal electronic health records (EHR) mandates.” [1]  The cloud offered an opportunity to streamline maintenance in the system. As Halamka says, “”Do you think that running, say, an Oracle database instance on a storage area network under your doctor’s desk is going to work very well?”

Developing a Scalable Solution

Halamka and his team chose a small, scalable solution running integrated practice management and EHR software as the initial project. They weren’t prepared to turn to a large commercial provider, so they hosted it themselves at a central location. In the beginning, they weren’t sure how many of the 400 physicians affiliated with BIDMC would participate. So they need to build out an infrastructure with secure web access that could scale as needed. VMware’s server virtualization and EMC’s storage area network (SAN) technologies provided the backbone for their solution.

Storage Challenges

As it turns, they discovered storage needs were higher than expected. ”We initially planned for six terabytes of storage total,” says Bill Gillis, the CIO of the Beth Israel Deaconess Care Organization (BIDCO). “(N)ow we’re projecting eight terabytes, and we’ll probably end up needing more like 10 terabytes if everybody signs up.” As they expand storage, they also plan to expand connectivity between BIDMC and other healthcare facilities.

Overcoming a Slow Internet

On Halamka’s blog, “Life as a Healthcare CIO,” Halamka discusses an unseen challenge. The speed on the Internet. He writes, “SaaS is only as good as the internet connections of the client sites.”[2] “Our EHR cloud is served to the practice via public internet over SSL,” says Gillis. Unfortunately, Metro Boston did not have the robust internet infrastructure to support their needs. Additionally, they discovered that speed of ping response does not indicate true performance. As Gillis explains, “Many cloud hosted applications are sensitive to latency, packet loss, fragmentation & jitter.”

There were ISP connectivity problems, but they had no way to document the problem and the ISP wouldn’t take action. “After engaging third party network sniffing firm,” says Gillis, “we discovered the real culprit impacting performance – network latency.” They ended up utilizing a small, low cost black box application installed at each site. This delivers “deep and detailed network data back to a secure cloud.” Now they can pinpoint specific problems with documented log information that allows them to address to specific issues and work with the ISP to correct.

Halamka offers a concluding reflection on their success in the private cloud, “SaaS is only as good as the privacy protections you purchase or build yourself.   Performance is only as good as your network connection.”

[1] Beth Schultz. “Cloudy, but Clear Sailing Ahead.” ON Magazine
[2] John D. Halamka, MD. “The Reality of SaaS.” Life as a Healthcare CIO, March 26, 2013

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