CIO Todd Schnack says the growth of electronic data has come as no surprise, and the practice is struggling more with the need for immediate data access than data storage issues. "As we continue to add providers, the growth of data is pretty linear-but we have to keep all that data for immediate access."
Archiving is not an option because patients increasingly are demanding more information on their medical conditions and want the information electronically, Schnack notes. And in the age of smartphones, "patients, our staff and providers basically have a computer in their pocket that can handle more complex data reporting and queries."
Further, the demands of governmental agencies and insurers for quality reporting drives more data growth. So, the practice can't archive because on several fronts it needs its data readily available.
Not alone
Rockford Orthopedic isn't alone. As providers continue to adopt clinical information systems or add to what they already have, they're facing the same two fundamental issues: How to store all that data and where to find the space.
Most providers beef up their back-end infrastructures by adding servers, and/or rent space in third-party data centers. But the decisions and strategies to take are not that straightforward.
Virtualization, storage area networks and cloud computing have become viable options, but each has its drawbacks. And while third-party storage is attractive, optimal control of data may be beyond the reach of the outsourcing provider, which requires strict oversight by providers. (see story, page 35).
While deciding how to manage an expanding storage/server infrastructure can be tough, paying for the services and hardware is easier thanks to plummeting prices for data space. In addition, a critical ancillary technology that makes sense of it all-dashboards-is becoming more sophisticated and user-friendly.
Going virtual
Three years ago, Alice Peck Day Memorial Hospital was quickly running out of space to add more applications and servers. Since then, the hospital has increasingly used server virtualization, and now is adopting storage area network technology, to reduce its data storage footprint.
Virtualization technology allows applications to be consolidated in a smaller footprint by eliminating the need for a physical server per application, explains Lorraine Nichols, the hospital's information services director. For instance, you can name a server and associate a specific application with it-such as e-mail on server 6. If server 6 fails, the virtual host detects it and moves the data on server 6 to another server. This provides business continuance at the physical hardware level.
So far, Alice Peck Day has consolidated 25 physical servers into a virtualized environment where they connect to three host servers from VMware Inc., Palo Alto, Calif. These host servers manage all the resources needed to run the applications that originally ran on the 25 physical servers.
"In the past, if any of these items failed on any of the 25 physical servers, we had to wait for a part to be shipped, installed and perhaps reload the application to bring it back online," Nichols says. "Now, the host servers know how to share these resources, which protects against various hardware failures. It essentially eliminates that single point of failure that you have in a traditional physical server environment." The hospital has seven other servers for applications that don't work with virtualization.
Serious about SANs
Now, the hospital is looking at increasing its use of storage area networks to further manage future data growth. A storage area network comprises computers and storage devices connected over a high-speed optical network used to move data among the various storage devices, allows sharing data between different network servers, and provides a medium for data backup and restoration, and data archiving and retrieval.
Alice Peck Day Memorial Hospital uses a SAN for Microsoft Exchange e-mail and at some point in 2012 will bring in another SAN to support virtual desktops running Citrix technology.
The new SAN will house the data storage for the Citrix environment, and will enable access to information systems via smartphones, iPads, laptops, and tablet computers. The SAN also will support virtual desktops, which will help with maintenance, Nichols says.
The hospital will continue to consider SAN technology for other applications because of space allocation, she adds. "It helps consolidate space into a smaller footprint, reduces energy costs, and offers greater flexibility for disaster recovery."
When Alice Peck purchased Greenway Medical Technologies' electronic health records software for its owned clinics in early 2010, it also wanted technology that offered high availability and redundancy for the EHR.
Greenway had recently partnered with Stratus Technologies of Maynard, Mass., which sells the Avance server performance monitoring product.
The primary site with two servers (the application on one and database on the other) is in the hospital and the second site is in another building with two exact duplicate servers. If the primary site should fail, the Avance software automatically powers up the secondary servers and switches to the secondary site with no interruption to the users and no intervention from the I.T. staff, Nichols says.
A significant upgrade this summer of its practice management and EHR software, from eClinicalWorks Inc., necessitated new storage needs at Rockford Orthopedic. Capacity on its servers maxed out and the practice turned to a "network attached storage solution," says CIO Schnack, which uses another server with dozens of large-capacity hard drives and solely dedicated to storage, he explains. "You can add more storage without replacing the EHR server. It's basically adding more external drives to the EHR server." The practice also uses data virtualization and has looked at the "cloud," or off-site storage accessible via the Internet, "but we feel that gives up control considerably and introduces network performance challenges," Schnack says.
