Enterprise Software

Hospital successfully installs back up/recovery hot site with zero downtime

In this case study, see how Hunterdon Hospital deployed a new infrastructure with no service interruption.

Hunterdon Medical Center's CIO wanted the healthcare facility's new remote backup/recovery hot site installed and brought online as quickly and easily as possible, without interrupting existing processes or sacrificing patient quality care.

Going with QuadraMed as the overall vendor made that goal feasible. "If I was to make a recommendation to anyone, I'd say select an HIS (health information systems) vendor and let them drive," Glenn Mamary, CIO of the 176-bed acute care facility in Flemington, NJ, told TechRepublic.

That was in the third quarter of 2003, when the hot site went live. There's also been a major upgrade of QuadraMed's Web-native Affinity HIS system, which is built on InterSystems' post-relational CACHÉ 5 database. This year, Hunterdon plans to implement a series of new systems. Those plans include wireless system access to the IDN's physician order-entry system and work with tablet PCs.

Disaster recovery: Evaluating new solutions

QuadraMed was no stranger to Hunterdon, which has been a QuadraMed Affinity customer since 1998. What Mamary was asking of QuadraMed this time was a complete, electronic medical record system that would provide clinicians access to patient information "anywhere, anyplace, anytime."

Hunterdon already had a reputation for improving patient healthcare through technology. Hospitals & Health Networks calls Hunterdon one of the nation's "Most Wired" medical centers.

However, the technology needs of a hospital system are very different from those of a non-medical business. Hunterdon is a non-profit healthcare organization in Flemington, NJ, committed to providing a full range of quality services that respond to the needs of the community. Hunterdon Healthcare System is partnered with the Hunterdon Physician Practice Association, forming Hunterdon Healthcare Partners LLC, an integrated delivery network (IDN) with 21 locations and about 2,000 employees; 11 physician practices; a health and wellness center; a visiting health and support center; and 1,400 desktops that handle approximately 347,000 patient encounters annually. None of those patients can reasonably be asked to wait while Hunterdon upgrades any of its technology.

Prior to the new hot site, Hunterdon used a vendor that assisted with offsite storage and other disaster recovery systems. Hunterdon did daily backups and those backups were tested. "If we were to have a casualty, we'd have to order a batch shipment," Mamary said.

For a long time, Hunterdon was satisfied with this system. The vendor was always very accommodating and often was little more than a phone call away. However, there were always the nagging realizations that Hunterdon would not necessarily be the vendor's priority and what could happen if Hunterdon suffered a real disaster. Hunterdon, Mamary explained, would always have to compete with the vendor's other customers, which could cost precious time. "I wouldn't know where we'd be on the totem pole," he said.

Then Hunterdon installed its critical information systems, a development Mamary said was a "big turning point." That change came as Hunterdon continued to grow and that growth brought its own issues. "As we grew, the expenses grew as well," he said. The old backup and recovery system was no longer the best option.

Hunterdon officials soon were mulling the value of a hot site and this led a few years ago to a business impact analysis study, in which Hunterdon officials looked into what would happen if their systems went down or became unavailable.

Benefits of a remote facility

Hunterdon had a number of options. They could contract out but that would be expensive. They could build onto what they already had in place but the existing procedures and systems already were inadequate and adding on would make them cumbersome. So Hunterdon began testing and finalizing plans to develop the hot site, using in-house manpower and resources. They soon found that, done this way, the hot site not only became a disaster survival and recovery location but also could be used for training and other purposes, Mamary said.

Other benefits tipped the scale in favor of this new disaster management and recovery solution. Hunterdon would not only enjoy full and immediate access to the computer room, but also full use of the facility's equipment for such tasks as printing, offloading, and training. "We'd actually get to utilize all our assets," Mamary said. "They wouldn't just be sitting there."

These observations were backed up by Hunterdon Technology Manager Alberto Cruz-Natal, who pointed out that the health care system examined a number of "what-if" scenarios and is very pleased with the results. "We can react better when the technology changes," he said. This also provides better security.

The benefits extend even beyond the disaster recovery system and facility. Mamary said he appreciates having full control over what operating systems were installed on which computers and always knowing the OS distribution, something they never enjoyed with the vendor.

The new system was implemented in about six months. "What we did was hold the line on the hospital information system," Mamary said. This can be crucial, he explained. Hospitals that need to expand their information systems often have trouble implementing better, more streamlined solutions because of the need for constant change. Instead, they usually end up adding on, which often creates unwieldy and insecure systems.

This was where the importance of QuadraMed became most apparent. The benefit of using QuadraMed as a single contractor was that QuadraMed was able to coordinate almost all of the project. For instance, they worked with the IBM reseller and they were able to oversee the project enough to be sure that the new HIS system worked as envisioned. This eliminated the problem of multiple people setting multiple priorities, he explained. "They all worked together with QuadraMed as the leader," he said.

InterSystems, creator of CACHÉ, reported to QuadraMed. CACHÉ's speed and reliability were key to the high level of system performance Mamary wanted to achieve. In disaster recovery mode, Hunterdon can obtain a database at the remote hot site in less than two hours, a dramatic improvement over its old system. Also key to the success of the implementation is the CACHÉ RAD environment, which made it possible for QuadraMed developers to quickly customize Affinity to meet Hunterdon's specific needs.

QuadraMed Affinity Patient Registration helps expedite patient flow and improve Master Population Index (MPI) accuracy. QuadraMed Imaging is used to scan insurance cards so that Hunterdon staff can access information on those cards. QuadraMed affinity Patient Charting makes documentation easier, more thorough, and far more accessible

Hunterdon plans to implement QuadraMed Affinity Computerized Physician Order Entry (CPOE) this year.

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