Major, Very Expensive Infrastructure
Upgrade"> To make sure an automated group practice management and EHR system would succeed, Fallon began by opening its wallet and embarking on a major infrastructure upgrade, moving from the shared hub LANs and 256K-bps frame relay links to 100M-bps switched LAN links and a 10M-bps TLS (Transparent LAN Service). Fallon, already a Cisco Systems data center switch and router customer, opted to stick with the network equipment supplier and deploy Catalyst 3550 switches in each of the 20 sites, giving users switched 100M bps links to each desktop at all locations."We looked at the network and tried to eliminate as many single points of failure as we could," Paul said. "We have dual cores [switches] in the [data center] so that if a card or a whole switch should fail, all our servers will automatically fail over to [the redundant core]. Were also building a hot site at another location for disaster recovery and replicating the electronic health record system over to that site. If the data center were to fail, we could move everyone over to that hot site." For security, Fallon implemented redundant Cisco PIX, or Private Internet Exchange, firewalls as well as Ciscos Intrusion Prevention System. Each site also includes an open-source IDS (intrusion detection system) that reports to a Cisco console for monitoring and alerting. To present the application to what will eventually be 1,300 users, Fallon chose to implement the Epic system on a 24-server Citrix Systems farm dedicated to the Epic software. "We wanted to make sure nothing else affects the availability of Epic," Paul said. The database supporting the Epic applications, Intersystems Cache database, runs on an Itanium-based Hewlett-Packard HP Integrity rx7620, a 10-processor box running HP-UX with 20GB of memory. That, too, is clustered for redundancy, and the cluster is linked to an EMC Clariion storage network as well as to the Cisco Catalyst 6509 switch via Gigabit Ethernet. "The reporting piece of Epic is on another [Integrity] 7620 with an EMC storage network," Paul said. "That ensures that any reporting activities would not affect Epic." Fallon also upgraded 1,600 PCs that will be used exclusively to access the Epic software. The PCs are either 1.8GHz or 2.3GHz systems, and they are installed at every station as well as in offices across Fallons 20 sites. By years end, every examination room will have a PC to provide physicians with fast access to patients charts and records. "Included in [Epic] are interactive communication tools the physician [can use] to show the patient details of what their condition is and where its affecting them," Paul said. "We also [implemented a filmless] radiology system [last year], so the physician in the exam room [will be able to] show the patient their [X-ray] electronically." Fallon officials had considered giving physicians tablet PCs but determined the technology was not ready for widespread use, and Epic is not yet a "tablet-friendly" system, Paul said. "Tablets are not ready for docking and undocking. Were [anticipating] 10,000 docks a year. Were not sure theyd [tolerate that]; they are still too hefty to carry around from one exam room to the next, and the battery life isnt there yet," she said. Unlike many new application deployments, managing the new EHR system was not an afterthought. "When the decision was made to go to the electronic record, we knew we could not [continue to take a passive] approach to monitoring that system," Harrop said. "The object of the game was to get ourselves to a point where we could monitor and alert prior to the point where users would see [a problem and act on it]. We wanted to head off that call [to the help desk]." Even before the Epic software was rolled out, IT staff at Fallon gathered requirements, put out an RFP (request for proposal) for a management system and carefully selected its tools. Although several of the major enterprise systems management playersincluding BMC Software, HP and CAresponded, Fallon chose the smaller Heroix and its eQ and Longitude application and system performance monitoring tools. Next Page: Making communication and decision-making easier for everyone.
At the same time, in the data center, Fallon set up dual Catalyst 6509 switches to ensure high availability of the EHR system. Each remote site, which had either linked to the data center via a 256K-bps frame relay link or was daisy-chained to larger offices via point-to-point T-1 links, was upgraded to 10M-bps TLS services from Verizonbacked up by a combination of redundant link types from Charter Communications and DSCI. A Cisco router in every site connects to the TLS, and the Cisco LAN switch in each side connects to the backup links.