Internal Cloud Manages Health Records

By Bob Violino  |  Posted 2009-06-08

See also: Best Practices slideshow.

Providing secure, electronic health records (EHR) is becoming a priority for health-care institutions. Beth Israel Deaconess Medical Center in Boston is taking an innovative approach to the challenge, deploying virtualization to transform its EHR data center into an internal cloud that allows the facility to deliver a software-as-a-service (SaaS) solution for electronic records to more than 200 private physician practices throughout Massachusetts.

Beth Israel Deaconess is a teaching hospital that treats more than 250,000 patients a year. It operates the Beth Israel Deaconess Physician Organization (BIDPO), which provides a variety of services, including electronic health records, to support hundreds of independently owned member physician practices.

Officials at the medical center knew that more than 200 private practices located throughout eastern Massachusetts were eligible to take part in the BIDPO EHR initiative. “Each of those practices is a separate business entity. From a design standpoint, we knew that meant each practice required its own database,” says Bill Gillis, manager of clinical application services at Beth Israel Deaconess.

The medical center’s options where to create a distributed client/server model with servers located at each practice, or a centrally hosted model with all key components housed and maintained in a single location, Gillis says. Officials determined that a hosted model was the best choice.

“Once we made that decision it came down to scalability,” Gillis says. “While we had 200-plus eligible practices, we didn't know how many would actually decide to take part.” The concern was that the medical center would build the EHR capability at great expense, and only a few practices would sign up.

“We knew we needed a SaaS model that would give us the ability to grow and expand, as needed,” Gillis says. “Something extremely flexible and dynamic, able to grow and adapt on demand. Basically we could have built a big grand hotel, only to have a few guests ever check in. [What] we needed was a housing development where we can build the houses at will.”

In order to achieve its goals, the medical center turned to server virtualization, deploying the VMware platform from VMware Inc. Virtualization would enable the medical center to minimize hardware requirements, effectively manage server capacity and provide the agility needed for future growth.

The solution was designed by Beth Israel Deaconess and Concordant, a provider of consulting and managed services for the health-care industry. The medical center also engaged VMware partner Third Brigade to help provide the security needed to protect the sensitive electronic records.

Because records are now available to practices via SaaS, participating physicians aren’t required to deploy any hardware in their practices, and Beth Israel Deaconess doesn’t have to provide physicians with constant on-site technical support, Gillis says.

The medical center quickly got a sense of the value of the SaaS solution, Gillis says. A specification was changed unexpectedly and he estimates it would have cost $300,000 to make the needed adjustments in a traditional hardware-based environment. With the virtualized environment, the cost was only $20,000, representing a savings of 93%.

Server virtualization is expected to generate ongoing operational savings for BIDPO. Concordant has found that virtualized solutions can reduce total cost of ownership for practice management and EHR systems by 40%.

“The big benefit is it allows us to provide an EHR to a small physician practice at an affordable cost,” Gillis says. “EHRs are complex systems with network, hardware and software components. They include interfaces to clinical results delivery systems such as lab and radiology. Implementing and maintaining these systems are costs most practices don't fully understand nor have qualified staffing to deliver.”

A SaaS model allows the medical center to provide all the resources practices need to access records. “This allows the physicians to use the EHR to its full potential with no real worries about the backend details,” Gillis says. “For the patient, it provides the foundation for true clinical integration at a cost their physicians can truly afford.”

 Beth Israel Deaconess sees potential in other types of virtualization implementations. “In the current budgeted phases of the project, we are only implementing server virtualization. Desktop virtualization does hold some promise for future phases of the project,” Gillis says. “Right now though, we are concentrating on delivering the EHR to the enrolled practices to meet our clinical integration project timelines.”