Avoid Network Flatlines

We're all familiar with the phrase "code blue" - it means that a hospital patient's heart has stopped. At Community Health Network's (CHN's) (Indianapolis) hospitals, however, there was another kind of emergency - a code white. This code alerted employees to network downtime. Even though a code white could be predicted ahead of time, it still created its share of trauma. Hospital doctors, nurses, and clerks, for instance, had to try to predict what information they would need during the two-hour downtime and print patient files and other information in advance. Additionally, if information needed to be captured during a code white, it had to be written down on paper (hence "white") and later entered into the appropriate application. This resulted in extra labor and a greater chance of errors.

DAS Slumps As Network Scales
As CHN's facilities added new applications to their repertoire, such as a pharmacy system, a radiology information system, and a bedside documentation application, IT administrators had to guess how much storage would be needed to support a particular application. More often than not, the DAS (direct attached storage) network proved both inefficient and expensive. First, in a DAS network, administrators typically allocate 60% more storage than is immediately needed to create a buffer and to lessen downtime. Second, because of the inherent configuration of a DAS network - individual storage servers dedicated to individual applications - access times and system backup times become increasingly sluggish as the network grows.

In early 2000, CIO Ed Koschka and CTO Rick Copple decided to migrate the hospitals' networks to a SAN (storage area network) environment. This move would prove to be not only an immediate fix to CHN's code white and storage capacity planning problems, but a step toward another goal on the duo's plate: an all-digital facility.

Defibrillate SAN With Virtualization Software
CHN's SAN initially comprised an IBM Shark storage subsystem with Fibre Channel (FC) connectivity within the building where it was housed at the East Community Health facility. To get the maximum benefit from its SAN deployment, CHN added DataCore Software Corp.'s (Ft. Lauderdale, FL) SANsymphony storage management and virtualization software to the system. The software provided a fourfold performance acceleration to the healthcare network's SAN. "The read rate and caching capabilities of the virtualization software reduced our backup times from 25 minutes to 7 minutes," says Copple. "Additionally, our database consistency verification process went from 30 minutes to 10 minutes." Besides giving CHN's network a needed boost, the storage virtualization enabled the healthcare network entity to save money on its disaster recovery initiative as well. "Without the SANsymphony software, we would be forced to purchase a second IBM Shark subsystem," says Copple. "Because the software creates a platform-agnostic environment, we were able to use two IBM FAStT subsystems synchronously mirrored. This is significantly less expensive than purchasing a second IBM Shark using PPRC [peer-to-peer remote copy] - a hardware-based disaster recovery and workload migration solution." Using the built-in mirroring functionality of its storage management software, CHN is able to asynchronously mirror data over the IP (Internet protocol) network to a third FAStT subsystem that is located at The Indiana Heart Hospital (TIHH), 11 miles away. CHN, like many other enterprises, chose asynchronous mirroring for its disaster recovery site because of distance limitations and to better utilize its bandwidth (2 Gbps) between its data centers. Because synchronous mirroring requires confirmation from the host site before signaling I/O (input/output) completion to the requesting host, it is typically used only for high-bandwidth connectivity. "This was another reason we did not want to use our Shark for disaster recovery purposes," recalls Copple. "Because the Shark uses a built-in PPRC protocol, we would have been forced into synchronous mirroring, which adds an extra step to the mirroring process. The time required for this extra step would have introduced the potential for data loss in a disaster recovery situation."

Between the two data centers, CHN stores 8 TB of data - 4 TB of live data and 4 TB of data that is mirrored in the event of storage server downtime. Using SANsymphony software's GUI (graphical user interface), IT administrators are able to manage heterogeneous resources (e.g. servers running on UNIX platforms and servers running on Windows 2000 platforms) from a central console. This means the arduous task of having to do volume management on every application server is eliminated. Additionally, the storage management software eliminates having to predict how much storage capacity is needed by giving administrators a centralized "pool" view of their storage. And, by employing specific network rules, IT administrators are automatically notified when the storage pool falls below a certain level.

Document Imaging Is Next Step To All-Digital
When TIHH opens its all-digital facility in a few weeks, it will be among the few paperless and filmless hospitals of the world. CHN's other four hospitals - all located in the Indianapolis area - will take a phased approach from paper to digital. "In the medical community there is a mindset that you have to generate and store paper," says Copple. "With proper training and patience, healthcare employees see the value of electronic data compared to paper-based data."

At CHN's other four hospitals, Copple and his IT staff will take a phased approach toward that goal of being all-digital. One technology that currently plays a key role in this transition is document management. CHN's hospitals use a Filenet document imaging solution, which includes Panagon capture software. Its document imaging solution is integrated with scanning hardware such as Kodak, Ricoh, and Fujitsu scanners and Kofax interface cards. With its document management solution in place, CHN is able to scan paper documents such as patient health records, patient financial service forms, and lab reports. "In all, we scan about 7.5 million documents per year, which does not include documents that are provided by outside electronic services," notes Copple. That works out to an average of 1.88 million documents per hospital. When you think about the fact that that number will be cut down to nearly zero in one hospital, you can begin to see the time savings of generating documents electronically and keeping them electronic.

Integrated Patient Records Yield Safer Medical Diagnoses
One of the final steps in going all-digital in the hospitals will be to roll out digital X-ray machines that are designed to capture and present X rays on computers without the need to produce film. CHN has been working with GE Medical Systems and will use their PACS (picture archiving and communication systems) imaging solution to achieve a filmless environment as well as a paperless one. The final feature that will be available at TIHH will be a GE Centricity Information System, an electronic patient medical record technology that integrates patient information - including images, waveforms, and complete medical history - into a single electronic record that will span a patient's lifetime. Clinicians will more easily be able to view patients' medical histories and provide safer care while at the same time be able to spend more time with patients.