Embed Size (px)
Citation preview
William “Buddy” GillespieDirector Healthcare Solutions
Distributed Systems Services (DSS)
Edith DeesVP & CIO
Holy Spirit Hospital
Meaningful Use Forecast:
Cloud Computing and Disaster
Preparedness
Presentation Content
–Dispelling the Myths around the Cloud: Catching the Virtualization Wave
• Cloud and security: Is my data really safe?
• Cloud-based solutions:
–Examining functionality, cost and system consolidation
• Impact on EHR projects, from meaningful use to ICD-10 transition
Presentation Content
Lay of the DR landscape: What you need to know
about HIT and disaster preparedness
Linking DR and cloud storage:
–Steps to take and assessments to make
Industry best practices:
–What are the pros and cons of cloud-based disaster
recovery for health care providers?
–Cloud and security: Is my data really safe?
–Data availability – the real cost of downtime in a 24/7 hospital environment
Case Study: Holy Spirit Hospital
On shared drive
• Our story of DR and preparedness: From top down
and bottom up, what you need to know
• Perspectives from a HIT CIO:
• How IT leaders can safeguard and mitigate risk
through data storage and cloud strategies
• Dispelling the Myths around the Cloud: Catching the Virtualization Wave Holy Spirit Hospital
Presentation Content
US Healthcare Spending
Legislative Background
Health Information Technology for Economic and Clinical Health Act (HITECH) H.R.1
– $2 billion for ONC
– $18 billion for CMS
NPRM January, 2010
Final Rule July, 2010
Implementation begins
• Hospitals - October, 2010
• Medicaid - January, 2011
• Physicians – April, 2011
6
Defining Meaningful Use
Three components of Meaningful Use
MU Objectives and Measures
– Core and Menu set
Clinical Quality Measures
–Core, Alternate Core, and Additional CQMs
Stages
–Stage 1 – 2011
–Stage 2 – 2013*
–Stage 3 – 2015*
7
Timeline – Meaningful Use
It’s a journey – 3 Stages over 5 Years
Meaningful Use & IT
9
• IT is Getting Closer to Patient Care
– PACS, CPOE, EHR, Med Administration
• Increased Demands for Higher Availability
– Technology Integrated into Clinical Workflow
• Increased Regulations?
– PA Act 13
– FDA
EMR Adoption ModelHospitals continue to move up the HIMSS Analytics EMR Adoption Model
Healthcare increasingly will use analytics to driveclinical and operational improvements to meet business challenges
HIMSS Survey-Priorities
What is a Cloud?
Dictionary Definitions
– 1 : a visible mass of particles of condensed vapor (as
water or ice) suspended in the atmosphere of a planet
(as the earth) or moon
– 2 : something that has a dark, lowering, or threatening
aspect
– 3 : something that obscures or blemishes
Source: http://www.merriam-webster.com/dictionary/cloud
What is a Cloud?
National Institute of Standards and Technology (NIST)
• Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources… that can be rapidly provisioned and released with minimal management effort or service provider interaction.
• Essential characteristics: On-demand self-service, broad network access, resource pooling, rapid elasticity, measured service.
• Service models: Cloud Software as a Service (SaaS), Cloud Platform as a Service (PaaS), Cloud Infrastructure as a Service (IaaS)
• Deployment models: Private cloud, Community Cloud, Public Cloud, Hybrid Cloud
Source: The NIST Definition of Cloud Computing (Draft). NIST
Special Publication 800-145 (draft)
What is a Cloud?
15
• Infrastructure Delivery Mechanism – Platform– Computing (Windows/Linux), Storage, Network
– Capacity on Demand; Rapid Deployment; Metering
• Commonly Confused With ASP, SaaS, RCO, etc.– Isolated from infrastructure
– May be delivered via cloud infrastructure; may not be
• It’s Marketing
Leveraging Cloud for MU
EMR as a service
Departmental solutions as a service (e.g. lab)
Health Information Exchanges
Non-core application services
– Contract Management
– Office applications
– Mail and Calendar
Why Cloud Computing Now? Reduce Cost
– 30 percent less cost on the average
Faster time to Value
– MU achievement on-time
Preserve Capital
– Subscription model vs. capital expense
Availability of Skills
– Outsourcing critical technology skills
17
Evolution of Data Centers
18
1970’s 1980’s 1990’s 2000’s 2010’s 2020’s
Mainframe Data Centers
Server Data Centers
Co-location
Managed Services
Cloud Computing
HIMSS Survey-Infrastructure
20
EMR & digital medical imaging systems will drive data growthand storage demand
21
Cloud Services
Private Cloud vs. Public Cloud
• PRIVATE CLOUD
-Dedicated infrastructure to a specific client
• PUBLIC CLOUD
-Shared infrastructure across multiple
clients
The Public Cloud
23
Benefits
• No Capital Expenditure
• No DC Required
• Less Support Required
• Capacity on Demand
• Pay for What You Use
• Highly Mobile
• Inexpensive High
Availability
Drawbacks
• Immature Platform
• Connectivity Limitations
• OS Limitations
• Standards/Regulations
Still Evolving
• Ownership/Control of
Data
Concerns for HIT in the Cloud
(Security) HIPAA. Is a BAA needed from your cloud provider?
– International Standards Organization (ISO)
requirements for an Information Security Management
System, ISO 27001
– SAS 70 Type 1 (Design) and Type 2 (Effectiveness)
Audits of Controls
– Cloud Security Alliance (CSA) Security Guidance for
Critical Areas is Cloud Computing
– Each health care entity must decide what is sufficient
Concerns for HIT in the Cloud
(Connectivity)
The “skinny straw”
The critical path for system performance is bandwidth and
latency to the cloud service provider.
Evaluate bandwidth and latency requirements for any
candidate application or service.
Dedicated connection or “meet me on the internet”
Ensure sufficient network connectivity is included in any
cost/benefit analysis.
Is a fully redundant network connection required?
Concerns for HIT in the Cloud
(Availability)
• General Business / Financial Applications
• Business hours focused
• Scheduled downtime is okay
• Clinical Systems
• Specific uptime guarantees in the contract
• Financial penalties for not meeting service level
agreements (SLA)
• Ability to terminate contract if SLA is not met
• Alignment with your scheduled maintenance windows
Supporting Business Agility
– Add new capabilities and capacity
– Quicker response to business needs
– Economies of scale
– Experiment-innovate without investment
Reducing Capital Outlay
– Prorated expense via operational dollars
– Lease vs. buy technology
– Reduce internal cost by average of 30 per-cent
Business Drivers
Scale & Elasticity
– Scale and flex to the customer needs
Ability for Rapid Provisioning
– Customer needs are automatically addressed
– On-demand services and infrastructure
Internet Access
– Link from cloud to internal applications
Billing via Metering Services
Monitor and Measure quality of service
– Service Level Agreement
– Dashboard
Security
Attributes of Cloud Services
Infrastructure as a Service (IaaS)
– Cloud delivery of computing technology as a service
Platform as a Service (PaaS)
– Cloud delivery of software development and testing as a service
Software as a Service (SaaS)
– Cloud delivery of the ability to run applications via cloud hosting
– Most common
– Cloud provides end to end services
– Per-use fee structure
Desktop as a Service (DaaS)
Types of Cloud Services
How Flexible is Your Existing Technology Infrastructure?
What is the Architecture of Your Existing Data Center?
What are the Current Costs with your Existing
Environment?
What are the Security Issues?
What is the flux of your Current Healthcare Business?
How do you build the Business Plan and Migrate to the
Cloud?
Questions to Consider:Cloud Decision?
We design, install, manage and maintain our client’s’ IT infrastructures – from the Desktop to the Data Center
Incorporated in 1995
Headquartered in Reading, PA
Growing at double-digit rate
Employ over 110 professionals
Deep expertise, industry certifications, low turnover
• IBM Premier Business Partner – Systems, Software, Services
− Over 60 technical certifications
• Cisco Premier Partner
• APC Silver Partner
• VMWare Enterprise Partner
DSS Overview
DSS Healthcare Cloud Computing Experiences
32
Hospital A
DSS is High Availability Site
Real time replication of transactions
Hospital B
DSS is Disaster Recovery site with dedicated Infrastructure.
Databases are transferred daily
Plan is to migrate to High Availability
Physicians Practices
Production environment
Dedicated Infrastructure
Databases backed up off site
DSS Healthcare Cloud Computing Experiences
Broad portfolio of solutions, deep expertise
The DSS data center is a single-story Tier III, SAS70 Type II certified data center with 14,780 square feet of 24” raised floor for client hosting and co-location services.
Best practices approach, ITIL-based processes
Sound PMI-based project management and commitment to continuous improvement
Team of 120 people in the local geography
Commitment to understanding the healthcare industry and providing solutions that work
Proven track record, long-term relationships with clients
References
What are the Barriers to Companies Moving to the Cloud?
www.ceo2ceos.com/?p=65 An excellent article suitable for non-
technical audiences.
The Skinny Straw: Cloud Computing's Bottleneck and How to
Address It.
http://www.cio.com/article/499137/The_Skinny_Straw_Cloud_Co
mputing_s_Bottleneck_and_How_to_Address_It
Building Return on Investment from Cloud Computing.
http://www.opengroup.org/cloud/whitepapers/ccroi/index.htm
Introduction
We are a community Catholic health system sponsored by the Sisters of
Christian Charity. Holy Spirit Health System provides high quality, cost-
effective health services to develop healthy communities in the greater
Harrisburg area and South Central Pennsylvania. We have a 316-bed
hospital, with a 30 bed cardiac hospital within a hospital committed to
providing the best in care, technology and staff.
Edith Dees, VP/CIO, has been with the health system for the past six years.
On shared drive
Case study of experience: Holy Spirit Hospital
• Our story of DR and preparedness:• From top down and bottom up
• Perspectives from a HIT CIO:• How IT leaders can safeguard and mitigate risk
through data storage and cloud strategies
• Dispelling the Myths around the Cloud• Catching the Virtualization Wave
CURRENT STATE
Original phone demarc /data center established forty years ago during new construction
Like many data centers of the era, best location to allow growth found in basement, out of the way of core clinical services.
On shared drive
CURRENT STATE
Systems housed in conditioned space were primarily batch processors where system interruptions are more acceptable than with real-time applications.
Auxiliary data center established ten years in repurposed medical arts building suite with 8’ ceilings. Original data center surrounded by immovable operations.
– 60% Virtualized
– Maxed out power
– Cooling challenge with only 8’ clearance. Six CRAC units in place.
On shared drive
PROCESS REVIEW
Determined growth in basement ill-advised
–Water seeks lowest level
– Limited power and cooling
• Proximity to power plant and HVAC
– Displace other departments who need proximity to core hospital
– Investment and risks would be sizeable with limited expansion
On shared drive
PROCESS REVIEW
Medical Arts Building data center expansion limitations
– Structural reinforcement required to bear equipment weight load in office building
– Room elevation does not support heat displacement
– Power and HVAC limitations
– Pedestrian-sized elevators
– Exterior windows
On shared drive
DATA CENTER IN A BOX
On shared drive
PROCESS REVIEW
Requires parking lot space near power plant which would displace physicians and/or patients from Medical Arts Building
Total costs much higher than anticipated
Campus aesthetics
On shared drive
HSHS IT has been in the “Cloud” for decades
Core revenue cycle applications, private network
Core clinical applications, private network
Joint Commission® portal, public network
Outsourced transcription, private network
Virtualized servers for past 5 years, private network
On shared drive
Healthcare applications are generally “Fat”
On-site servers are still required for communications, printing, faxing, etc.
– For example, we have 24 servers on-site to support the clinical applications hosted in NJ.
On shared drive
Best applications for outsourced cloud:
Business Continuity automated fail-over
– DR is not discussed. Do what you need to do to keep us operational.
• Clinical
• Door Access
• Office Automation
Disk-to-disk DR minutes rather than hours versus recovery from tape backups stored off-site
• As more applications store images, tape backups become a speed to recovery issue.
On shared drive
Best application for outsourced cloud
Single vendor per “Cloud” for “Thin” applications
– Bundled support costs
– Better vendor management
On shared drive
Cost Estimate for Tier 3DATA CENTER:Repurpose existing campus structure
Campus connectivity $ .5M
Demolition/Begin Exterior $ .9M
Design/Permits $ .5M
Pre-Purchase Power and HVAC $1 M
$2.9M
On shared drive
Cost Estimate for Tier 3DATA CENTER:Repurpose existing campus structure
$12M -$23M depending on technology and size
Professional Fees
Design Fees
Construction Cost
Fit outs
Furniture
Equipment
On shared drive
Cost Estimate for Tier 3DATA CENTER: Time
Time Factor – Years rather than Months– Perform feasibility study and identify location
– Identify HVAC and power technology/requirements
– Site visits and reference checks for multiple alternatives
– Provide financials including cash flow for CFO review
– Make case for expansion to Executives
– Obtain Board approval, not usually received in one presentation
– Find the money, reprioritize expenditures
– Negotiate the construction contracts
– Begin construction
– Staff and equipment relocation
On shared drive
Thank you
Questions?
