24/7 Uptime for Electronic Health Records: Microsoft Windows-based EHRs and Stratus Medical Grade Servers. Healthcare

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1 by Stratus Technologies, The Availability Company April 2009 Healthcare 24/7 Uptime for Electronic Health Records: Microsoft Windows-based EHRs and Stratus Medical Grade Servers

2 Abstract The long migration to electronic health records (EHRs) in the U.S. is set to speed up with the funding authorized by the American Reinvestment and Recovery Act of Recognizing how electronic health records help improve outcomes for patients, hold down rising costs and increase access to quality care, physicians and practice managers evaluating EHRs can be expected to assess their application software options thoroughly. The availability and reliability of the information technology (IT) infrastructure that supports the EHR application merit the same attention, yet tend not to be as well-understood. What are the specific risks when clinicians can t access electronic health records? How far-reaching are the consequences when EHR data is lost, or its integrity is compromised? This paper offers a look at the mission-critical role of EHR systems, and introduces high availability and continuous availability solutions that build in uptime protection to ensure the continuity of operation that both caregivers and patients can depend on. EHRs Improve Outcomes, Lower Costs An EHR, which some refer to as an electronic medical record (EMR), represents much more than simply a digital chart. When implemented and used in line with best practices, EHRs can make patient health records (PHRs) instantly accessible from any location at any time. Decisions about care can be based on complete information, and records are always current. Medical errors resulting from transcription mistakes and being unable to read a clinician s handwriting are prevented. Decision support tools, including treatment guidelines and protocols, may also be provided to assist caregivers. Expensive inefficiencies are eliminated as well. For starters, data about a patient need only be entered once. Money that might go to redoing tests is saved when all of the patient s results are available for review. The cost of administering claims can be driven down when the data required by payers is documented and online. Furthermore, denial of claims can be reduced. Improvements that result from implementing and using EHRs have been documented, and experts predict the impact of EHRs will grow as adoption increases. For example, a Johns Hopkins University study, originally reported in the Archives of Internal Medicine, looked at the use of clinical information technologies at 41 hospitals in Texas. Researchers analyzed death rates, complications, length of hospitalization and cost associated with greater and lesser levels of automation. A 10-point increase in the use of online notes and records was linked to a 15% lower death rate. 1 If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save 100,000 lives annually, said a senior author of the study, Neil R. Powe, MD. 2 Another expert, Dr. David Brailer, who served as head of the health information initiative under President George W. Bush, has estimated a fully computerized health record system could save the industry between $200 and $300 billion annually. 3 24/7 Uptime for EHRs: Microsoft Windows and Stratus Medical Grade ftserver Systems Page 1

3 Accelerating EHR Adoption The start up investment in IT has stood in the way of many U.S. hospitals and physicians interested in EHRs, especially group practices and independent doctors. The American Reinvestment and Recovery Act of 2009 specifies funding and other provisions intended to reduce those obstacles. The legislation spells out significant financial incentives and penalties, carried out through the Medicare and Medicaid programs, to encourage doctors and hospitals to adopt and use certified electronic health records. Physicians will be eligible for $40,000 to $65,000 for showing that they are meaningfully using health information technology, such as through the reporting of quality measures. Hospitals will be eligible for several million dollars in the Medicaid and Medicare programs to similarly use health information technology. Federally qualified health centers, rural health clinics, children s hospitals and others will be eligible for funding through the Medicaid program, states a Congressional fact sheet summarizing the legislation. 4 Incentive payments will phase out over time. Ultimately, Medicare payments are reduced for physicians and hospitals that do not use a certified electronic health records that allow them to electronically communicate with others. 5 A Mission-Critical Clinical Tool EHRs take on a vital role in ensuring continuous access to patient data and empowering caregivers to collaborate. In addition to the required functionality, interoperability and security, an EHR system must also have inherent availability and reliability or its mission is in jeopardy. Picture a scenario in which the EHR system serving a physician s office or group practice is down unexpectedly for 60 minutes during office hours. When health records and test results are not available on demand, patient safety may be at risk. Delays and backlogs build as caregivers scramble to do their best under the circumstances, causing the interruption to cascade to affect all patients seen that day. Even the briefest of outages could be devastating. It s not difficult to envision a situation where the doctor has minutes to make a life or death decision: The EHR system is down when a critically ill patient comes in, and the physician administers medication that reacts adversely with a drug that a different doctor prescribed earlier. Other consequences are that costs and inefficiencies mount. Lawsuits can follow missed diagnoses. Encounter data may have to be recorded manually and entered into the system later. And in a hospital or emergency medical services (EMS) setting, patients can require care at any hour of any day, not just when appointments and procedures are scheduled. Standardization of electronic health records will raise the need for dependability still higher. When EHRs achieve interoperability, true community health record (CHR) and health information exchange (HIE) systems can be created. Health history, diagnostic records, lab results, prescribed medication and more will be on hand whether a patient sees her primary care doctor, visits a specialist or needs urgent care at the emergency room. This will help to ensure high-quality care in every encounter, including for medically underserved people who lack access to consistent treatment from the same doctor or clinic. 24/7 Uptime for EHRs: Microsoft Windows and Stratus Medical Grade ftserver Systems Page 2

4 Uptime Is an EHR Necessity EHR availability is a necessity for patient safety and healthcare cost containment Ensures the right patient gets the right medication at the right time A single healthcare transaction may be of critical importance Real-time online data promotes efficiency and lowers healthcare costs 1.5M preventable adverse drug events yearly 6 Online records linked to 15% lower death rate 7 Annual savings between $200 and $300 billion 8 To avoid compromising patient safety, driving up costs, spawning delays and creating inefficiencies, protection against IT downtime should be planned into EHR systems. Not only can the standard of care for the individual patient be improved, but it will also be possible to gain insights for evidence-based healthcare guidelines. Authorized health professionals will be able to analyze aggregated data from many EHR and CHR systems to show which treatments yield the best outcomes across larger populations and to reveal public health issues. (Data security and privacy must still be protected, of course.) Understanding Downtime Risk For all these reasons and more, the exposure is considerable when the availability of mission-critical clinical systems, including EHRs, is not adequately provided for. Availability, as the term is used in information technology, describes the condition of IT systems, components and/or networks functioning as expected when they are needed. This term is used interchangeably with uptime. (A related term, reliability, refers to the technology and features that provide availability.) According to Mark R. Anderson, CEO of AC Group, One area of growing importance is technology uptime when mission-critical clinical applications are deployed. Based on our research, if a system is not available a minimum of percent (four 9 s) of the time, healthcare organizations will not consider the application reliable enough to use in the future. Based on our published study, Cost of Downtime, every 9 below the percent costs the average 300-bed hospital more than $3 million per year and over $1 million for the average 50-provider practice, said Anderson. 9 However, when the EHR is not supported by the right information technology infrastructure, sufficient availability cannot be achieved without significant complexity, labor and expense. And the focus of hospitals, group practices and physicians is on providing the best patient care, rather than on IT. The 24/7 Uptime for EHRs: Microsoft Windows and Stratus Medical Grade ftserver Systems Page 3

5 barrier can be prohibitive enough that healthcare providers of any size may be left dangerously overexposed to downtime. Availability Solutions for EHRs Healthcare settings benefit from superior availability, operational simplicity and financial advantage with every Stratus ftserver -based EHR solution they implement. Easy to install, use and maintain, Stratus servers set the standard in uptime protection making an enormous impact on effectiveness for a fraction of the cost of the total EHR solution. What s more, Stratus provides maximum availability protection for a range of CCHIT Certified (Certification Commission for Healthcare Information Technology) application solutions from established EHR software providers. Besides safeguarding the accessibility and integrity of EHRs during daily operation, ftserver systems can be integral to disaster recovery (DR) for electronically stored health data as mandated by the Health Insurance Portability and Accountability Act (HIPAA). Continuous Availability with ftserver Systems With more than 300 installations in hospitals, clinics and physician practices worldwide, Stratus Technologies provides award-winning availability hardware and software ready to support the EHR of the 21 st century. Medical Grade ftserver systems, running the Microsoft Windows Server operating system, build in Continuous Processing technology designed to assure industry-leading uptime from the moment they are powered on. Since their introduction in 2002, the average real-world performance of ftserver systems has exceeded the gold standard of % uptime annually in installations that span the globe. That level of availability translates to less than five minutes of unscheduled downtime per year. * These fault-tolerant Intel processor-based servers are engineered with components that provide automatic fault detection, phone home, and dozens of other innovations that prevent downtime and data loss. Unlike standby servers, server clusters and other alternatives that minimize downtime through quick recovery and need a skilled operator to set up and maintain them Stratus ftserver systems afford uninterrupted operation. That means healthcare providers are able to keep uptime high and IT ownership costs low. Among the most highly regarded features of Stratus ftserver systems is their ActiveService architecture, the unique combination of capabilities that enables built-in serviceability, self-monitoring and diagnostics, proactive remote support and troubleshooting by service engineers. Award-winning ftserver Active Upgrade technology ** in addition eliminates the planned downtime that other servers impose while upgrades and enhancements to operating systems, service packs, applications and system software are installed. Premiere software providers and systems integrators sell and support Stratus ftserver systems to provide comprehensive EHR systems that clinicians depend on with confidence. These include Perot * Stratus Technologies Uptime Meter, ** Currently for Windows Server operating environments only. 24/7 Uptime for EHRs: Microsoft Windows and Stratus Medical Grade ftserver Systems Page 4

6 Systems MEDITECH Solutions Group (formerly JJWild); Pulse Systems, Inc., developer of Pulse Patient Relationship Management; and Sage Software Healthcare, Inc., provider of the Sage Intergy EHR. Conclusion Electronic, standardized medical records are poised to enable long-sought improvements to healthcare delivery in America. To encourage prompt action by hospitals and doctors, the recently signed economic stimulus package includes incentives as well as penalties. Adopting EHRs places significant responsibilities on professional staff, however. While the IT infrastructure and duties expand with an EHR system, the number of personnel attending to that technology will likely remain the same. Every component of this IT-based clinical tool including the information technology infrastructure should have sufficient robustness built in to enable caregivers to focus on their mission. The result will lead to resilient EHR systems both clinicians and patients can trust. About Stratus Technologies Stratus Technologies is a global solutions provider focused exclusively on helping its customers achieve and sustain the availability of information systems that support their critical business processes. Based upon its 29 years of expertise in server and services technology for continuous availability, Stratus is a trusted solutions provider to customers in healthcare, life sciences, manufacturing, telecommunications, financial services, public safety, transportation & logistics, and other industries. For more information, visit ### Stratus, ftserver and Continuous Processing are registered trademarks and the Stratus Technologies logo, ActiveService, Active Upgrade and Uptime Meter are trademarks of Stratus Technologies Bermuda Ltd. CCHIT and CCHIT Certified are registered marks of the Certification Commission for Healthcare Information Technology. Dell is a trademark of Dell Inc. Intel is a registered trademark of the Intel Corporation in the United States and other countries. Microsoft and Windows Server are registered trademarks of Microsoft Corporation in the United States and/or other countries. All other trademarks and registered trademarks are the property of their respective holders. 1, 7 The Washington Post, Wired Hospitals Post Lower Death, Complication Rates, January 27, 2009, 2 Advance for Health Information Professionals, Study: HIT Makes Hospitals Safer, February 11, 2009, 3, 8 CNNMoney.com, Obama s big idea: Digital health records, January 12, 2009, 4, 5 Majority Staff of the Committees on Energy and Commerce, Ways and Means, and Science and Technology, Title IV - Health Information Technology for Economic and Clinical Health Act; Health Information Technology for Economic and Clinical Health Act or HITECH Act, January 16, 2009, 6 The National Academies, Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers Comprehensive Strategies for Reducing Drug-Related Mistakes (news release), July 20, 2006, 9 Stratus Technologies, Stratus Medical Grade Servers Deliver 24/7 Online Information Access and Application Availability (news release), February 19, 2008, Stratus Technologies Bermuda Ltd. All rights reserved. X986 24/7 Uptime for EHRs: Microsoft Windows and Stratus Medical Grade ftserver Systems Page 5

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