The hospital set an aggressive six-month timetable for implementing the EHR system because it had to meet grant deadlines. "Normally, I'd advise you to spread it out some, because we didn't have time to learn from one or two implementations before we moved on to the next one," Crowley said.
To save money and avoid server sprawl while managing systems centrally, the hospital went with a VMware virtualized server environment. The hospital also chose Stratus Medical Grade ftServer and ftScalable Storage for the core of the cloud infrastructure to provide the required uptime to serve the various physician practices.
"Had we not done server virtualization and some other things, our costs would have been higher, but even still, it was higher than we'd projected," Crowley said.
"It's one thing when I can send out an e-mail in our hospital saying we're going to be down for maintenance today, but now we're answering to all these other clinics," Laforge added. "We had to look at ourselves as a SaaS provider. The hardware fault tolerance of the Stratus equipment combined with VMware gave the kind of uptime we felt we needed to provide."
The hospital has four virtualized servers and one server for vCenter, which cost several hundred thousand dollars in hardware alone.
Crowley and LaForge are still working on integrating the hospital's laboratory and radiology departments with the EHR system, but the technology has been available to the rest of the hospital and to affiliated and nonaffiliated physician practices since May. Nonaffiliated practices have their own discrete database instances, but all of them pay the hospital for the service based on a chargeback model.
"From that perspective, it's a SaaS model to them," LaForge said.
In some cases, regional hospitals with large IT shops have opted to build out their data center infrastructure in order to host affiliated and nonaffiliated hospitals in their areas. As IDC's Hanover puts it, "IT often is not a core competency for hospitals and physician practices." Moreover, a small clinic isn't likely to keep good IT personnel around for long, she added.
The system at University of Pittsburgh Medical Center (UPMC) is a good example of shared EHR services. UPMC is an $8 billion integrated global health enterprise headquartered in Pittsburgh, and it's one of the leading nonprofit health systems in the country.
For all intents and purposes, UPMC runs a private cloud. All healthcare, financial and administrative applications run in a shared environment.