Implementing EMR
MSHA's approach is to implement the EMR in stages; stage one was getting paper-based data into electronic form. "We started by scanning the paper during admission and after discharge into electronic form. We ended up with TIFF images, what I call a poor man's EMR," says Eshbach at MSHA. From there, the hospital can overlay notations and tags to the images. In this form, the patient's record runs less than 1MB per page.

MSHA moved rapidly beyond the first stage by incorporating its clinical data repository into the EMR. "That's the core of the EMR," says Eshbach. A dashboard was added to ensure relevant information jumped out, as well as drill-down capabilities to get more details. A clinical decision support system uses the data to suggest the next step in a patient's treatment. In subsequent stages, MSHA will integrate PACS and other systems.

Siemens Medical Solutions provides MSHA's EMR system. In 2004, MSHA acquired an EMC Symmetrix DMX for its EMR. It also uses EMC's Centera to store images and various EMC Clariion models for other data. Its total storage environment has grown to 60TB, which is backed up to tape using IBM Corp.'s Tivoli Storage Manager.

MSHA archives its patient records using the archiving tools of its radiology PACS system. Older images are migrated "from our faster, more costly EMC Symmetrix to a less-costly spinning disk [Centera]," says Eshbach. "We back up, bu...

Fault tolerance and disaster recovery for EMRs are critical. Partners HealthCare System uses EMC's SRDF to replicate the EMR to a Symmetrix in another data center so "the data is always available," says Pappagianopoulos. The EMR is also backed up to tape and every medical department maintains a contingency plan to keep operating should EMR data ever not be available.

"This data is our highest level of criticality. We use a lot of belts and suspenders" to ensure availability, adds Pappagianopoulos.

Midland Memorial Hospital implemented an active-passive server cluster for fault tolerance using HP servers and a redundant HP SAN setup. It also deployed redundant switches on the front end of the server cluster so "there's no single point of failure," says the hospital's Whiles.

To ensure high availability, Midland Memorial Hospital maintains two data facilities approximately four miles apart and connected by a gigabit link. It backs up nightly to the second SAN and makes snapshots of core EMR components every 15 minutes; these are then sent to an offline server in case of a catastrophic failure. "We've been totally electronic for over a year," says Whiles.

By 2014, every healthcare provider will be under pressure to go completely electronic for the EMR. "EMR storage is like a smoldering virus," says Run-yon. And it's a virus IT doesn't want to let get out of control.

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