The jury's still out on the American Recovery and Reinvestment Act (ARRA) of 2009 and whether the $19 billion directed at healthcare will bring the U.S. medical community in to the digital age. In the meantime, one Boston- based hospital is helping small private physicians adopt electronic health record (EHR) technology using a mixture of virtualization, Software as a Service and cloud computing concepts.
Bill Gillis, a manager of clinical application services at Beth Israel Deaconess Medical Center estimates that only a small percentage of Boston-area physicians "have something that you could call EHR -- maybe 10%."
That's a problem for the hospital and its sister company, Beth Israel Deaconess Physician Organization (BIDPO), as it tries to grow its network of private healthcare providers. To join BIDPO, providers must implement electronic health records, but most providers have neither the capital nor the technical muscle to implement these pricey systems, Gillis said.
Only about 10%of Boston-area physicians use electronic health records.
And by failing to implement "meaningful use" of EHR by 2010, including e-prescribing and quality of care performance tracking, those physicians will lose out on stimulus funds, which come to $42,500 for physicians with a 20% Medicaid case load.
To jumpstart adoption, BIDPO recently built out a hosted EHR and practice management offering to which participating providers can subscribe on a monthly basis, eliminating the need for them to make up-front capital investments or try to implement the software on their own.
Specifically, BIDPO offers providers software from eClinicalWorks, which also provides practice management functions like scheduling and billing. That software is, in turn, hosted on a cluster of servers running VMware ESX.
Gillis said the eClinicalWorks solution meets the stimulus act's "meaningful use" stipulation for EHR. "We expect all the physicians [that use the service] to be eligible for the full $40,000."
Hedging against uncertainty
BIDPO's decision to build its infrastructure out using virtualization was borne of uncertainty. Without virtualization, it would have had to construct what Gillis called "a classic clustered environment," complete with redundant dedicated servers sized to accommodate peak demand.
The problem was BIDPO didn't know "how many providers would sign up, Gillis said. The project was originally conceived to service up to 300 private practices. Since then, 149 practices have committed to the program, and management has decided to extend the effort to providers owned by the hospital network. Thus, "if we had built it for 300 providers, we would have been wrong."
Currently, the electronic health records implementation runs on a cluster of six Hewlett-Packard Co. servers, and BIDPO will add additional servers as more providers come online, at a rate of two to four per month.
Going the virtualization route also insulated the project from what could have been a huge unanticipated expense. An update to the eClinicalWorks software improving its Web-based SSL capabilities put big new processing demands on the servers. If eClinicalWorks had been running on dedicated hardware, Gillis estimates the organization would have had to purchase an additional $325,000 worth of equipment. Because it was virtualized, "the spec change was just a matter of adding some more resources and VMware licenses," totaling $20,000, Gillis said.
Thus, the decision to virtualize proved to be critical. "I don't know if we would have been able to continue the project after that kind of hit," Gillis said.
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