Transcript NRHP IT Meeting - System Computing Services

Nevada Rural Hospital Partners
Network Connectivity Overview
2010
Todd Radtke
Regional CIO – NRHP
775-827-4770
[email protected]
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About NRHP
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Established in 1987
14 Rural Nevada Community Hospitals
NRHP hosts shared applications and
provides IT services
NSHE/SCS NevadaNet is our WAN and is
critical to supporting our vision
Supporting member viability by implementing
shared health information technology
solutions
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NEVADA RURAL HOSPITAL PARTNERS INFORMATION MANAGEMENT VISION
NRHP Mission: Improve the viability of rural hospitals
through shared services, resources, and advocacy
Hospital viability depends on
-A supportive operating environment
-Adequate financial resources
-Quality human resources
-Appropriate array of high quality services
-Adequate facilities and technology
NEVADA RURAL HOSPITAL PARTNERS INFORMATION MANAGEMENT VISION
The technology vision: NRHP members maximize productivity, economic efficiency, the
quality of care, and patient safety through the application of appropriate technology to the
processes of clinical care and hospital management
When detail is added to that statement, the vision is one in which, someday, NRHP hospitals will have integrated internal information
systems that support clinical and administrative functions. Members will have access to high speed connectivity that supports
communication, telehealth, data transfer, storage and recovery. NRHP hospitals will have electronic medical records and other tools
designed to enhance the quality of care, access to information, productivity, and financial viability. All types of closed records will be in
digital format. When it makes economic sense, web-based applications will be shared among member hospitals over secure connections.
Members will have qualified Information Management personnel supported by centralized expertise. Processes that assist members with
good decision making, and implementation support, will be in place.
Management
Knowledge
Connectivity
Capability and
Applications
Funding
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NEVADA RURAL HOSPITAL PARTNERS COMPONENTS of INFORMATION MANAGEMENT
Management
Establish and commit
NRHP strategic plan
Establish decision
making process
Knowledge
Connectivity
Provide central
expertise
Establish and
maintain secure
connections
Develop members'
internal expertise
Provide sufficient
bandwidth and
redundancy
Manage Change
Provide ongoing
education
Establish need
Maintain control of
access and usage
Capability and Applications
Funding
Integrate members'
legacy software
within hospitals
Maintain
communication
applications
Member funded
internal budgets
Develop and expand
document mgmt
program
Develop and
maintain security
applications
NRHP - obtain grant
funding - HRSA,
OAT, SHIP, and
possibly utilize loan
pool
Develop PACS
capability, including
standardized RIS
Develop shared
applications
Complete research
Pilot project
Develop expertise
at Board levelsmembers and NRHP
Develop standards
and policies
Assist members to
comply with
regulations
HIPAA
Develop decision
making guidelines
Establish, monitor
and maintain LANs
and WAN
Provide for
information systems
support
Provide for backup
and support
Provide for systems
control
Provide secure data
backup
Develop and
maintain central data
storage
Plan for long-term
conversion to EMR
Develop data disaster
recovery capability
Develop
applications for
quality & pt. safety
Expand Telehealth
applications, incl.
teleradiology
NNAHEC Coordinate NevNet
telemed, USF
discounts, other
funding, cmprsd.
video
ORH/UNSOM support, coord., and
CAH funding
USCC Maintain/expand
NevNet and allow
access
Expand capacity of
compressed video
Document
information systems
Revised 4/08
Address
sustainability issues
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Information Management Components:
Connectivity
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Establish and maintain network security
Provide sufficient bandwidth and redundancy
Maintain control of access and usage
Manage wide area network (WAN)
Monitor and report network usage
Provide for backup and support
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Information Management Components:
Capability and Applications
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Process Improvement
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Integration, document management, PACS
Shared Radiology Archive
Long Term conversion to EMR
Maintain communications applications
Develop and maintain shared applications
Develop disaster recovery capabilities
Develop clinical applications
Expand telehealth applications
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Current NRHP IT Services
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Provide centralized I.T. expertise
Educate NRHP Board and member I.T. staff
Support IT decision-making re: integrated systems, electronic health records, and
health information exchange
Maintain and support a secure Wide Area Network
Host member email services
Host central software applications
Integrate members’ legacy software systems
Maintain and support a central electronic archive
Enhance/expand members’ PACS capability, teleradiology functionality, efficiency and
support
Maintain relationships that enhance members’ connectivity
Manage the Universal Service Fund discounts for members
Provide I.T. leadership at the State level, helping to shape responses to rural needs
Manage I.T. grant-funded programs and reporting
Assist members with vendor negotiations
Manage NRHP’s I.T. vendor contracts and software licenses
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Shared Applications that depend on NevadaNet
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Hosted Email and shared calendaring
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900 plus users
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Spam management
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Enhancements – shared calendars, webmail –
Shared HL7 integration
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Over 1 million messages a month are processed
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Reduces data entry of patient demographics into clinical applications ( lab and
radiology )
Sharepoint sites
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Risk Management, LiCON, Member CEOs and IT
Web Site Hosting
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Hosted at powervps ( not on nevadanet )
Shared Credentialing application
Shared Risk Management
SGMS firewall reporting
Central PACS Archive – 450,000 studies to date
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Primary PACS archive is hosted at Pennington with a plan to move to SCS
data center
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Secondary archive is located at NRHPs offices
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DISRN Radiology Network
DISRN Project
Diagnostic Imaging System for Rural Nevada
PGH - Lovelock, NV
HGH - Winnemucca, NV
Dry Laser
Film Printer
BMGH - Battle Mountain, NV
Phase 1
RadSight
Connect station
TYPICAL TOPOLOGY
Konica CR
MedWeb
RadSight
Connect station
Konica CR
RadSight
Connect station
Konica CR
RadSight
Connect station
RadSight
Connect station
Konica CR
image acquisition devices ( typical )
CT, ultrasound, MRI, Flouro, Film
scaner, xray, etc
RadSight
Diagnostic Station
MGGH - Hawthorne, NV
Forward copy
Web based access to
support teleradiologists
from northstar ( typical )
DR systems
SLMC - Yerington, NV
RadSight
Connect station
Desert Imaging
BC - Boulder City, NV
RadSight
Connect station
GE
CCH - Fallon, NV
NevadaNet
T-1
Public Internet
Site to Site VPN Security
MedWeb
MedWeb / NovaRad
DILS - Caliente, NV
WBRH - Ely, NV
Phillips Easyweb
1
10 00 M
0M b
bp ps
s
lT
-1
s
PACS
Mesquite, NV
D
ua
Desert Radiology
CVMC - Minden, NV
MedWeb
Central Medweb
Northstar access point
( forward studies from BMGH, HGH, etc
Great Basin
Owyhee Indian Heath
RadSight Archive Station
NorthStar Imaging
MedWeb
RAID
Network
Redundancy
Mgmt
and tape backup
IE
NRHP - Reno, NV
MedWeb
Interface Engine
Patient Demographics and
Billing data from hospital
information systems
- Central Archive - 7 year storage
- Secondary read site - redundancy
- Central RIS - scheduler, charges, front desk administration
- Ability to import patient demographics from each hospital admitting system ( HL7 or
scripting ) and attach to exam or send export file to radiologist
- Each hospital needs to be able to produce digital copies for patients to take off-site
- NevadaNet WAN will support the DISRN project
- Develop central RIS
Nye Regional
RadSight
Connect station
Central RIS
( future )
Windows
Authentication
RAID
Server
Storage Archive
UNR UNSOM Pennington
Data Center - Reno, NV
VP
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Radiology Vendor Access
Route studies to vendors
Import reports from vendors
Central PACS Archive 1_14_07
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NRHP Tele-radiology Archive Overview
PRIMARY
UNR Data Center
5000GB Archive
MIRROR
DATA
Typical Hospital Server
NevadaNet
Typical Hospital
Information System
SECONDARY
NRHP Office
5000GB Archive
Replication Site
Robotic Tape Library
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NRHP Network
Connectivity
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NRHP Network Overview
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Redundant Sonicwall PRO3060s provide
network security, including intrusion
prevention, gateway anti-virus and content
filtering services
All site to site traffic is secured IPSEC VPN
Hub ( NRHP and Archive locations ) and
Spoke ( hospitals ) topology
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Nevada Rural Hospital Partners
Yellow:
Sites currently on the NevadaNet Backbone
Incline Community Hosp.
Incline Village
Smith Valley Med. Ctr.
Wellington
Humboldt Gen.
Winnemucca
Owyhee Community
Owyhee
Northeastern Nv. Regional
Hospital - Elko
NRHP
Reno
Carlin
Fire
Academy
GBC
Winne
Carson Valley Hosp.
Minden
SCS
Elko
LCSD
BM
SCS
Reno
Internet, Internet 2 &
BRIN
CENIC
SACRAMENTO, CA
Wend
Battle Mtn. Gen. Hosp.
BM (2)
RENO
METRO
FIBER
LOOP
South Lyon Med. Ctr.
Yerington (2)
WNCC
Carson
2007
WilTel
POP
Reno
ECSD
Elko
IRP
POP
UNR
Redfield
GBC
Ely
Churchill County Hospital
Fallon
ECSD
Eureka
WNCC - Lovelock
William Bee Ririe
Ely (2)
Mt. Grant Hosp.
Hawthorne
Pershing General
Lovelock
LCSD
Panaca
Grover C. Dills Med. Ctr.
Caliente
Nye County Hosp.
Tonopah
CENIC
Los Angeles, CA
(Internet &
Internet2)
CCSN
HTC
Pahrump
NCSD
Tonopah
WilTel
POP
LV
LAS VEGAS
METRO FIBER LOOP
SCS
Las
Vegas
Future
Boulder City
Hospital
Mesa View Regional
Hosp.
Mesquite
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WAN status
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Current T-1s are not sufficient to handle our traffic – recommend 6-10
Mbps for tele-radiology and future applications.
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Some sites have upgraded to dual T-1s
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Sites that need additional bandwidth
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NRHP, WBRH, BCH and HGH
SLMC, MGGH
Sites that need to install new T-1s to isolate from the bundled education
circuits
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PGH, NRMC, GCDMC
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Battle Mountain 10mbps wireless connection to the fiber backbone with
a T-1 as a backup is working well
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NRHP will develop an infrastructure plan to increase bandwidth and
provide redundant links – the issue is funding ( direct or grant )
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Challenges
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WAN - Single and dual T-1s with no out of
band backup (DSL, alternate routing, etc)
QOS – priorities critical applications to
maximize bandwidth
Lack of bandwidth
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Cost of T lines a major barrier
Redundancy is critical to NRHPs ability to
host clinical applications
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Current Issues
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Last mile connectivity
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Opt-E-man might be a solution, 10Mbps $700 per month
per end, would need NSHE support / design - Can NSHE
support this ?
QOS – at one time SCS proposed a MPLS layer to
support QOS – is this still an option ?
Video scheduling – NRHP members require the
ability to schedule telemedicine consults – Can we
manage our own video calls ?
SCS support – 8x5 only, can members call circuit
provider after hours ?
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Current Projects
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SLA with SCS to co-locate one rack at the
data center – target July1 2010
Upgrade to 6Mbps at NRHP offices
Humboldt fiber upgrade
Caliente – offered 50M fiber – Need SCS
support for video connectivity (T-1 or dry pair)
Reviewing Smith Valley clinic connectivity –
possible T-1 to Yerington network
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Grants update
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BTOP
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NRHP is involved with 3 applications
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NSHE – fiber access points Hwy50 and I80
NHA – fiber network, data centers and shared EMR
DOIT – microwave build-out and last mile
NRHP also has a request into senator Reid
for IT infrastructure upgrades including
routers, LAN equipment, PCs, servers and
additional video equipment
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Conclusions
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Expand NRHP members network infrastructure:
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Expand hospital health information system capabilities:
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Statewide broadband communications will allow healthcare organizations to
access and exchange information rapidly. NRHP and SCS have been
working to expand the NevadaNet infrastructure and provide a quality of
service level to healthcare data
Expand the use of HIT within hospitals to enhance the capture and storage
of complete patient health information electronically in a uniform manner.
Member hospitals utilize electronic information systems but need to focus on
eliminating the paper records and providing access to the electronic data
that they do have. The data being captured is frequently fragmented in
disparate systems throughout the hospital.
Enhance the use of EMR systems in community-based practices
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In order for patient health information to be useful, it must be captured
electronically at the point of care.
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Wrap UP !
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NRHPs mission to support members
depends on NevadaNet !
Co-locating shared applications to SCS and
resolving last mile issues is a top priority
Redundancy is still a concern –
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DSL or other broadband would require NAT redesign
Alternate routing via link to nearby facilities
Off NevadaNet options – MPLS cloud, etc
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