(Healthcare) IT Evolution Revisited
I recently was fortunate to participate in the 6.x Peer-to-Peer Information Exchange at MEDITECH’s beautiful new Joanne Wood Conference Center in Foxboro, Massachusetts. There were many interesting discussion threads, both public and private, among the representatives of over 65 MEDITECH customers but the ones that “perked up my ears” like my cat, Mindy’s1, were Trending Towards Cloud, High Availability, and IT Focus Shifting Away From Physicians. It is one of those sunny and cool fall days that we brag about here in New England, so if you will walk with me, metaphorically, I would love to explore these a little.
Trending Towards Cloud
Whether coming from MAGIC, Client/Server 5.X, or earlier versions of Client/Server 6, MEDITECH leaders as well as participants seemed to be mindful of the “migration to the Cloud” happening in the general IT space. The “thought horizon” encompassed a future, fully-platform-3-enabled HCIS that might run in more generic Public Cloud like Amazon, Google, or Microsoft Azure2. The near-term discussion focused on the practical realities of exposing a legacy client/server application with a dynamically growing base of pure web content appended to the Internet. Architecture diagrams for MEDITECH Client/Server 6.15 with #Web look like something I made on my Spirograph as a kid. Sweeping lines have a panoply of differently-named and diversely-provisioned background, communication, transaction, and web rendering servers interconnecting legacy NPR and MAT file servers, feeding data to traditional Data Repository and now also to Business and Clinical Analytics, and serving up pages through a reverse-proxy protected and load-balanced web-server farm to a diverse audience of clinicians, patients, and administrative employees. A client could be a person using a browser in a mobile device, or a full “fat-client” desktop abstracted on a farm of CITRIX or VMware Horizon VM’s.
Accomplishing this ballet of interlocking IT precision with unfettered performance, near-perfect security, and instant accessibility turns out to be a task that is possibly best suited for managed hybrid cloud. Public Cloud is architected primarily for pure web services, like e-commerce shopping applications and airline reservations, backing up your photos, or managing your “retail experience” at Target3. Existing private cloud data centers at hospitals have generally been purpose-built around one or more applications and have one or two strengths but multiple weaknesses, including, not infrequently, security and networking. Managed Hybrid Cloud is an intentional merging of the strengths of your hospital’s IT platform capabilities and the capabilities of a healthcare-sensitive, cloud-enabled IT service provider who gets how to tackle your platform 2 needs while securely enabling you on (Web) Platform 3. Harry Potter fans will appreciate that in truth, we are standing in the proximity of platform 2 and ¾’s. (Go ahead, run at that wall.)4
In a Wednesday session on High Availability, Mike Belkner, AVP at MEDITECH, shared on the specific advancements MEDITECH has made towards enabling a near-zero-downtime IT environment. Major announcements included support of highly available metro storage clusters as managed by EMC’s VPLEX SAN virtualization engine, and HP’s 3-PAR embedded Peer Persistence capability. Support of storage clustering allows version-compliant MEDITECH file server workloads to safely, and in many cases, transparently endure the failover and fail back of their servers, storage, or both in a VMware Metro Storage Cluster powered by one of these technologies. Even more excitingly, MEDITECH is supporting MS Windows Server Clustering, which will eliminate the recurring chronic pain of patching Windows Server for MEDITECH customers. The Office of the CTO here at Park Place, ably led by Matt Donahue, has been in the thick of testing, validating, and templating these highly available configurations, which we discuss in detail at our 6.15 Pathfinder Webinars4. We are even offering this enhanced service level contemporaneously in our managed hybrid cloud, OpSus|Live.
That being said, not everybody has a limitless IT infrastructure budget. The second SAN, extra servers, and complex networking needed to accomplish High Availability are not cheap. I can’t tell you how many times I have walked into a favorite Community Hospital customer and observed with some sense of irony the shiny new atrium, the obligatory latte stand, and (wait for it) the 10-year old network switches in the closets5. If you are worried about availability, and you can’t afford the $2,000 per square foot upgrade to Tier 4 data center space in your hospital, it may be time to consider cloud options, or to invest your local capital in upgrading your own data center space and core systems within the realm of reason.
IT Focus Shifting Away From Physicians
Yikes! Don’t run away from me like I just broke a glass of Laffite-Rothschild over my tux shirt at a fancy party. It was only a few years ago that all of healthcare was being re-engineered around the needs of physicians and other front-line clinicians, and rightly so. Putting the right information in those hands (should) enable patient safety, better medical outcomes, and more efficiency. In the town-hall style group discussions that were all the buzz at #MEDITECHP2P, I repeatedly heard super users, CIO’s, doctors, and administrators talk about population health measures, avoiding readmits, and getting patients to take more ownership of their own health. It’s as if we already presume the physicians are on board, and in many cases they are. The pendulum may well be swinging back to fiscal sanity, as more hospital CEO’s and CFO’s, cognizant of the big-dollar collapses of ARRA-fueled “system upgrades” and painfully aware of the need to engage their patient communities, are demanding a bigger role in IT strategy planning.
It was a great event, well managed by MEDITECH and enjoyed by attendees. I hope to see many of you at MEDITECH’s CIO and Physician Forum in November. Sign-up here if you haven’t already. http://home.meditech.com/en/d/newsroom/pages/0315mdcioforumannouncement.htm
Jim Fitzgerald, Unindicted Co-conspirator
Endnotes and definitions
1. Dogs have owners. Cats have staff.
2. Platform 3 or Cloud/Mobile/Social. The third great evolution of the technology platform, the first two being Terminal/Mainframe and Client/Server. A popular marketecture delusion in which legacy hardware vendors get to sell you all the equipment you used to buy, plus even more to “cloud-enable” you.
3. That’s Tar-jayh, to my fellow Target-lovers. Check out this way article which finds their new CIO smartly bucking a trend and bringing IT jobs back onshore, and incidentally, really showing you what Platform 3 looks like:
4. For a more in-depth review of Technology Platforms and MEDITECH 6.15 technical architecture, join one of our MEDITECH 6.15 Pathfinder Webinars, recurring around every six weeks. The next one is Wednesday the 30th of September. Reach out to us at email@example.com for an invite.
5. You may be glad you waited. Talk to us about network virtualization.