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Hosted private cloud speeds Epic EMR system rollout

A healthcare firm faced the daunting deadline challenge of deploying an Epic EMR system in eight months. US Signal's hosted private cloud helped the client beat the clock.

The argument for cloud computing often revolves around speed and agility, attributes that came in handy for US Signal when it needed to help a client with a crushing deployment timeline and exacting technical standards.

The story of how US Signal, an IT solutions company, provided a hosted private cloud for Pine Rest Christian Mental Health Services, based in Grand Rapids, Mich., starts with a business decision. For nearly two decades, Pine Rest had maintained a joint operating agreement with another healthcare organization, through which it accessed an electronic medical record (EMR) system. But the mental health organization, preferring to work independently, concluded the agreement in late 2017. As a result, Pine Rest had eight months to field a new EMR system to meet a separation-imposed deadline.

Pine Rest evaluated EMR products and selected Epic Systems' software, which can take up to 24 months to deploy. The accelerated eight-month schedule ruled out an in-house deployment of the Epic EMR system. "There was no time to set up a data center," said Bill Johnson, director of information systems and services at Pine Rest.

US Signal's hosted private cloud

Adam KesslerAdam Kessler

Against that backdrop, Pine Rest tapped US Signal to provide a single-tenant, hosted private cloud for the Epic deployment. Adam Kessler, professional services director at US Signal, said the healthcare facility -- had it opted to assemble its own infrastructure -- would have faced lengthened timelines with regard to designing the infrastructure architecture, procuring equipment and standing up the new infrastructure among other tasks.

US Signal provided the infrastructure for the Epic deployment in its Kentwood, Mich., data center, about seven miles from Pine Rest's main campus. US Signal's hosted private cloud operates in a VMware environment and uses Cisco Unified Computing System servers. Windows is the primary OS, but the facility also employs some Linux servers. Connectivity from the private cloud to Pine Rest is through multiprotocol label switching.

There was no time to set up a data center.
Bill Johnsondirector of information systems and services, Pine Rest

US Signal, in some cases, had to depart from its standard data center loadout to accommodate Epic's infrastructure needs. For example, US Signal wasn't able to use its typical storage systems due to Epic's recommended approach for creating snapshots.

"Epic is very strict on hardware requirements," Kessler said, noting the software vendor has a list of approved platforms for every infrastructure layer.

Pine Rest, however, was able to meet its eight-month deadline. The Epic EMR system went live in June 2018. The decision to outsource to US Signal's hosted private cloud contributed to the quick turnaround, but the sizable project team also played an important role. Kessler estimated the team numbered close to 100 people, including Pine Rest, Epic and US Signal personnel, as well as other third-party vendors and EPIC consultants.

Epic, as the EMR vendor, drove the project. "They have a really good set of processes for implementing software," Kessler said, noting US Signal integrated into the Epic-Pine Rest implementation team.

As part of US Signal's role on the project, the company had a few employees obtain certifications in different Epic EMR system components. The certifications enabled US Signal to contribute managed services technicians able to take on system administrator duties.

Disaster recovery approach

US Signal's Kentwood facility serves as the primary data center for the Epic EMR system deployment. The company also provides disaster recovery as a service (DRaaS) through its Southfield, Mich., data center in the Detroit metropolitan area. The DRaaS capability was quickly put to the test: A a bug in a firmware update caused storage in the primary data center to become unavailable. This outage occurred the night following the go-live date and triggered a move to the Southfield backup data center.

That center served as the main data center for a few days and, even though it wasn't intended as a production environment, exceeded Epic's recommended performance level, Kessler noted.

The ability to obtain production-level performance from a DR environment enabled Pine Rest to consider the Southfield data center as more of a secondary production facility, Kessler explained. As a result, US Signal rearchitected the DR environment so it can operate in active-active mode as opposed to active-passive mode. In an active-passive approach, a DR center remains on standby until it is needed.

In active-active mode, however, application layer elements and third-party applications are configured to run in both the primary and secondary data centers simultaneously, Kessler noted. This approach allows for a much faster failover and provides greater redundancy and availability, he added.

Cloud-first strategy

Pine Rest's deployment of Epic in a hosted private cloud is one aspect of a broader cloud strategy. The organization houses some infrastructure and applications in its own data center. For example, Pine Rest uses Citrix in-house for end-user computing, operates a storage area network and hosts business applications, such as a time-and-attendance system. But going forward, Pine Rest is taking a cloud-first approach.

"As software packages come up for renewal, we are going to look at the cloud first," Johnson said. "Why shouldn't this be in the cloud? Why does it have to be in our data center?"

Pine Rest's cloud shift keeps security considerations at the forefront. Johnson said Pine Rest follows NIST security guidelines, the Health Insurance Portability and Accountability Act and the state of Michigan's Mental Health Code, which he said is more stringent than HIPAA.

Security was a key topic in Pine Rest's initial discussions with US Signal and part of the mental health organization's vetting process. Johnson said that process included speaking with other US Signal healthcare customers to verify the company's security claims. Conferring with other industry CIOs should be part of any healthcare organization's cloud adoption due diligence, he noted.

"You really have to make sure [cloud] fits your needs," Johnson said.

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