NEW ORLEANS -- Hospitals contemplating running Epic electronic health record implementations virtualized on Intel x86 Linux servers have a test farm to try it out, vendors announced today at HIMSS 2013.
Dell Healthcare, in collaboration with Red Hat Linux and VMware, has opened a facility near Epic Systems Corp.'s Verona, Wis., headquarters that hospitals may use, the companies said.
Not only are the AIX and Unix configurations more expensive, they are far more complicated and difficult to set up for data backup and disaster recovery.
Last year, Epic quietly let it slip at its annual user meeting that it would support that particular Red Hat-VMware configuration, which in effect made the EHR more affordable for medium-sized hospitals. That's exactly what happened for St. Joseph's Hospital Health Center, where IT manager Chris Snow is working on an Epic rollout slated to go live in mid-2014.
A hospital-wide, multidisciplinary team evaluated many EHR systems en route to picking Epic's. And Epic would have been the hospital's choice even if it had to run the system on traditional AIX and UNIX servers, which was the only choice up until last year. But once the 431-bed hospital's clinicians selected its EHR vendor, Linux was the obvious choice for IT staffers charged with building the back end support for it, Snow said.
Not only are the AIX and Unix configurations more expensive, they are far more complicated and difficult to set up for high-data-availability backup and disaster recovery (DR) between St. Joseph's two data centers, Snow said. With the Linux-VMware setup, it's much more simple and straightforward to bounce server configurations and data between the two centers when needed.
"IBM has done a lot over the years to bring down some of the costs of doing [DR] but it's still quite expensive," Snow said. "Whereas with Linux, it's a little cheaper operating system, but the way you work with it, especially the way it works with VMware, ... it's a huge hit for us."
Knowing VMware helps with an Epic implementation
While Snow is one of the earliest U.S. adopters of Epic on Linux, he said the idea was more manageable because St. Joseph's IT staff had been virtualizing servers for other applications, and had a feel for how it would work on its network. The hospital ran a total of 250 virtual servers and 200 physical servers on the network before bringing Epic online.
Other hospitals thinking of similar Epic implementations -- if it's their first stab at using VMware -- might be best served piloting some smaller projects to understand how it fits into their network, to prevent an EHR implementation path from becoming overwhelming, Snow said. "We had a strong VMware infrastructure to begin with," said Snow, who added that first-time Linux users shouldn't be put off by its open source roots, because the Red Hat support and network controls also simplify management. "If you had nothing, the choices on the way to go are huge. There are multiple ways to deploy VMware. ... [O]nce you've decided on a path, the pieces just fall into place."
That's also where Dell Healthcare and its Verona testing facility come in, said August Calhoun, vice president and general manager at Dell Healthcare. Not only is there a server test bed where hospitals can experiment with configurations, but there's also an auditorium space and other areas where hospital IT staff can receive training on how the Epic, VMware and Red Hat systems work together.
VMware and Dell sources made it clear they were speaking for themselves and not on behalf of Epic, but they surmised that while Epic blessed the running of its EHR on the particular configuration described above, it wasn't particularly interested in designing the infrastructure on which it runs -- leaving the testing and validation to Dell, VMware and Red Hat.
"Epic's been supportive of this effort; they see value for the customers," said Frank Nydam, VMware health care chief technology officer.
Right now, running Epic on less expensive servers that can be administered by employees more plentiful in the talent pool than AIX or Unix specialists is a way for Dell to angle into medium-sized hospitals that might not have been able to run Epic the old way. That could change moving forward, however, as larger hospitals replace legacy servers and take a look at the Linux idea. At least Dell's hoping so.
"I don't have to go too far to find a community hospital or rural health system -- they're the first and most rapid adopters of this -- [that's having] a problem finding the talent to run Unix," Calhoun said. "But I think we're going to see, in this area just like every other area, more Linux, more open systems and fewer closed, proprietary systems."