Based in Daytona Beach, Florida, Halifax Health serves Volusia and Flagler counties and provides a continuum of healthcare services through a broad network of different facilities. 

These include a tertiary hospital, two community hospitals, an urgent care facility, psychiatric services, a cancer treatment center with five outreach locations, the area's largest hospice, a center for inpatient rehabilitation, outpatient rehabilitation clinics, primary care walk-in clinics, a clinic specializing in women's health, a pediatric care community clinic, three children's medical practices, a home healthcare agency and an exclusive provider organization.

THE PROBLEM

"We wanted to create multiple instances of our Meditech EHR environment," said Mike Marques, CIO at Halifax Health. "While our two Meditech instances lived on one storage array, we aimed to extend Meditech across multiple arrays to increase resiliency and ensure business continuity.

"However, the legacy infrastructure required additional, costly arrays, hardware and licensing to make this possible," Marques explained. "In addition, it was costly and difficult for us to locate engineers that were trained in the legacy solution, because it was complex to manage. One of the biggest challenges that we had was that the ability to cluster Meditech required additional hardware."

Needing a Meditech-compatible solution that would allow Halifax Health to cluster its storage with three arrays, the health system took the opportunity to revisit its entire infrastructure. This ended up being the only capital purchase in 2020. The new storage solution would have to meet or exceed existing performance criteria, but also deliver efficiencies in cost and employee staffing.

PROPOSAL

IT vendor Pure Storage offered Halifax Health the ability to create multiple Meditech instances with three FlashArrays that the organization could use out of the box. The result would be increased resiliency and data availability, Marques explained.

"Resiliency and business continuity are especially important for our coverage area in Florida, which can be vulnerable to hurricanes and affect our ability to serve the community," he said. 

"Pure Storage would enable us to run one instance in a physical data center at our Daytona Beach campus, and run another on our Deltona campus 40 miles inland. If a natural disaster were to affect Halifax Health's main facility, the IT team could rely on the other instance as a backup and continue to function as an organization. The team can also failover proactively."

Halifax Health clinicians expect that Meditech be online all the time. "Five nines" of uptime – 99.999% – is no longer good enough, he said. Clinical staff do not ever want the EHR to go down. The health system wants to get to a point where it has minimal outages that are scheduled and unscheduled, and this new set-up was going to help it achieve that goal, Marques said.

"At the end of the day, I'm a risk manager; that's what I have to do. Now that we're more resilient, and have multiple physical locations, it really has become our own cloud that we manage and host."

Mike Marques, Halifax Health

"Pure Storage would enable us to retain full control of our infrastructure, without extremely high operating expenses," said Marques. "But more important was the promise of simplicity and proactive management – where the infrastructure upgrade wouldn't require us to spend a tremendous amount of time supporting it, and that we could share responsibility with a partner for ensuring that the environment is stable and performing well 24/7, 365 days a year."

Halifax Health officially migrated its Meditech EHR environment to Pure Storage in early October 2020.

MEETING THE CHALLENGE

"We were the first hospital to cluster our Meditech environment, so we were blazing new trails," Marques noted. "Pure Storage is going to play an important role in our Meditech architecture as we move forward. And the best part about that is that we can do it without a lot of additional infrastructure and complexity."

The biggest decision that Halifax Health made was to go from a single storage array to three. The only way it could do that both cost-effectively and from a resource management perspective, was with Pure Storage's Flash Array, Marques contended. With the Flash Array, the health system can manage three arrays with the same resources needed to manage a single array.

"Today, in addition to Meditech, more than 200 applications, including all of our tier 1 applications, such as PACS, tele-tracking and several other EHRs, run on Pure Storage," he added. "Our goal is to be able to restore an entire data center rapidly. Just by implementing Pure Storage, we've already reduced our recovery point objectives and recovery time objectives significantly because we have that replication in place."

Halifax Health is starting to have discussions about "stretching Meditech." Pure Storage is a key ingredient to being able to make Meditech highly available across two data centers 40 miles apart.

"So, the nice part is it's all built-in to the Pure Storage solution. We do not need another piece of hardware to manage or hardware that can fail," Marques said. "We have 95% of the infrastructure in place. We're just waiting on some dark fiber construction to be completed."

RESULTS

Halifax Health has seen many important results.

"First, the clinician experience is an important gauge for success," Marques said. "For very good reasons, clinicians do not have patience for delays for mission-critical applications such as EHRs. So, having a high-performing storage environment is critical. The infrastructure has to be on point at all times.

"My predecessor used to say his goal was to keep the clinicians off the computer as much as possible," he continued. "I have the same goal. Clinicians want to be in the room caring for the patient. The best way we can support them is by having reliable infrastructure that performs well. With our Pure Storage implementation supporting Meditech, we've had no complaints whatsoever from a performance standpoint, and no news is good news."

The implementation also has enabled Halifax to optimize its IT human resources, which are in higher demand and stretched thinner than ever in the age of COVID-19. While its infrastructure has grown, the organization is able to manage the same infrastructure with the same if not fewer resources, and staff are able to cross-train. The storage management team also is happier, Marques reported.

"Pure Storage's simplicity allows our IT team to focus on optimizing and enhancing IT, instead of spending time managing storage," he said. "The disk expansion process is 10 times faster, which is easier on staff and reduces the opportunity for mistakes."

Halifax Health has reduced the time spent managing storage by 75%. That has proven valuable during COVID-19. For example, the staff needed to develop an in-house telemedicine application rapidly, as well as a virtual waiting room application and more.

"We had to repurpose staff to deploy the telehealth platform in three days," Marques recalled. "This was a big transformation in a very short time. There's been a tremendous demand for IT resources in multiple areas. And so, the fact that we're not spending as much time managing storage allows us to help with other projects that have a big impact on clinical workflow, our patients, and our visitors. We've had a big focus on that with all the changes that have taken place."

Halifax Health also benefits from the ability to cross-train engineers, increase staffing efficiencies and minimize any technology-related frustrations, Marques said. Retaining talent is essential, and the new storage infrastructure delivers a much more enjoyable experience when it comes to managing the environment, he said.

"We've also reduced risk significantly by spanning our storage array across three data centers," he said. "At the end of the day, I'm a risk manager; that's what I have to do. Now that we're more resilient, and have multiple physical locations, it really has become our own cloud that we manage and host. We support 55 physical locations from our three data centers, and we're in full control of it."

Staff has been able to achieve the same uptime performance and better resilience with the same, if not fewer, resources, which is a significant achievement – especially at a time when resources are more precious than ever, he added.

ADVICE FOR OTHERS

"Evaluate all options thoroughly and encourage technical staff to look outside of the typical offerings available," Marques advised. "Ensure a thorough and consistent hardware evaluation process and always require a proof of concept. Testing is incredibly important when evaluating hardware, especially something as mission-critical as enterprise storage. Our organization leverages a weighted scoring matrix, which creates a thorough, objective evaluation and grading system to help with hardware selection."

Further, do not pigeonhole the organization with one particular vendor or solution, Marques added.

"As a CIO or an IT leader at any level, you're responsible for evaluating critical infrastructure," he concluded. "When it comes to storage, it's important for organizations to have a very stable storage platform and make that the priority. Protecting our data is a top priority."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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