As the only hospital in a 10,000-square-mile area, Sky Lakes Medical Center provides a complete range of medical services for the residents of four rural counties, including cancer treatment, joint and spinal care, diagnostic imaging, and an assortment of primary and specialty physician clinics.

Located in Klamath Falls, Oregon, Sky Lakes Medical Center is a not-for-profit, community-owned, internationally accredited acute care teaching hospital serving more than 80,000 people in south-central Oregon and northern California.

THE PROBLEM

"As a critical component of the community's healthcare center, the Sky Lakes information services department responds to critical and sometimes competing demands: Deliver unfailing reliability and availability from our infrastructure for lifesaving patient care, and do it on a modest budget," said John Gaede, director of information systems at Sky Lakes Medical Center.

"As director of Sky Lakes information services, I've spent years making do with what we had: four racks of traditional three-tier information technology architecture – including a rack of blade servers running 500 virtual machines and 200 terabytes of storage in a single data center – and only a team of six to manage all of it," he said.

In a community hospital, anyone who works in IT wears multiple hats: A network administrator could be doing everything from fixing a PC to configuring switches or solving wireless problems, all in the same day, he added.

"We are now able to isolate and assign distinct security zones for specific endpoints and applications in our standalone community hospital. Traditionally, this would only have been available in very large healthcare organizations with deep technical personnel benches and pocketbooks."

John Gaede, Sky Lakes Medical Center

"In late 2016, it became clear that major upgrades to our core IT infrastructure would be necessary," he recalled. "Servers and storage were nearing the end of support. At the same time, Sky Lakes' diagnostic imaging clinicians were eager to adopt new tools that require massive amounts of data processing and storage.

"I knew we had to be smart about tackling the big challenges we faced," he continued. "With our limited resources, we needed to find a way to provide state-of-the-art, highly available and reliable IT infrastructure to support healthcare when patient lives depend on it."

PROPOSAL

To solve this problem, Sky Lakes turned to hyperconverged infrastructure (HCI). Instead of managing separate but integrated compute, storage and networking tiers, now the IT team could unify and manage it all in a single solution.

"Hyperconverged infrastructure brings something we need desperately in the community hospital: simplicity," Gaede explained. "We don't have enough hours in the day or enough money in a year to do all the things we need to do for the organization. Solutions that simplify our infrastructure help us a great deal.

"To make sure we found the right partner, my team undertook extensive HCI vendor evaluations of five potential solutions," he said. "Through a rigorous nine-month process, Cisco won us over with the simplicity of Cisco HyperFlex, its commitment to the solution and an attainable implementation roadmap."

MEETING THE CHALLENGE

To date, Sky Lakes has migrated all of its workloads to Cisco HyperFlex, including clinical systems for the Cancer Treatment Center, perinatal monitoring and radiology imaging, running two clusters with a total of 16 nodes.

"We're not defining only certain workloads for HyperFlex. We're all in," Gaede said. "Sky Lakes is running about 634 virtual servers and every flavor of system on Cisco HyperFlex, and with Cisco Intersight we have a single pane of glass for management.

"The small footprint of HyperFlex also provides Sky Lakes with savings on power and cooling," he continued. "By reducing four racks of compute, storage and networking to just two-thirds of one rack, Sky Lakes now spends 70% less on data center power usage. The compact, relatively self-contained platform now permits Sky Lakes to fully replicate the entire HyperFlex environment."

In the past, it would have been much less efficient and more costly to do with multiple systems. Now the organization has full redundancy, he added.

Gaede also breathes more easily, knowing that patient information is secure, with HyperFlex data storage drives self-encrypted at the core. In addition, Sky Lakes is implementing a full portfolio of enterprise security features, including Cisco DNA Center network management, a cloud-based secure Internet gateway, firewalls and security analytics.

"Micro-segmentation in our network is huge," Gaede noted. "We are now able to isolate and assign distinct security zones for specific endpoints and applications in our standalone community hospital. Traditionally, this would only have been available in very large healthcare organizations with deep technical personnel benches and pocketbooks, and it helps us protect clinical systems, even when many vendors struggle to keep up with security updates."

Sky Lakes extended the system to its new Collaborative Health Center, which provides a single location for five clinics to increase patient access to healthcare. In addition, Sky Lakes implemented Cisco's upgraded networking backbone, wireless and unified communications system, running on HyperFlex and managed through Intersight.

By running the unified communications system on HyperFlex, Sky Lakes now is able to efficiently and economically complete an enterprise-wide transformation of its entire legacy phone system, Gaede said. Sky Lakes further integrated Stanley Healthcare Technologies with Cisco DNA Spaces for real-time location services (RTLS) and temperature monitoring of vital lifesaving equipment and medications.

RESULTS

When COVID-19 hit the community, because of the technology already in place, Sky Lakes was able to set up a drive-through testing site in 24 hours and establish telehealth capabilities in 48 hours.

When the first COVID-19 vaccine arrived at Sky Lakes, there was no time to waste. Within three hours of receiving the first doses, Sky Lakes administered its first shot and stood up a call center for scheduling vaccinations over a weekend. Instantly the call center was able to take on up to 1,000 calls at a time.

Sky Lakes also implemented a robot running on the Cisco wireless solutions to do bedside visits. The result was the ability to reduce the use of PPE and provider exposure, while still managing to appropriately treat COVID-19 patients and eventually discharge them home to more fully recover.

"As noted, by reducing four racks of compute, storage and networking to just two-thirds of one rack, Sky Lakes now spends 70% less on data center power usage," Gaede said. "The compact, relatively self-contained platform now permits Sky Lakes to fully replicate the entire Cisco HyperFlex environment at a second data center."

ADVICE FOR OTHERS

In healthcare, most organizations operate on a margin of 3% or less, so investments have to be absolutely strategic, Gaede stated.

"What drove Sky Lakes to make investments in advanced technologies like hyperconverged infrastructure and Intersight is efficiencies," he advised.

"With limited budgets and resources, there is always more demand for technologies than there are people or resources, so we need technologies that make us more efficient and are highly available because they are critical to patient care.

"With technologies that provide real efficiencies, we're able to quickly stand-up solutions in urgent situations – critical to saving lives," he concluded.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.