Nevada Rural Hospital Partners Network Connectivity Overview 2010
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Transcript of Nevada Rural Hospital Partners Network Connectivity Overview 2010
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Nevada Rural Hospital PartnersNetwork Connectivity Overview 2010
Todd RadtkeRegional CIO – NRHP775-827-4770 [email protected]
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About NRHP
Established in 1987 14 Rural Nevada Community Hospitals NRHP hosts shared applications and
provides IT services NSHE/SCS NevadaNet is our WAN and is
critical to supporting our vision Supporting member viability by implementing
shared health information technology solutions
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NRHP Mission: Improve the viability of rural hospitals through shared services, resources, and advocacy
Hospital viability depends on -A supportive operating environment -Adequate financial resources -Quality human resources -Appropriate array of high quality services -Adequate facilities and technology
The technology vision: NRHP members maximize productivity, economic efficiency, the quality of care, and patient safety through the application of appropriate technology to the
processes of clinical care and hospital management
ManagementCapability and Applications
Knowledge Connectivity Funding
NEVADA RURAL HOSPITAL PARTNERS INFORMATION MANAGEMENT VISION
When detail is added to that statement, the vision is one in which, someday, NRHP hospitals will have integrated internal information systems that support clinical and administrative functions. Members will have access to high speed connectivity that supports communication, telehealth, data transfer, storage and recovery. NRHP hospitals will have electronic medical records and other tools designed to enhance the quality of care, access to information, productivity, and financial viability. All types of closed records will be in digital format. When it makes economic sense, web-based applications will be shared among member hospitals over secure connections. Members will have qualified Information Management personnel supported by centralized expertise. Processes that assist members with good decision making, and implementation support, will be in place.
NEVADA RURAL HOSPITAL PARTNERS INFORMATION MANAGEMENT VISION
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Management Knowledge Connectivity Capability and Applications Funding
Manage Change
Develop members' internal expertise
Develop standards and policies
Establish decision making process
Assist members to comply with regulations
Provide for systems control
USCC - Maintain/expand
NevNet and allow access
ORH/UNSOM - support, coord., and
CAH funding
NRHP - obtain grant funding - HRSA, OAT, SHIP, and
possibly utilize loan pool
Member funded internal budgets
Provide central expertise
Establish need
Complete research
Pilot project
HIPAA
Document information systems
Provide ongoing education
Maintain control of access and usage
Provide sufficient bandwidth and redundancy
Establish and maintain secure
connections
Provide for information systems
support
Establish, monitor and maintain LANs
and WAN
Develop and maintain security
applications
Develop PACS capability, including standardized RIS
Integrate members' legacy software within hospitals
Develop expertise at Board levels-
members and NRHP
NNAHEC - Coordinate NevNet
telemed, USF discounts, other funding, cmprsd.
video
Develop and expand document mgmt
program
Develop and maintain central data
storage
Develop data disaster recovery capability
Expand Telehealth applications, incl.
teleradiology
Maintain communication
applications
Plan for long-term conversion to EMR
Expand capacity of compressed video
Develop applications for
quality & pt. safety
Establish and commit NRHP strategic plan
Develop decision making guidelines
Address sustainability issues
Provide for backup and support
Develop shared applications
Revised 4/08
Provide secure data backup
NEVADA RURAL HOSPITAL PARTNERS COMPONENTS of INFORMATION MANAGEMENT
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Information Management Components: Connectivity Establish and maintain network security Provide sufficient bandwidth and redundancy Maintain control of access and usage Manage wide area network (WAN) Monitor and report network usage Provide for backup and support
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Information Management Components: Capability and Applications Process Improvement
Integration, document management, PACS Shared Radiology Archive Long Term conversion to EMR Maintain communications applications Develop and maintain shared applications Develop disaster recovery capabilities Develop clinical applications Expand telehealth applications
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Current NRHP IT Services Provide centralized I.T. expertise Educate NRHP Board and member I.T. staff Support IT decision-making re: integrated systems, electronic health records, and health
information exchange Maintain and support a secure Wide Area Network Host member email services Host central software applications Integrate members’ legacy software systems Maintain and support a central electronic archive Enhance/expand members’ PACS capability, teleradiology functionality, efficiency and
support Maintain relationships that enhance members’ connectivity Manage the Universal Service Fund discounts for members Provide I.T. leadership at the State level, helping to shape responses to rural needs Manage I.T. grant-funded programs and reporting Assist members with vendor negotiations Manage NRHP’s I.T. vendor contracts and software licenses
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Shared Applications that depend on NevadaNet Hosted Email and shared calendaring
900 plus users Spam management Enhancements – shared calendars, webmail –
Shared HL7 integration Over 1 million messages a month are processed Reduces data entry of patient demographics into clinical applications ( lab and
radiology ) Sharepoint sites
Risk Management, LiCON, Member CEOs and IT Web Site Hosting
Hosted at powervps ( not on nevadanet ) Shared Credentialing application Shared Risk Management SGMS firewall reporting Central PACS Archive – 450,000 studies to date
Primary PACS archive is hosted at Pennington with a plan to move to SCS data center
Secondary archive is located at NRHPs offices
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DISRN Radiology Network
UNR UNSOM Pennington Data Center - Reno, NV
Great Basin
NorthStar Imaging MedWeb
Desert Radiology
PGH - Lovelock, NV HGH - Winnemucca, NV BMGH - Battle Mountain, NV
WBRH - Ely, NV
CCH - Fallon, NV
SLMC - Yerington, NV
BC - Boulder City, NV
100Mbps
DILS - Caliente, NV
MGGH - Hawthorne, NV
- Central Archive - 7 year storage- Secondary read site - redundancy- Central RIS - scheduler, charges, front desk administration- Ability to import patient demographics from each hospital admitting system ( HL7 or scripting ) and attach to exam or send export file to radiologist- Each hospital needs to be able to produce digital copies for patients to take off-site- NevadaNet WAN will support the DISRN project- Develop central RIS
Owyhee Indian Heath
Desert Imaging
MedWeb
MedWeb / NovaRad
MedWeb
DR systems
MedWeb
GE
CVMC - Minden, NV
Phillips Easyweb
RadSight Archive Station
Web based access to support teleradiologists from northstar ( typical )
RadSight Connect station
image acquisition devices ( typical )
CT, ultrasound, MRI, Flouro, Film scaner, xray, etc
Forward copy
RadSightDiagnostic Station
TYPICAL TOPOLOGY
Central RIS( future )
IE
RadSight Connect station
RadSight Connect station
RadSight Connect station
RAID Storage Archive
Konica CR
DISRN ProjectDiagnostic Imaging System for Rural Nevada
Konica CR
Konica CRKonica CR
RAID Redundancy
and tape backup
Northstar access point( forward studies from BMGH, HGH, etc
NevadaNet T-1
Public InternetSite to Site VPN Security
NetworkMgmt
NRHP - Reno, NV
Dual T
-1s
WindowsAuthentication
Server
Phase 1
Dry LaserFilm Printer
100Mbps
Nye Regional
MedWeb
RadSight Connect station
RadSight Connect station
RadSight Connect station
RadSight Connect station
VPN
Radiology Vendor AccessRoute studies to vendorsImport reports from vendors
PACSMesquite, NV
Central PACS Archive 1_14_07
Interface Engine Patient Demographics and Billing data from hospital
information systems
Central Medweb
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NRHP Tele-radiology Archive Overview
NevadaNet
Typical Hospital Server
Typical HospitalInformation System
UNR Data Center5000GB Archive
NRHP Office5000GB ArchiveReplication Site
Robotic Tape Library
MIRRORDATA
PRIMARY
SECONDARY
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NRHP Network Connectivity
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NRHP Network Overview
Redundant Sonicwall PRO3060s provide network security, including intrusion prevention, gateway anti-virus and content filtering services
All site to site traffic is secured IPSEC VPN Hub ( NRHP and Archive locations ) and
Spoke ( hospitals ) topology
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LCSDBM
Humboldt Gen.Winnemucca
Northeastern Nv. Regional Hospital - Elko
Battle Mtn. Gen. Hosp.BM (2)
Nevada Rural Hospital Partners
Grover C. Dills Med. Ctr.Caliente
WNCCCarson
LCSDPanaca
CCSNHTC
Pahrump
GBCEly
GBCWinne
ECSDElko
Pershing GeneralLovelock
NCSDTonopah
Nye County Hosp.Tonopah
Carson Valley Hosp.Minden
Owyhee Community Owyhee
NRHPReno
Churchill County HospitalFallon
CENICSACRAMENTO, CA
Mt. Grant Hosp.Hawthorne
South Lyon Med. Ctr. Yerington (2)
CENIC Los Angeles, CA
(Internet & Internet2)
WNCC - Lovelock
Incline Community Hosp. Incline Village
Wend
William Bee RirieEly (2)
LAS VEGAS METRO FIBER LOOP
IRPPOP
WilTelPOPReno
RENOMETROFIBER LOOPInternet, Internet 2 &
BRIN
WilTelPOPLV
SCSLas
Vegas
Smith Valley Med. Ctr.Wellington
Boulder CityHospital
UNRRedfield
ECSD Eureka
SCSReno
SCSElko
Carlin Fire
Academy
Mesa View Regional Hosp.
Mesquite
Yellow: Sites currently on the NevadaNet Backbone
Future
2007
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WAN status Current T-1s are not sufficient to handle our traffic – recommend 6-10
Mbps for tele-radiology and future applications.
Some sites have upgraded to dual T-1s NRHP, WBRH, BCH and HGH
Sites that need additional bandwidth SLMC, MGGH
Sites that need to install new T-1s to isolate from the bundled education circuits PGH, NRMC, GCDMC
Battle Mountain 10mbps wireless connection to the fiber backbone with a T-1 as a backup is working well
NRHP will develop an infrastructure plan to increase bandwidth and provide redundant links – the issue is funding ( direct or grant )
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Challenges
WAN - Single and dual T-1s with no out of band backup (DSL, alternate routing, etc)
QOS – priorities critical applications to maximize bandwidth
Lack of bandwidth Cost of T lines a major barrier
Redundancy is critical to NRHPs ability to host clinical applications
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Current Issues
Last mile connectivity Opt-E-man might be a solution, 10Mbps $700 per month
per end, would need NSHE support / design - Can NSHE support this ?
QOS – at one time SCS proposed a MPLS layer to support QOS – is this still an option ?
Video scheduling – NRHP members require the ability to schedule telemedicine consults – Can we manage our own video calls ?
SCS support – 8x5 only, can members call circuit provider after hours ?
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Current Projects
SLA with SCS to co-locate one rack at the data center – target July1 2010
Upgrade to 6Mbps at NRHP offices Humboldt fiber upgrade Caliente – offered 50M fiber – Need SCS
support for video connectivity (T-1 or dry pair) Reviewing Smith Valley clinic connectivity –
possible T-1 to Yerington network
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Grants update
BTOP NRHP is involved with 3 applications
NSHE – fiber access points Hwy50 and I80 NHA – fiber network, data centers and shared EMR DOIT – microwave build-out and last mile
NRHP also has a request into senator Reid for IT infrastructure upgrades including routers, LAN equipment, PCs, servers and additional video equipment
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Conclusions
Expand NRHP members network infrastructure: Statewide broadband communications will allow healthcare organizations to
access and exchange information rapidly. NRHP and SCS have been working to expand the NevadaNet infrastructure and provide a quality of service level to healthcare data
Expand hospital health information system capabilities: Expand the use of HIT within hospitals to enhance the capture and storage
of complete patient health information electronically in a uniform manner. Member hospitals utilize electronic information systems but need to focus on eliminating the paper records and providing access to the electronic data that they do have. The data being captured is frequently fragmented in disparate systems throughout the hospital.
Enhance the use of EMR systems in community-based practices In order for patient health information to be useful, it must be captured
electronically at the point of care.
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Wrap UP !
NRHPs mission to support members depends on NevadaNet !
Co-locating shared applications to SCS and resolving last mile issues is a top priority
Redundancy is still a concern – DSL or other broadband would require NAT re-
design Alternate routing via link to nearby facilities Off NevadaNet options – MPLS cloud, etc