Conceptual Model for an IAAS Model in Healthcare

Abstract

The organization is currently struggling with an ad hoc EMR that has lost market share and has not met certification criteria for meaningful use. My plan lays out a new virtualized organization that runs on an infrastructure as a service (IAAS) model. This model will help improve current work flow processes and improve organizational efficiency. My model will utilize wireless routers, thin clients, and leverage a designated EHR cloud service provider.

1. Identify all critical elements and technologies necessary to achieve stated goals of your project.

In order to successfully implement a new cloud based electronic health record (EHR) that will be beneficial to our organization. I looked into specific technologies that will be needed in order for our organization to save on cost, leverage current technology, improve data security, and establish a smooth transition of data migration. The key technologies that we will need to successfully implement a new wireless EHR that runs on cloud technology include:

·      A wireless local area network (WLAN) router.

·      Thin clients to replace traditional desktops for a virtualized desktop infrastructure (VDI).

·      EHR host that provides an IAAS over a virtual private cloud (VPC) that runs on a public server.

Thin clients are beneficial to developing a virtualized infrastructure. Thin clients are less expensive investment wise compared to traditional desktops and easy to maintain. This type of technology will help to ensure easy integration of a new cloud based EHR (Deboosere et al, 2012). Taking the approach to virtualizing our organization will benefit the organization when we plan to implement a cloud based technology that offers a full package IAAS. The reason for selecting an IAAS cloud EHR is due to the many benefits which include standard updates, storage flexibility, and remote access. Moreover, implementing an IAAS that runs on a VPC over a public server offers more security to our data transmissions (Bhardwaj, Jain, & Jain, 2010).

Since our focus is to use wireless technology, we will use a wireless router based on wireless fidelity (WIFI) or 802.11x media access protocol to avoid collisions (Cowley, 2012). These routers will be scattered departmentally to avoid interference and a reduction in transmission speeds. For example, the various departments including ICUs, mother & baby, emergency services, radiology, oncology, and surgery centers will all have a dedicated WLAN router. This router will then transmit data to a centralized router that can pass information throughout the organization.

2. Describe the resources you will require to achieve your project goals.

Resources we will need is access to high speed internet with WIFI standards, thin client technology, wireless routers, and an HER/cloud host. High speed internet access that has a minimum of 100 mbps is what is recommended for a single hospital system (HealthIT.gov, 2013). According to Mitchell (2017) WLAN can produce up to 54mbps. Therefore, segmenting each department with a designated router will allow for each department to get the most out of the bandwidth with little interference. This will not only be beneficial to transmission rates, but also less expensive than its counterpart wired local area routers (wiredLANs).

Virtualizing the infrastructure of our organization helps to effectively connect each node within the organization with a reduced cost on help desk services. The primary reason we would transfer all desktops from traditional desktops to thin clients is to reduce IT expenses, as well as clear up desktop cluster, and it’s more sensible for remote access users.  Moreover, thin clients are more easily adept to connecting to a cloud server with all the same characteristics less the cluster of traditional desktops (Eli the Computer Guy, 2015).

Lastly we will contract an EHR host that offers cloud based services on an IAAS model. Software as a service (SAAS) models such as Salesforce offer reliable technologies that can be rented on a monthly or annual basis to organizations. The software is accessed via the internet and stored on local servers. The benefits of IAAS models however, remove the cost of local servers and allow organizations to be flexible with storage needs and routine system updates. Removing these costly components will allow our organization to continue to run smoothly with little local interruption and improve standardizations. One of the bigger issues in healthcare is a lack of standardizations. Using a cloud based IAAS models such as the newer Athena Health models will improve work flow and access to information (Athena Health, 2011).

3. Architect, at a high level, your proposed solution and draw a diagram in a software application of your choice, typically Power Point or Visio

4. List and describe clinical applications and/or services that will run on your proposed infrastructure. In the case of EMR, describe which services will be in the cloud and whether there are any services that will need to be hosted internally and why or why not.

The clinical applications that will run on the proposed infrastructure are laboratory information systems (LIS), radiology information systems (RIS), pharmacy information systems (PIS), room monitors (i.e. blood pressure monitors and pulse oximetry monitors), and thin clients in each patient’s room. LIS systems include all laboratory test orders and results that traditionally store chemistry and other medical laboratory testing into a local database. RIS systems include all imaging services MRI, CT, Ultrasound, and other radiological images that are stored traditionally in a picture archiving and communication system (PACS). PIS include pharmacy inventory management systems as well as prescription information for patients.

            The organizations goal will be that all systems running within our network be stored on the vendor’s cloud. This will help reduce any storage inefficiencies and help our organization have easy access to real time data. With an integrated cloud solution our organization will have access to resources on demand, and see a reduction in information latency that you get as a results from traditional ad hoc servers (Athena Health, 2011).

5. Identify benefits and risks to business operations and patient care environment, resulting from your proposed solution. Briefly describe how you will address the risks identified

Risks of my model include possible data security concerns due to cloud based infrastructure with no local servers, vendor reliability, poor application performance, and internet downtime. These risks are fundamentally the greatest risks we run when implementing a cloud based solution. In order to reduce any security issues with cloud based services we will ensure that our cloud provider (i.e. the EHR vendor) offers a designated virtual private cloud. This creates more security for our organization and will help reduce possible breaches. When accessing information over a VPC organizations can leverage security models similar to Amazons VPC model for its applications web services (AWS) that enhance the security and reliability of cloud services by increasing security and restricting access to only the client (Morad, 2014).

Vendor reliability is another concerns. What we will do prior to investing in a designated vendor is research the organization and investigate its history. Typically, organizations such as Allscripts, Athena health, Epic, and Cerner hold larger market share and are the top EHR vendors at this time. However, with a constantly shifting demand in technology by simply looking at history is not enough. We will need to select a vendor based on product design, startup pricing, implementation support and post implementation support, interoperability to other health systems, and weather the system has been certified to meat meaningful use (HealthIT.gov, 2014).

Internet downtime is the final risk. Cloud services require internet in order to access the systems. In the event of natural disasters or power outages the router will go down and there will be no access to the cloud servers. Our solution will be to invest in a backup generator that will reboot the system immediately after a power outage. One benefit of thin clients is that even if a system shuts down you can access your previous account simply by logging in to another thin client nearby.

Benefits include reduction in local resources, cost savings on expensive local servers, rapid upgrades, flexible data storage plans, and large network access.

6. Briefly describe to senior management and why your solution is a good fit.

Senior management including c-suite individuals CIO, CSO, and other leadership members will play a critical role in helping identify the best solutions. Their roles are to primarily equip our end user teams with knowledge needed to successfully transition from current EMR to new solution.  They also play a critical role in helping fund this new idea and allocating resources so that implementation is successful. My idea will have long lasting benefits for the organization. Long term organization are transitioning in-house data centers to cloud resources. This solution helps to leverage costly resources on one time purchases and allocate monthly resources to more patient beneficial technology.

References:

Athena Health. (2011). Clud-based ehr benefits. Retrieved from: https://www.athenahealth.com/knowledge-hub/ehr/cloud-based

Bhardwaj, S., Jain, L., & Jain, S. (2010). Cloud computing: A study of infrastructure as a service (IAAS). International Journal of engineering and information Technology, 2(1), 60-63. Retrieved from: http://s3.amazonaws.com/academia.edu.documents/7299777/cloud%20computing%20a%20study%20of.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1497837504&Signature=uKd1diWHX03eu%2F46d9862JSi7m8%3D&response-content-disposition=inline%3B%20filename%3DCloud_computing_A_study_of_infrastructur.pdf

Cowley, J. (2012) Communications and Networking. Westmidlands, UK: Springer

Deboosere, L., Vankeirsbilck, B., Simoens, P., De Turck, F., Dhoedt, B., & Demeester, P. (2012). Cloud-based desktop services for thin clients. IEEE Internet Computing, 16(6), 60-67. Retrieved from: https://biblio.ugent.be/publication/3234753/file/3234767.pdf

Eli the Computer Guy. (2015). Questions: is vdi a good idea for small/medium business. Retrieved from: https://www.youtube.com/watch?v=LZiG5UtrTCQ

HealthIT.gov. (2013). What is the recommended bandwidth for different types of health care providers. Retrieved from: https://www.healthit.gov/providers-professionals/faqs/what-recommended-bandwidth-different-types-health-care-providers

HealthIT.gov. (2014). Step 3: selecting or upgrading to a certified EHR. Retrieved from: https://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr

Mitchell, B. (2017). Wired vs Wireless Networking. Retrieved from: https://www.lifewire.com/wired-vs-wireless-networking-816352

Morad, S. (2014) Amazon virtual private cloud connectivity options. Retrieved from: http://media.amazonwebservices.com/AWS_Amazon_VPC_Connectivity_Options.pdf