eHealth Saskatchewan is the custodian of electronic health records in the province of Saskatchewan, and manages the record of all interactions that one million residents have with the healthcare system. Information on immunizations, drug prescriptions, clinical encounters, diagnostic imagery and lab testing have been consolidated into one patient record to provide an individualized history for use by medical practitioners and healthcare institutions. eHealth’s mandate also extends to vital statistics, and the organization manages birth and death records, marriage certificates and information from other life events. According to Jay Benson, manager IT architecture, eHealth Saskatchewan, “from a data perspective, we kind of know everything there is to know about every individual in the province as it relates to the beginning of life, interactions with the healthcare system, and the end of the lifecycle.”
The IT infrastructure and resources needed to support electronic records are significant, and have proved an onerous requirement for many of the smaller healthcare organizations in the province in what Benson described as “a day and age of reduced budgets and doing more with less.” To address this challenge, eHealth Saskatchewan now acts as a managed services provider, delivering IT services out of its data centre on behalf of several healthcare regions. Benson added: “this allows regional IT staff to focus on what they need to, which is support for practitioners and ultimately, the patients that they see, while we worry about the hard IT, backend stuff.” Today, eHealth provides these services for a relatively small subset of the practitioner community; however, Benson expects this activity to grow to extend across a good portion of the province’s 13 healthcare regions and associated agencies.
Currently, eHealth Saskatchewan employs approximately 300 people, half of whom work in IT specific roles. The organization also has many information management, data warehousing and data analyst specialists on staff to manage information governance, security and privacy requirements. IT needs are delivered out of a single data centre with just over a thousand virtual and non-virtual servers: 60 percent of these are Windows/Intel based (and include Cisco UCS and HP gear), and 40 percent are Solaris (Oracle hardware) and mid-range. “In terms of raw numbers in the data centre, or a fully hydrated version of that, we’re in the 20 to 40 terabyte kind of range,” Benson added, though the organization leverages a lot of compression and deduplication technology to “keep its storage footprint down.”
To further optimize and support extension of its managed services reach, eHealth Saskatchewan is now engaged in three initiatives. The first project involves migration to a multi-data centre environment as its single facility has had issues from auditing and DR perspectives. Benson explained: “if somebody presents at a healthcare facility and a practitioner needs access to patient data right away but can’t have it, that can be very problematic. So we need a distributed way of thinking.” A single data centre can also experience latency challenges due to Saskatchewan's extensive geography. So while many organizations are engaged in data centre consolidation, eHealth is migrating from one to two facilities.
A second project involves standardization on the Cisco UCS platform. For now, the organization is maintaining its Solaris installation base, a strategy that Benson argued is needed to support application lifecycles and data, which tend to be longer in healthcare than in other sectors, and which require stringent testing and certification. Ultimately, the IT group intends to transition as much as possible away from Solaris to the UCS/Windows/Linux platform. eHealth Saskatchewan’s third initiative entails the creation of a healthcare private cloud.
Building service provider assets
The goal of eHealth’s cloud initiative is to leverage new infrastructure capabilities to support development of its managed service provider role. While IT customers in the individual regions may continue to provision their own servers, eHealth will deliver automated selections of backup and recovery, as well as consistent versions of standardized desktop to practitioners. eHealth Saskatchewan is now in the process of standing up its two new data centres – “people are racking and stacking as we speak,” Benson added – and is working through core network design and for the interconnect between the data centres to enable transfer of workloads back and forth between facilities.
As partners for building its private cloud, eHealth Saskatchewan has chosen to work closely with VMware and EMC on the install of an enterprise hybrid cloud solution that will sit on top of the UCS compute hardware, and on the deployment of a federated end user computing offering. So far, with the support of partners, the IT group has completed early stage design for the hybrid cloud and end user computing projects, and is working with VMware/EMC resources onsite to stand up various components. By year end, the team expects the new environments will be ready to accept “real work.”
eHealth’s decision to deploy the VMware/EMC virtualization solution was a product of two factors. As a long-time customer of VMware with approximately 95 percent of its infrastructure virtualized on the vSphere platform, the eHealth organization was felt that work with this group was the next logical step. “We did the comparison and looked at competitors,” Benson explained, “and while the solution had to fit the requirements, a lot of it came down to the partnership and the investment we already had. To move away from that VMware platform would have taken time, energy and staff training – it would have just been too complicated, and there was a no compelling reason in favour of it.” Since eHealth was buying software on a province-wide basis, it was possible to achieve the scale needed to make the deal with VMware fit from a price point of view. Additionally, EMC’s professional services and the packaging of the solution meant that time to market became a compelling factor. Benson described “time to market” as a key driver in the organization’s decision to work with VMware and EMC on the cloud project: “If we had tried to do this ourselves, our expectation was that it would have taken 18 to 24 months of effort, which we are doing in four with the help of VMware and EMC. In addition to storage, EMC’s professional services included delivery of engineered solutions based on combinations of the entire product stack, and partnership with eHealth on standing up the solutions in the eHealth environment.
Productivity and operational benefits
Saskatchewan is in the enviable position of being able to open healthcare facilities. Drawing on its new cloud capabilities, eHealth Saskatchewan will be able to provide 100 percent of the requirement for virtual desktop for practitioners in a new regional hospital and a new provincial children’s hospital. According to Benson, this is important because “practitioners want both their hands. Our ability to put thin client terminals in each room (provided by Imprivata) will mean practitioners can take a proximity card, tap the reader for single sign in log in, and behind them they will have a virtual desktop session that follows them from room to room with all of the applications and data needed to work and interact with patients.” And they will not have to carry a device to achieve immediate access to electronic health records, or to order prescriptions, etc.
As Benson explained, while some regions may choose to manage deployment of thin client devices independently, they will source through eHealth in order that each customer receive the benefit of economies of scale in device procurement. And while eHealth manages the core desktop image, the organization will work with regional partners to “package and bubble the particular applications that individual regions will want to present.” Over time, the province is looking towards standardization of these systems as well, as opposed to serving up multiple, single instances of ADT applications, to further improve on the efficiency of IT delivery.
Beyond the productivity benefits outlined above, eHealth also expects to realize significant data centre efficiency improvements through it private cloud implementation. Interestingly, though provincial data residency requirements for healthcare information and the personally identifiable nature of the data demand the creation of private cloud infrastructure located within the province, eHealth infrastructure will also act as a kind of public cloud resource for the regions and its citizens.
Benson described ‘cloud’ as consisting of four key components: virtualization, standardization, automation/orchestration, and usage-based billing or show back capabilities. “As a managed service provider,” he noted, “we have to be able to provide each of these. So whether we charge directly or indirectly, however money transfers within the organizations, I still need to know what it costs me to run that service so that I can recover that cost.” As a not-for-profit organization, eHealth Saskatchewan will have pricing and costs that are identical, and but cannot subsidize service delivery to regional organizations. With the new VMware based cloud, eHealth will have the transparency and reporting needed to deliver services on a sound accounting basis. “For our customers [regional healthcare organizations], this billing is important. For us, standardization and automation is very important: our staff is busy and there’s a lot of work that is done every day just keeping those systems up and running. We need to find a way for our IT staff to be more efficient, to become more focused on the practitioner/patient care side of the equation, than on building servers.”
While the eHealth team has not yet had time to measure implementation benefits, Benson and his CIO are looking toward to faster time to IT service delivery, a more agile approach, and transformation of IT from a bottleneck to an enabler of innovation. According to Benson, the CIO’s goal is “to have IT disappear.” For Benson, the goal is to ensure that IT never acts as a barrier to business: in terms of specific KPIs on cloud implementation, the team will consider metrics such as monitoring the resources it typically takes to provision or to decommission machines, how many of these events are there in the traditional environment, how does the Dev/Ops cycle work and how will this change as eHealth moves into cloud and as the organization transitions to an agile from the classic waterfall approach. “These will be indicators of success for us as IT becomes less of a barrier and frankly disappears – how our job functions change and IT teams converge,” he concluded.