Some stories are better told from the beginning and others from the end. In the case of LifeBridge Health, based in Baltimore, Maryland, our tale is best told in a series of flashbacks that start in September 2007.

That’s when Sinai Hospital, one of four institutions in the LifeBridge network, was named a Top Hospital by the Leapfrog Group for the second year in a row. Among 1,285 institutions participating in Leapfrog’s 2007 quality and safety survey, Sinai was one of 41 to receive the prestigious honor, which recognizes hospitals’ success in boosting patient safety standards, treating high-risk diseases according to scientific evidence, and using electronic prescribing programs to reduce errors in administering medications.

What success looks like

This award and others we have received affirm a strategy we launched in 2004. Our goal then was to create an advanced infrastructure—wireless, paperless, and automated—to support our core mission of providing excellent care in a cost-effective way across the four major institutions in our network: Sinai Hospital of Baltimore, Northwest Hospital Center, Levindale Hebrew Geriatric Center and Hospital, and Jewish Convalescent and Nursing Home.

Today, with many components of that strategy in place, we are realizing tremendous benefits in the areas of patient safety, staff efficiency, and cost management. Here are just three examples:

Accurate, timely patient information

Enabled by mobile computers-on-wheels (COWs), doctors and nurses can access a patient’s complete medical record, including medical images, right at the bedside. Physicians can order tests and medications, and providers can immediately confirm when procedures are completed. As a result, treatment decisions are based on up-to-the-minute information.

Faster, safer administration of medicines

Today, 89% of all medication orders are entered electronically, analyzed for possible drug interactions, and then automatically routed first to the pharmacist for review and approval and next to the nurse, who electronically documents when the medication was dispensed. This process has not only enhanced patient safety but also has achieved a 76% reduction in the time it takes to approve meds.

Faster patient discharges

With secure remote access to clinical applications, physicians don’t need to come to the hospital to review the patient’s file and sign a discharge order. They can do so online, allowing patients to go home earlier and freeing up beds for incoming patients.

Creating an advanced infrastructure

To enable these capabilities and others yet to be implemented, LifeBridge made major infrastructure investments over a multi-year period. One of the key initiatives was to replace a 30-year-old data center with a 20,000-square-foot technology center that houses our 90-plus IT staff members. With this facility in place, we were able to:

• Centralize 14 critical applications, including patient registration, clinical systems, financials, e-mail, and the enterprise interface engine.
• Replace our physical film library with a picture archiving communications system (PACS) to streamline the retrieval and management of medical images.
• Create a high-performance, high-availability SAN to serve as a centralized repository for patient records, medical imaging, and business data.
• Install a voice and data wireless network to support the mobility needs of providers throughout our facilities.
• Implement secure remote access so physicians can review patient records and enter orders from their homes, offices, and other offsite locations.

The quest for a one-hour recovery

Being well on our way to eliminating paper records, we knew it was essential to create robust business continuity capabilities. We deployed a backup data center at Northwest Hospital, 10 miles from the primary data center. All critical applications run at the backup site and data is replicated continuously, so no information is lost if we failover to the disaster recovery (DR) server.

In the past, if our data center went down, it might take days to restore basic functionality from tape. With the new environment in place, we set and met an aggressive recovery goal of being able to restore critical applications in one hour, even if key staff members were not available, as might happen during a disaster. We recently had a chance to test the plan when one of our vendors was not able to complete hardware updates to the production system during scheduled monthly downtime. We activated the plan and were able to bring everything back online at the usual time from the DR site.

Coping with rapid data growth

One of the biggest challenges we face is rapid growth in the amount of information that needs to be managed. Some of this growth comes from the normal accumulation of patient records and business information. A much larger share comes from the need to maintain multiple electronic copies of information as a precaution against data loss. This duplication is especially daunting for medical images, which are as large as 1.5GB for one study and promise to get larger as new technologies come online.

Managing the information lifecycle

We maintain five copies of each image, using an information lifecycle management (ILM) solution and tiered storage to meet diverse requirements for quality of care, regulatory compliance, cost management, and disaster recovery. For example, one copy is saved to high-performance tier-one storage to facilitate quick retrieval and viewing from high-resolution workstations. A compressed copy, also kept on tier one, allows physicians to view lower-resolution images within a medical record. The file is also replicated to archive storage and the remote data center—both utilizing less expensive tier-two storage—and saved to tape for long-term storage. ILM allows us to automate the policy-based management of all these copies while containing costs. High-resolution images are removed from costly tier-one storage at the point in the patient care cycle when retrieval needs are reduced.

What does the future hold?

As a result of explosive data growth, the number of file servers in our data center has nearly doubled, from 180 to 330, in just two years. We are looking at file server virtualization as a way to use onboard storage more efficiently and thus slow server growth. Virtualization will offer the added benefit of providing a lower-cost means of recovering second-tier applications.

On a more strategic level, we plan to integrate hospital-based electronic medical records with the ambulatory patient records maintained by our physicians at their offices, enabling providers to view a single, comprehensive record. We are also considering ways to provide patients with secure access to their own medical records. We believe that both these initiatives will help LifeBridge stay at the forefront of care in our region.