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Nevada Rural Hospital Partners Network Connectivity Overview 2010

Nevada Rural Hospital Partners Network Connectivity Overview 2010. Todd Radtke Regional CIO – NRHP 775-827-4770 todd@nrhp.org. About NRHP. Established in 1987 14 Rural Nevada Community Hospitals NRHP hosts shared applications and provides IT services

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Nevada Rural Hospital Partners Network Connectivity Overview 2010

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  1. Nevada Rural Hospital PartnersNetwork Connectivity Overview 2010 Todd Radtke Regional CIO – NRHP 775-827-4770 todd@nrhp.org

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. DISRN Radiology Network

  8. NRHP Tele-radiology Archive Overview

  9. NRHP Network Connectivity

  10. 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

  11. 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 )

  12. 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

  13. 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 ?

  14. 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

  15. 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

  16. 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.

  17. 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

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