by Stratus Technologies, The Availability Company ® April 2009
Count on Stratus for
Electronic Health Records That
Make the Grade — 24/7 Availability
The long migration to electronic health records (EHRs) in the U.S. is set to speed up with the funding
authorized by the American Reinvestment and Recovery Act of 2009. Recognizing how electronic
health records help improve outcomes for patients, hold down rising costs and increase access to
quality care, physicians and practice managers evaluating EHRs can be expected to assess their
application software options thoroughly. The availability and reliability of the information technology
(IT) infrastructure that supports the EHR application merit the same attention, yet tend not to be as
What are the specific risks when clinicians can’t access electronic health records? How far-reaching
are the consequences when EHR data is lost, or its integrity is compromised? This paper offers a look
at the mission-critical role of EHR systems, and introduces high availability and continuous
availability solutions that build in uptime protection to ensure the continuity of operation that both
caregivers and patients can depend on.
EHRs Improve Outcomes, Lower Costs
An EHR, which some refer to as an electronic medical record (EMR), represents much more than
simply a digital chart. When implemented and used in line with best practices, EHRs can make patient
health records (PHRs) instantly accessible from any location at any time. Decisions about care can be
based on complete information, and records are always current.
Medical errors resulting from transcription mistakes and being unable to read a clinician’s handwriting
are prevented. Decision support tools, including treatment guidelines and protocols, may also be
provided to assist caregivers.
Expensive inefficiencies are eliminated as well. For starters, data about a patient need only be entered
once. Money that might go to redoing tests is saved when all of the patient’s results are available for
review. The cost of administering claims can be driven down when the data required by payers is
documented and online. Furthermore, denial of claims can be reduced.
Improvements that result from implementing and using EHRs have been documented, and experts
predict the impact of EHRs will grow as adoption increases.
For example, a Johns Hopkins University study, originally reported in the Archives of Internal
Medicine, looked at the use of clinical information technologies at 41 hospitals in Texas. Researchers
analyzed death rates, complications, length of hospitalization and cost associated with greater and
lesser levels of automation. A 10-point increase in the use of online notes and records was linked to a
15% lower death rate. 1
“If these results were to hold for all hospitals in the United States, computerizing notes and records
might have the potential to save 100,000 lives annually,” said a senior author of the study, Neil R.
Powe, MD. 2
Another expert, Dr. David Brailer, who served as head of the health information initiative under
President George W. Bush, has estimated a fully computerized health record system could save the
industry between $200 and $300 billion annually. 3
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Accelerating EHR Adoption
The start up investment in IT has stood in the way of many U.S. hospitals and physicians
interested in EHRs, especially group practices and independent doctors. The American
Reinvestment and Recovery Act of 2009 specifies funding and other provisions intended to
reduce those obstacles. The legislation spells out significant financial incentives and penalties,
carried out through the Medicare and Medicaid programs, to encourage doctors and hospitals
to adopt and use certified electronic health records.
“Physicians will be eligible for $40,000 to $65,000 for showing that they are meaningfully using
health information technology, such as through the reporting of quality measures. Hospitals
will be eligible for several million dollars in the Medicaid and Medicare programs to similarly
use health information technology. Federally qualified health centers, rural health clinics,
children’s hospitals and others will be eligible for funding through the Medicaid program,”
states a Congressional fact sheet summarizing the legislation. 4
Incentive payments will phase out over time. Ultimately, “Medicare payments are reduced for
physicians and hospitals that do not use a certified electronic health records that allow them to
electronically communicate with others.” 5
A Mission-Critical Clinical Tool
EHRs take on a vital role in ensuring continuous access to patient data and empowering caregivers to
collaborate. In addition to the required functionality, interoperability and security, an EHR system
must also have inherent availability and reliability ⎯ or its mission is in jeopardy.
Picture a scenario in which the EHR system serving a physician’s office or group practice is down
unexpectedly for 60 minutes during office hours. When health records and test results are not available
on demand, patient safety may be at risk. Delays and backlogs build as caregivers scramble to do their
best under the circumstances, causing the interruption to cascade to affect all patients seen that day.
Even the briefest of outages could be devastating. It’s not difficult to envision a situation where the
doctor has minutes to make a life or death decision: The EHR system is down when a critically ill
patient comes in, and the physician administers medication that reacts adversely with a drug that a
different doctor prescribed earlier.
Other consequences are that costs and inefficiencies mount. Lawsuits can follow missed diagnoses.
Encounter data may have to be recorded manually and entered into the system later.
And in a hospital or emergency medical services (EMS) setting, patients can require care at any hour
of any day, not just when appointments and procedures are scheduled.
Standardization of electronic health records will raise the need for dependability still higher. When
EHRs achieve interoperability, true community health record (CHR) and health information exchange
(HIE) systems can be created. Health history, diagnostic records, lab results, prescribed medication
and more will be on hand whether a patient sees her primary care doctor, visits a specialist or needs
urgent care at the emergency room. This will help to ensure high-quality care in every encounter,
including for medically underserved people who lack access to consistent treatment from the same
doctor or clinic.
EHRs That Make the Grade ⎯ 24/7 Availability Page 2
Ensures the right patient
gets the right medication
at the right time
adverse drug events yearly 6
Uptime Is an EHR Necessity
EHR availability is a necessity for patient safety
and healthcare cost containment
A single healthcare
transaction may be of
Online records linked to
15% lower death rate 7
Real-time online data
promotes efficiency and
lowers healthcare costs
Annual savings between
$200 and $300 billion 8
To avoid compromising patient safety, driving up costs, spawning delays and creating
inefficiencies, protection against IT downtime should be planned into EHR systems.
Not only can the standard of care for the individual patient be improved, but it will also be possible to
gain insights for evidence-based healthcare guidelines. Authorized health professionals will be able to
analyze aggregated data from many EHR and CHR systems to show which treatments yield the best
outcomes across larger populations and to reveal public health issues. (Data security and privacy must
still be protected, of course.)
Understanding Downtime Risk
For all these reasons and more, the exposure is considerable when the availability of mission-critical
clinical systems, including EHRs, is not adequately provided for.
“Availability,” as the term is used in information technology, describes the condition of IT systems,
components and/or networks functioning as expected when they are needed. This term is used
interchangeably with uptime. (A related term, “reliability,” refers to the technology and features that
According to Mark R. Anderson, CEO of AC Group, “One area of growing importance is technology
uptime when mission-critical clinical applications are deployed. Based on our research, if a system is
not available a minimum of 99.99 percent (four 9’s) of the time, healthcare organizations will not
consider the application reliable enough to use in the future.
“Based on our published study, Cost of Downtime, every ‘9’ below the 99.99 percent costs the average
300-bed hospital more than $3 million per year and over $1 million for the average 50-provider
practice,” said Anderson. 9
However, when the EHR is not supported by the right information technology infrastructure, sufficient
availability cannot be achieved without significant complexity, labor and expense. And the focus of
hospitals, group practices and physicians is on providing the best patient care, rather than on IT. The
EHRs That Make the Grade ⎯ 24/7 Availability Page 3
arrier can be prohibitive enough that healthcare providers of any size may be left dangerously
overexposed to downtime.
Availability Solutions for EHRs
With more than 300 installations in hospitals, clinics and physician practices worldwide, Stratus
Technologies provides award-winning availability hardware and software ready to support the EHR of
the 21 st century. From our Avance High Availability software to our continuous availability Stratus ®
ftServer ® systems, we offer solutions that maximize uptime for every budget. Reliability is built in so
that physicians and hospitals can stay focused on patient care.
Healthcare settings benefit from superior availability, operational simplicity and financial advantage
with every Stratus availability solution. The industry’s most effective, easiest-to-own uptime
protection makes an enormous impact on effectiveness ⎯ and can be had for a fraction of the cost of
the total EHR solution.
What’s more, Stratus provides maximum availability protection for a range of CCHIT Certified ®
(Certification Commission for Healthcare Information Technology) application solutions from
established EHR software providers.
Besides safeguarding the accessibility and integrity of EHRs during daily operation, Avance software
and ftServer systems can be integral to disaster recovery (DR) for electronically stored health data as
mandated by the Health Insurance Portability and Accountability Act (HIPAA).
High Availability with Avance Software
The maximum level of high availability is delivered by the most affordable solution on the market:
Avance. Easy-to-use and cost-effective, Avance is the software-driven availability solution that
delivers 99.99% uptime (less than one hour of downtime per year on average) using a pair of x86
servers. As a result, smaller group practices and individual physicians are able to afford to purchase
and maintain the uptime protection needed at the server level.
In contrast to other high-availability solutions, Avance High Availability is instant and automatic. No
special hardware or skills are required to set up the Avance solution. With a single click, the software
installs a high availability environment that immediately protects against the high costs of downtime,
data loss and reduced productivity.
The software’s predictive reliability features identify, isolate and report faults for rapid repair, while
full resource sharing enables the system to use unaffected components if a hardware or software error
is imminent. There is no need for onsite, specialized IT support because Avance can be monitored
remotely using a standard Web interface.
What’s more, virtualization is embedded in the Avance solution. Server virtualization can likewise
mean less computing hardware to buy, valuable office space reclaimed, lower costs for ongoing IT
upkeep and smaller electricity bills.
Dell Healthcare and Life Sciences and their top-tier solution providers feature Stratus Avance software
in exceptionally reliable EHR systems running on Dell servers.
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Stratus ® Stratus Avance software
® Avance software
Award-winning Availability Solutions
Stratus EHR Value Proposition
�Total �Total Availability �� �� Operational Simplicity �� �� Financial Advantage
High Availability: >99.99% uptime
�� InfoWorld Technology of the Year Award:
“Best HA Solution for SMBs
�� Partner XChange XCellence Award:
Award-Winning Stratus Solutions
Continuous Availability: >99.999% uptime
Stratus ® fault-tolerant ftServer ® Stratus systems
® fault-tolerant ftServer ® systems
�� InfoWorld Technology of the Year Award 2007, 2008
“Best Fault-Tolerant Platform”
The industry’s most effective high and continuous availability solutions have earned top honors.
Continuous Availability with ftServer Systems
Medical Grade ftServer systems build in Continuous Processing ® technology designed to assure
industry-leading uptime from the moment they are powered on. Since their introduction in 2002, the
average real-world performance of ftServer systems has exceeded the gold standard of 99.999%
uptime annually in installations that span the globe. That level of availability translates to less than
five minutes of unscheduled downtime per year. *
These fault-tolerant Intel ® processor-based servers are engineered with components that provide
automatic fault detection, “phone home” and dozens of other innovations that prevent downtime and
data loss. Standard Windows ® and Linux ® applications do not need any modifications to benefit from
Unlike standby servers, server clusters and other alternatives that minimize downtime through quick
recovery ⎯ and need a skilled operator to set up and maintain them ⎯ Stratus ftServer systems afford
uninterrupted operation. That means healthcare providers are able to keep uptime high and IT
ownership costs low.
Among the most highly regarded features of Stratus ftServer systems is their ActiveService
architecture, the unique combination of capabilities that enables built-in serviceability, self-monitoring
and diagnostics, proactive remote support and troubleshooting by service engineers.
Award-winning ftServer Active Upgrade technology ** in addition eliminates the planned downtime
that other servers impose while upgrades and enhancements to operating systems, service packs,
applications and system software are installed.
Premiere software providers and systems integrators sell and support Stratus ftServer systems to
provide comprehensive EHR systems that clinicians depend on with confidence. These include Perot
* Stratus Technologies Uptime Meter, http://www.stratus.com/uptime/index.htm
* * Currently for Windows Server ® operating environments only.
EHRs That Make the Grade ⎯ 24/7 Availability Page 5
Systems’ MEDITECH Solutions Group (formerly JJWild); Pulse Systems, Inc., developer of
Pulse Patient Relationship Management; and Sage Software Healthcare, Inc., provider of the Sage
Electronic, standardized medical records are poised to enable long-sought improvements to healthcare
delivery in America. To encourage prompt action by hospitals and doctors, the recently signed
economic stimulus package includes incentives as well as penalties.
Adopting EHRs places significant responsibilities on professional staff, however. While the IT
infrastructure and duties expand with an EHR system, the number of personnel attending to that
technology will likely remain the same. Every component of this IT-based clinical tool ⎯ including
the information technology infrastructure ⎯ should have sufficient robustness built in to enable
caregivers to focus on their mission. The result will lead to resilient EHR systems both clinicians and
patients can trust.
About Stratus Technologies
Stratus Technologies is a global solutions provider focused exclusively on helping its customers
achieve and sustain the availability of information systems that support their critical business
processes. Based upon its 29 years of expertise in server and services technology for continuous
availability, Stratus is a trusted solutions provider to customers in healthcare, life sciences,
manufacturing, telecommunications, financial services, public safety, transportation & logistics and
other industries. For more information, visit www.stratus.com/healthcare.
Stratus, ftServer and Continuous Processing are registered trademarks and the Stratus Technologies logo, ActiveService, Active Upgrade and
Uptime Meter are trademarks of Stratus Technologies Bermuda Ltd. CCHIT and CCHIT Certified are registered marks of the Certification
Commission for Healthcare Information Technology. Dell is a trademark of Dell Inc. Intel is a registered trademark of the Intel Corporation
in the United States and other countries. Windows and Windows Server are registered trademarks of Microsoft Corporation in the United
States and/or other countries. The registered trademark Linux is used pursuant to a sublicense from LMI, the exclusive licensee of Linus
Torvalds, owner of the mark on a worldwide basis. All other trademarks and registered trademarks are the property of their respective
1, 7 The Washington Post, ‘Wired’ Hospitals Post Lower Death, Complication Rates, January 27, 2009,
2 Advance for Health Information Professionals, Study: HIT Makes Hospitals Safer, February 11, 2009, http://healthinformation.advanceweb.com/Editorial/Content/editorial.aspx?CTIID=3167
3, 8 CNNMoney.com, Obama’s big idea: Digital health records, January 12, 2009,
4, 5 Majority Staff of the Committees on Energy and Commerce, Ways and Means, and Science and Technology, Title IV -
Health Information Technology for Economic and Clinical Health Act; Health Information Technology for Economic and
Clinical Health Act or HITECH Act, January 16, 2009, http://waysandmeans.house.gov/media/pdf/110/hit2.pdf
6 The National Academies, Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually; Report Offers
Comprehensive Strategies for Reducing Drug-Related Mistakes (news release), July 20, 2006,
9 Stratus Technologies, Stratus Medical Grade Servers Deliver 24/7 Online Information Access and Application Availability
(news release), February 19, 2008, http://www.stratus.com/news/2008/index.htm
X948 © 2009 Stratus Technologies Bermuda Ltd. All rights reserved.
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