Draft: August 7, 2008 - Stratus Technologies


Draft: August 7, 2008 - Stratus Technologies

Stratus in


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

EHRs That Make the Grade ⎯ 24/7 Availability Page 1

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

1.5M preventable

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

critical importance

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

provide availability.)

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.

EHRs That Make the Grade ⎯ 24/7 Availability Page 4

�� ��

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:

“Innovative Technology”

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

this functionality.

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

Intergy EHR.


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.

EHRs That Make the Grade ⎯ 24/7 Availability Page 6

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