Managing the Right Network Infrastructure in Support of Electronic Health Record

Electronic Health Record (EHR) is heralded as the solution for improving the quality of patient care, in addition to enhancing provider effectiveness and lowering costs.  The new Health Information Technology for Economic and Clinical Health (HITECH) Act was implemented in 2009, and was designed to overcome economic barriers to EHR adoption by providing incentive payments to healthcare organizations, enabling such adoption. 

The approach that a healthcare organization takes to the implementation of an EHR solution will translate into how successful the outcome is. With many elements to manage, a comprehensive plan that addresses all potential challenges, and supporting strategic partnerships, become crucial to the success of the implementation.  

The Challenge: 

With a multi-site EHR deployment, as the case is with a distributed medical group or independent physician association (IPA), a critical consideration is the deployment and ongoing management of a sound wide area network (WAN) infrastructure. Whether the healthcare organization decides to deploy an on-premise or a cloud-based EHR solution that leverages a hosted service, the challenge of deploying and managing the network infrastructure and the associated underlying carriers can prove immensely challenging.

First, there is the decision of selecting a private network infrastructure, or leveraging a public Internet connection, while observing the security requirements established by the Health Insurance Portability and Accountability Act (HIPAA). Many organizations opt to leverage a virtual private network across an Internet connection, to avoid the complexity and cost associated with building and supporting a private network.

Second, there is the sizing of the network, to ensure the quality of the connection. With EHR representing not one but multiple applications (scheduling, patient records, etc.) requiring near-real-time access, medical organizations must ensure adequately-sized and symmetrically configured connections, which tends to drive the cost of those connections up.  

Third, there is the selection of the underlying carrier. Considering the importance of a site’s access to the hub (whether it’s the hosted service provider’s data center or the organization’s own data center), the quality of the carrier’s network is crucial to ensuring a successful implementation, which tends to also drive up the cost of the implementation. Despite the ubiquity of inexpensive and high-bandwidth broadband solutions, those solutions and associated providers do not offer satisfactory Service Level Agreements (SLAs), or tend to leverage network oversubscription, which in turn drives down the quality, thereby jeopardizing the customer experience.  

Once the right carriers and solution are selected, with limited resources and no off-the-shelf tools, healthcare organizations face the challenge of implementing, and controlling their services, connectivity spend and inventory. Many struggle to manage the carriers on their own, with inadequate tools, if any. In order to enable multiple practices and physician offices, they might settle for dealing with carriers directly, and accept the painful results:

• Lack of visibility or control of inventory, even for the most organized IT departments 
• No or limited aggregate buying power 
• Multiple numbers to call for service or support, and hours wasted on-hold 
• Lack of expertise in managing service delivery, and being subject to poor practices by the carriers 
• No clear or consolidated billing; often receiving a stack of unclear invoices laden with errors 

The Solution: TMaaS™ 

With a documented track record supporting IPAs like Muir Medical Group IPA (MMG), and Independent Physicians of El Camino Hospital (IPECH), vCom Solutions has revolutionized the way these companies manage the implementation and ongoing support of the telecommunication environment to support electronic healthcare records. Having pioneered and refined Telecom Management as a Service (TMaaS™), vCom is helping customers like MMG and IPECH regain control over their expenses, achieve greater visibility, and ultimately save money. 

vCom offers a complete suite of cloud-based Telecom Management software tools, complemented by a full portfolio of Professional Services, guiding customers through a complete process of Telecom Lifecycle-Management (TLM™).  This includes Carrier Selection, Procurement, Project Management, Technical Support, Bill Consolidation and Cost Allocation of all connectivity services.

The Pioneer and the Early Adopter

As a pioneer of EHR integration in Northern California, MMG partnered with vCom in 2007 to implement and roll out the network infrastructure to support its initiative. A group of early adopters, eager to test the selected hosted EHR platform, helped MMG’s management team iron out all the challenges of building a model that could be replicated across the entire 560-physician-member medical group. vCom worked with MMG’s project team, as well as its IT support organizations (software manufacturer, hosting service provider, application support team and hardware support consultants), to test multiple provider networks, and verify hardware configuration to support an optimal implementation. 

With over 60 physician practices underway and 20 more slated for 2010, the MMG-vCom team has rendered the implementation process to a “cookie-cutter” exercise, streamlining the service delivery and ongoing management of the network infrastructure on which MMG’s reliable EHR platform runs. 

Having refined the roll-out process with Muir Medical Group, vCom was able to replicate the model, with minor changes, to early EHR adopter, IPECH, who was founded with the mission and purpose of promoting physician independence and success through electronic clinical integration and efficient practice. Similar results ensued, with 35 physicians on board, and 20 more slated for 2010.

The Formula 

Step 1: Sourcing

With a carrier agnostic approach, and a focus on reliability, vCom is able to source from over a dozen of Tier 1 and Tier 2 ISPs, and offer medical groups like MMG or IPECH an important value proposition: a reliable carrier network with a robust SLA. Leveraging the buying power of all its clients, vCom is able to obtain significant savings without a compromise in quality, thereby providing the physician practices peace of mind, at a significantly reduced cost. For additional simplification, vCom is able to bundle standard hardware that meets the medical group’s requirements for security software support and functionality. For additional fault tolerance, vCom is also able to leverage technologies like ADSL, Cable or EV-DO, to provide backup Internet connectivity, in the case of a primary circuit failure.

Step 2: Deployment

In order to ensure the ability to replicate the success of each implementation, vCom assigns a dedicated team of Installation Coordinators and Implementation Engineers to manage the order and deployment process of carrier services. vCom’s installation team works with the Medical Group’s project team and IT support vendors to ensure a successful outcome and seamless implementation for the physician practices.

Step 3: Management

Installations can be managed and coordinated with the various vendors by leveraging vCom‘s vManager platform.  Trouble tickets, account inquiries or change requests across all offices, services and carriers can be opened and tracked easily.  vCom’s technical support engineers work with the Medical Group’s  staff to ensure expeditious trouble resolution.

Step 4: Billing Consolidation 

Not only does vManager act as a centralized view of all inventory and associated orders and tickets; it also offers a consolidated view of all billing across all offices and carriers. It provides extensive spend analysis reporting, affording the Medical Group visibility into telecom cost.  The result is: a single invoice and secure portal to manage telecom spend across multiple carriers and locations.

The Outcome 

The feedback from MMG and IPECH speaks to the quality of vCom’s performance, and expertise in enabling medical groups with the design, implementation, and ongoing management of a robust network infrastructure to support Electronic Health Record.

“vCom has worked with our project teams on implementation, production support, upgrades, router repairs, moves & relocations, invoice questions and growth,” said MMG’s CIO, Tina Buop. In addition, our account team has arranged for executive review of our joint workflow processes on a semi-annual basis. We are very pleased with their performance and follow-through.”

IPECH’s Executive Director, Kent Madsen, said: “Great team; great project management and communication.”  

Muir Medical Group IPA, Inc. is a panel of over 560 primary care physicians and specialists with offices throughout Contra Costa and portions of southern Solano and southern Alameda counties.  As a leading provider of innovative physician and patient technologies, MMG assists independent physicians with the automation of their practice and clinical operations which serve patients located throughout the San Francisco Bay Area.

About IPECH

IPECH is independent physicians cooperative in Silicon Valley, affiliated with El Camino Hospital in both Mountain View and Los Gatos, and dedicated to providing efficient, high quality care for our patients and their families. IPEC believes independent physicians are particularly well suited to providing direct, personalized healthcare—and that patients thrive when they can choose their own physicians and collaborate with them fully.  IPEC also believes independent physicians who are close to all aspects of their day to day practice are in the best position to deliver on the promise of these goals.

 About vCom Solutions

vCom Solutions is revolutionizing the way that multi-site companies manage their telecom environment. Having pioneered and refined Telecom Management as a Service (TMaaS™), vCom is helping Enterprise customers regain control over their expenses, achieve greater visibility, and ultimately save money.

vCom offers a complete suite of cloud-based Telecom Management software tools, complemented by a full portfolio of Professional Services, guiding customers through a complete Telecom Lifecycle-Management (TLM™) process.  That includes Carrier Selection, Procurement, Project Management, Technical Support, Bill Consolidation and Cost Allocation of all communication services.