Speeding Up and Scaling Healthcare IT with Hyperconvergence

Delivering quality healthcare in rural communities can be a challenge. Often, patients must travel to urban facilities to see a specialist. At Phelps Memorial Health Center, we believe in bringing medical care to patients close to home. Our 25-bed critical access hospital opened its doors in 1968 and currently employs approximately 275 healthcare professionals and nearly 100 contract staff.

Phelps Memorial is located in Holdrege, Nebraska, a small community that occupies less than five square miles and is home to nearly 6,000 people. We're an hour north of the Kansas border and a two-and-a-half-hour drive from our state capital in Lincoln. On any given day, we serve patients from within a 100-mile radius. Multiple times a month, we fly in surgical specialists from Colorado to serve the regional population. In addition, more than 35 specialists from across the state of Nebraska hold outreach clinics at our facility to serve our patients and keep them close to home. 

IT plays a huge role at Phelps Memorial Health Center. We use technology to provide the best possible care to our patients, and we are always looking for ways to do more. To give one example, we relaunched our website a few weeks ago to make it easier for patients to download forms, access their medical records, and pay their bills online.

Staying on top of the latest tools and technologies means investing in upgrading our infrastructure, and that requires us to think big while staying small. I've been with the hospital for seven years, and when I started, there were four of us on our IT team. Everyone on our team wore multiple hats. Two of us handled the big picture and infrastructure, one of us took care of our desktops and hardware, and the fourth member of our group assisted with maintaining our MEDITECH EHR. We all provided end-user support. Shortly after I began, we were running 100 concurrent VDIs and are now up to 300 (400 overall VDI desktops), but our team hasn’t tripled in size. Now in 2019, our IT team still consists of four people and our responsibilities have grown significantly over the last seven years. 

Early Adopters of Hyperconvergence

Phelps Memorial was an early adopter of hyperconverged infrastructure (HCI), thanks to our IT Director, Andy Van Campen. In 2012, just after I came on board, we took our first steps into the world of hyperconvergence. We replaced a portion of our aging Dell PowerEdge VMware ESX servers and EMC VNX 5300 SAN with SimpliVity OmniCube CN-3000 hyperconverged appliances.
 

We immediately saw the benefits of moving a portion of our traditional infrastructure to HCI. SimpliVity was not only easier to manage and scale than our previous solution, but it was also far more affordable. Here was a perfect storm of quality and cost.

Our next step was replacing our VMware vBlock 100 VDI cabinet with a hybrid SimpliVity/Lenovo system. Our setup consisted of dual SimpliVity/Lenovo x3650s and dual Dell compute nodes with mechanical hard drives at our production data center and disaster recovery site. Unfortunately, the experience was far from satisfactory. 

Troubles with Our Hybrid HCI Solution

After a couple of months, we started having problems with the Lenovo servers. Firmware issues resulted in boot times of 20 minutes or more, and then we started losing drives. At one point over the 2017 Thanksgiving weekend, two of the Lenovo servers at our production VDI environment failed. I worked with SimpliVity's tech support to perform a failover.
 

The process was somewhat strained. HPE had acquired SimpliVity earlier that year. The two companies were still in the process of integrating their operations, and the support team was short-staffed during the holiday. Still, we managed to pull through.
 

We reconfigured our VDI pools and ran them off our DR site. The process took roughly five hours because of the limitations of the Lenovo servers. SimpliVity's backup of our VDI parents saved the day, but it was clear that we needed to move up to fully hyperconverged infrastructure with solid-state storage.

The Grass Isn’t Always Greener

By 2018, we were ready for another upgrade. We needed more capacity and storage for Phelps Memorial's internal needs, but we were also running MEDITECH EHRs for two other hospitals in the region. After six years of using SimpliVity, we wanted to see what else was out there.
 

In the past, we looked at Cisco HyperFlex and Dell EMC VxRail, but neither of these platforms offered the flexibility, scalability, or the cost-effectiveness of HPE SimpliVity. The best solution was staying with our existing supplier but moving from hybrid SimpliVity/Lenovo equipment to all-flash HPE SimpliVity Gen9 and Gen10 clusters.
 

The difference was immediate and apparent. Our applications ran faster, and we had more storage capacity than we could use. VDI usage with VMware Horizon View tripled from 100 to 300 concurrent desktops at peak hours, and we can now recompose large linked clone pools during business hours in half an hour instead of 90 minutes—that’s three times faster.
 

In 2019, we continued our upgrades by adding two more HPE Gen10 pairs to our production and DR environments. I then migrated 90% of everything, except our EHR from our Dell EMC vBlock 540/XtremIO environment. Unfortunately, MEDITECH does not yet support HPE SimpliVity, this is one of the roadblocks to adopting a 100% hyperconverged solution at Phelps Memorial.

A New World

Now that I've given you a picture of what things look like behind the scenes, let me tell you about some of the exciting improvements our staff are seeing from a user perspective. As you know, patient confidentiality and cybersecurity are two of the biggest concerns in healthcare. That means we must limit access to our EHR, diagnostic imaging databases, and billing systems, among other things.

One of the ways we do this is through password management. In the past, our personnel had to input their login credentials every time they accessed one of our systems and potentially remembering three or four passwords to access different platforms. Now, everything goes through Imprivata OneSign.
 

Instead of typing their passwords dozens of times every day, they log in at the start of their shift and then tap their badge at any HP Zero client in the hospital when they have to access the system again in seconds. This new technology also frees them from having to enter their credentials as they move from one part of the hospital to the next.
 

We've also started using Nuance Dragon Medical dictation instead of having transcriptionists on staff. Previously, our providers would record voice notes to dictation recorder or make a call into the system. These were then uploaded to one of our servers. Our contracted transcriptions would then log in remotely and start transcribing everything. There was often a delay while we waited for them to finish their work.
 

Now, our medical staff can go to the physicians’ lounge after they finish their rounds in the morning and dictate their notes into a Dragon PowerMic microphone. They also have the option to use their cell phone (Dragon Mobile) for off-site dictation. Although the process isn’t totally perfected, it's faster and more secure than working with transcriptions.

The Foundation of Our Work

Our IT Director, Andy, emphasizes that IT is one of the foundations to our ability to deliver exceptional quality and compassionate care at Phelps Memorial. With the right hyperconverged infrastructure in place, we can continue to bring in these new technologies that enable our healthcare professionals to provide the best care to the patients we serve.

As I look at the future, I can see a day when everything at Phelps Memorial runs on hyperconverged infrastructure. In seven years, we've gone from two HPE SimpliVity nodes to 19, and I'm happy that we've migrated everything we can to the platform.

Our systems are faster, easier to manage, and we have plenty of room to grow. We can rest easy knowing we've given our IT, medical, and support teams everything they need to provide exemplary care to our patients.