Last fall, a spate of major merger announcements between hospital systems in the United States was the latest charge in a broader trend of marriages between hospitals and healthcare systems across the country. Mergers in September alone included the following:
However, once executives finalize such a deal, the real work begins. Combinations such as these can cause headaches for the surviving entity left managing all of the patient data. And more importantly, it can create the potential for mix-ups in individual medical information, which can have serious patient-health repercussions:
By Henry Martinez, Senior VP of Engineering, Vision Solutions
Last fall, a spate of major merger announcements between hospital systems in the United States was the latest charge in a broader trend of marriages between hospitals and healthcare systems across the country. Mergers in September alone included the following:
- Anthem Blue Cross Vivity announced that it would combine 15 California hospitals from seven hospital systems, bringing competing hospitals under one umbrella.
- Advocate NorthShore Health Partners’ announcement brought together 16 hospitals and created the largest health system in Illinois.
- Vidant Health, Wake Forest Baptist and WakeMed announced they will form a shared services operating company for three North Carolina systems.
- The Puget Sound High-Value Network combination will bring together eight hospitals and 163 clinics under one network.
However, once executives finalize such a deal, the real work begins. Combinations such as these can cause headaches for the surviving entity left managing all of the patient data. And more importantly, it can create the potential for mix-ups in individual medical information, which can have serious patient-health repercussions:
“How do hospital systems manage huge amounts of patient data when they come together to form a new, combined and more complex healthcare entity?”
“What are the potential patient care implications when data starts moving between heterogeneous systems?”
“What compliance factors must be managed?”
“What is the business risk - reputational, financial, or both - to the new entity if something goes awry?”
The healthcare CIO or IT leader should be the person in the organization who can stand up and say, “I’ve got this.”
But effectively managing these strategically critical migrations requires health system IT administrators to have a firm understanding on how healthcare data is replicated, the distinctions between real-time and periodic data replication, and when to employ one method versus another. Having this kind of breadth of knowledge also can help IT leaders stay abreast of the latest technologies available, which can potentially reduce the complexity of most migrations.
Don’t Expect a Band-Aid Approach to Fix IT M&A Complexities
Whether it’s two hospitals or two hospital systems, merging healthcare organizations means bringing together multiple IT organizations. In healthcare, as in nearly every other business sector today, the IT landscape is undeniably complicated. Pervasive, around-the-clock delivery of services to end users depends heavily on interdependencies between technologies that, in many cases, IT organizations have only recently embraced.
Add the regulatory complexity of healthcare and the newer requirements of electronic health records (EHR) and you’ve got a recipe that can put the hospital’s CIO in critical condition.
For example, patient outcomes at FutureCare, a nursing and rehabilitation center operator located in Baltimore and Washington, D.C., depend on ready access to electronic health records (EHR). In addition, HIPAA and other regulations require companies like FutureCare to protect the availability of patient data.
FutureCare adopted a high-availability software solution that allowed it to continue data operations if its primary server became unavailable, unstable, or crashed entirely.
While not a merger scenario, there is a lot to learn from FutureCare’s experience in protecting healthcare data and applications. From downtime due to everything from hardware failures, disk crashes and lengthy system maintenance, high availability gives you the peace of mind that your data and applications always will be available.
So, if you’re the CIO at an acquiring healthcare facility, you’ll know that your data is protected when it comes time to integrate your acquisition target’s databases, and you’ll be equally comfortable that the new, incoming data is accessible when it’s all said and done.
And, of course, when healthcare organizations come together in a merger or acquisition, proximity becomes an issue, as both previously autonomous companies may have data across multiple locations and multiple data centers. With the exchange of such high volumes of data, this scenario only grows more complicated as more data is shared across geographically dispersed physical, virtual or cloud servers.
Today, hospitals and healthcare systems must be able to transition to new platforms quickly and deliver accurate and timely information for consumption by computer systems operated by users and partners. Whether it’s because of a merger or acquisition; or just from general business updates, inconsistent attention to data migration and protection will no longer suffice – the ad-hoc or like-system Band-Aid that is keeping your IT solutions together is limited and won’t prevent long-term damage.
This is where replication, the process of sharing information between multiple computing or storage devices (that can be used for migrations as well as for data availability and recovery), comes in. For the replication process to work, there must be parity between the primary and backup servers.
When hospital systems merge, replication provides the essential bridge between those systems and can help lower costs, increase efficiency and limit risk exposure before, during and after a merger.
Replication allows hospitals and healthcare systems to synchronize multiple decentralized servers. As a result, replication is particularly useful in distributed computing environments. Replicating data across multiple servers maintains data in a synchronized state. In the interest of optimizing bandwidth, replication engines designed for efficiency only copy data that has been changed since the data was previously replicated.
Replication software allows the acquiring hospital system to migrate entire computing environments from the acquired system’s data center to its own. By automating these processes, companies reduce the time involved and the amount of manpower required to perform a migration, thus reducing costs. Depending on how robust the migration solution, it can also virtually eliminate any downtime during the migration, which can ensure your physicians have nearly uninterrupted access to patient data and that your accounting teams can continually access billing and payment systems. In addition, high availability solutions enable the IT team to test and verify that the migration destination is up and running before switching everything over, which gives them a backup plan, if they incur regulatory or technical problems at the destination.
Replication also can dramatically reduce the likelihood of a prolonged outage caused by a major system or environmental disaster by maintaining an exact duplicate of a hospital’s production system on a backup machine – and this machine can be physical, virtual, in the cloud - or a hybrid of all three. Additionally, high availability and disaster recovery (HA/DR) functionality limits downtime during planned outages for system replication and data maintenance.
Once you’ve committed to the idea that migration is not a question of whether your facility or system needs replication procedures, but rather a question of how best to utilize this process when considering your evolving requirements, structure and marketplace for healthcare data today, your company will be better poised for M&A and overall business growth.
Periodic versus Real-Time Replication: When the Difference Could be a Life Saver
Due to changing healthcare technology – storing new HIPAA requirements, and reacting to the sheer volume of data moving across servers and implementing the increasing options for data input – hospitals must be mindful of how they keep up with the latest innovation while overseeing simultaneoius replication and data backup.
New technology and new regulations will require new thinking in order to avoid ensure compliance and avoid costly mistakes that could impact patient outcomes or the bottom line.
One example of that new thinking is a shift from periodic replication to real-time replication.
Periodic replication involves a source system, often referred to as a publisher, batching several transactions over the course of a defined time period and sharing that “increment” with the other target, or subscriber, at the end of the collection process.
If you’re confused, let me put it another way. “Are you comfortable with your physicians losing the last 15 minutes of diagnostic data on a critical patient?”
Probably not.
Multiple parties often access patient data simultaneously while a patient is at the facility, so it’s critical that all data entries, whether they are vital signs, medical imagery or a physician’s patient notes, are replicated to the remote database in the exact order in which they were entered - and, importantly, that all attending staff have immediate access to the data. By comparison, periodic replication is more suitable for environments where data rarely changes, when the publisher and subscriber do not need to remain synchronized or where networks cannot tolerate large amounts of data shipped over short intervals.
As a result, periodic replication is no longer a viable option in healthcare. The dangers that lurk around the delay in data transference can mean costly errors that’ll affect the quality and consistency of data, including patient records.
Instead, more companies are seeking out real-time replication solutions where data and system setting changes are replicated from the publisher to subscribers as soon as they occur.
The Pulse of the Industry
M&A shows no signs of slowdown for the healthcare industry. Now, organizations need to consider what will prepare them for transition – with exactly zero negative impacts on patient outcomes.
In addition, as more hospitals shift to cloud storage or computational resources, IT economics shift with them. As a result, it is more important than ever to have tools that can readily move data from physical to virtual, or cloud or back – without having to invest in new tools or training.
In conclusion, data replication can solve a host of computing challenges for hospitals and healthcare systems during or after a merger, improving efficiency and profitability while reducing the risks of data loss, which could result in tremendous financial and legal ramifications.
