Choosing an ASP Versus Hosting Ourselves

By Cliff Robertson, MD, Franciscan Health System, Tacoma, Washington

Franciscan Health System, one of the largest Catholic, not-for-profit healthcare systems in the country wanted to implement Web based products that would connect our community of physicians, three hospitals with a combined 536 beds, a nursing home, a primary care clinic network and variety of other services in the south Puget Sound Region of Washington state. Once we decided on the set of applications and on the vendor we had yet another decision to make—did we want to host the data ourselves, have the vendor host it, or hire a third party? After much research we found it was much more economical, and an overall better management decision to have the vendor be our ASP.

Advantages of having an ASP
There are many advantages to having an ASP host your data including, the level of security as both physical and network security is improved by leveraging the ASP's infrastructure; technology, as there is a significant cost savings from not needing an additional investment in hardware, communications infrastructure, and expertise to administer products and maintain servers; and the management of the data as ASP vendors will help you meet HIPAA requirements for security, backup, and disaster recovery. These are all important things to consider when determining your budget, staff and resources for hosting the data or for choosing an ASP.

Security
An ASP should have on-site security that is provided 24X7 and includes closed-circuit cameras, secure-card key access, biometric scanners, mantraps and alarmed doors. Security personnel also monitor the center and manage the locking cabinets and cages in addition to building and environmental alarms that are monitored 24x7 by staff. The cost of putting this kind of security in place within our community- well you can imagine.

Power Outage Protection
The ASP hosting center should have Uninterruptible Power Supply (UPS) systems. UPS systems receive power from both the commercial power utility and in-house standby generators. Each UPS system provides redundant power distribution units (PDUs) with multiple standby generators available to provide power to the center within one minute of a commercial power outage. The one-minute gap is covered by the UPS battery system to ensure that no impact on equipment is experienced. During an extended commercial power outage, the diesel generators provide power using the fuel stored on site. The center has a multiple-day fuel supply with guaranteed contracts for fuel delivery if needed.

Fire Prevention
Fire suppression in an ASP's center should be achieved through a pre-action dry pipe system, in addition to state-of-the-art VESDA (air sampling) smoke detection systems. VESDA systems are 100 times more sensitive than conventional fire detection systems. Detectors are grouped into different zones. When one or more detectors detect smoke, the fire alarm panel opens the deluge valve to fill the sprinkler piping with water. In case of fire, the seal on the sprinkler heads must melt due to high heat and only then discharge water in only the affected area. Water will not be discharged in unaffected areas thus preventing damage to equipment and services in different zones.

Temperature Control
Chiller plants are also in an N+1 design. Multiple Computer Room Air Conditioning (CRAC) units providing air conditioning are strategically located to deliver lower temperature conditioned air to maintain a room temperature of 72°F. The Data Center is optimized specifically to provide an enterprise-class web, data, and applications server-hosting environment. The Data Center is protected from intrusion and failure by multi-layered security, fail-safe redundancy, diversity measures, and rapid response recovery measures.

Technology
Another factor to consider is the hardware and technology that is put in place to house and move the data.

Managed Storage for High Performance and Disaster Recovery
Managing the storage of the data can be effectively done by using redundant storage mechanisms and SnapMirror technology. Storage mechanisms will allow the applications and their data to run two to three times faster due to improved throughput, in addition to minimizing any potential downtime and having instant File-System Recovery. SnapMirror technology makes the information available in two locations so that in the event that a disaster makes the information in one location unavailable, servers in the other geographically remote location can be configured to continue to deliver your hosted customers.

Application data is stored securely on robust high-speed disk subsystems and is mirrored to provide minimal data loss should failure occur; additionally, data is backed up regularly and stored offsite.

In order to manage the data 24x7 there is software that can be implemented. This software monitors key services and protocols—such as HTTP (Web), SMTP (email) which can be "probed" at five-minute intervals. If the software finds they are unavailable, then a support team can be notified and immediately addresses the issue.

Optional Redundant Servers and Clustering
For customers who demand the highest availability, some ASPs will provide redundant servers and clustering. The clustering provides load balancing between the two servers, and also provides fail over should one server experience a hardware or software failure.

Summary
Franciscan choose the ASP route as our hosting solution as we, like all organizations we are interested in lowering costs, improving security, enhancing performance and meeting HIPAA requirements for security—and this was the most economical and timely solution.

Our ASP handles all administration services such as adding and removing users, configuration, and monitoring to keep the application running smoothly eliminating the significant labor cost for personal that specialize in particular areas. Our ASP guarantees application uptime and removes the potential IT headaches associated with disaster recovery. We are provided with all the necessary hardware, maintenance, Internet bandwidth, and data backup services for peak performance and the application data is stored securely on robust high-speed disk subsystems and is mirrored to provide minimal data loss should failure occur; additionally, data is backed up regularly and stored offsite.

Now physicians can retrieve all types of Clinical Messages (lab and radiology reports, transcriptions, emergency room information etc.) and perform automated workflow through any standard Web browser, even from home.

Cliff Robertson, M.D. is a part time practicing physician and is the president and chief medical officer for the Franciscan Medical, a 59-member physician practice, which is part of the Franciscan Health System in Tacoma, Washington. Dr. Robertson oversaw the organization and formation of FMG in November 1998–April 1999. The ASP referred to above is Axolotl Corp. For more information email crobertson@franciscan-mg.org