Business Continuity Meets Digital Dictation

By Steven Bonney

Ensuring Business Continuity – a financial imperative

Business Continuity (BC) and Disaster Recovery (DR) Planning are business imperatives in the healthcare industry. In fact, a recent survey conducted by a leading industry analyst showed that the top three CIO initiatives were Data Security, Disaster Recovery and Server Consolidation. Disaster Recovery was the CIO’s top priority in 21% of the facilities surveyed – and deservedly so. While Data Security and Server Consolidation are key agenda items, a poor Disaster Recovery Plan can save a facility from going out of business – or not.

Maintaining satisfactory levels of Patient Care and ensuring timely and accurate payment for services rendered have always been atop the list of healthcare-facility business priorities. Because facilities generally operate on razor thin profit margins, the financial imperatives to ensure Business Continuity in healthcare are obvious. Facilities literally cannot afford downtime, especially sustained downtime. Unfortunately, most facilities are ill… prepared that is, when it comes to having a viable plan to ensure Business Continuity.

In the fall of 2007, BCPWHO surveyed over 1000 healthcare facilities to determine the level of preparedness, as well as understand how much time and money are being invested into creating adequate Plans. The conclusion was that across the nation Business Continuity Planning & Disaster Recovery Planning is not standard practice in Healthcare. 1

Some statistics from the research 2 :

• 45% have a Business Continuity Plan (BCP)
• 69% BCP and Emergency Management Program handled by the same group
• 62% have an IT Disaster Recovery Plan (DRP)
• 81% BCP and DRP by same group

With less than half of the facilities having a BC/DR Plan, and the majority of those either not investing heavily in their Plan or testing their Plan, it is no surprise that Joint Commission set new policy into effect after Katrina to ensure that facilities would Plan. Facilities need to prepare for Surge – any unexpected and dramatic increase in patient activity due to an abnormal occurrence in the facility’s area – because not preparing can create serious and sometimes unrecoverable circumstances. Surge can arise from a wide array of events stemming from Natural Events or Human Events, such as Bridge Collapse, Terrorist attack, Hurricane and Flood just to name a few.

Unplanned downtime – another reason to prepare

BCP/DRP are key steps in being equipped to handle Surge, but Surge is not the only reason to prepare. Technology Events (e.g. Server failure) happen far more frequently than catastrophic events and can significantly impact operations as well. These more common crises don’t cause an inordinate influx of patients, but do create Patient Care and Reimbursement challenges just the same.

As facilities prepare a Business Continuity Plan to minimize their exposure to these potential circumstances they often engage consultants, like Beacon Partners, to perform Business Impact Analysis (BIA). Performing a thorough BIA is a key step in determining what amount of downtime is tolerable for each application and function within the facility. The BIA clearly defines the impact to the facility in terms of providing care and obtaining reimbursement, among other things.

Liz Rockowitz – former Executive Director for University of Miami Medical Group and Hospitals – now Regional Manager of Beacon Partners, Inc says, “A thorough and complete BIA should be performed in all areas. Facilities need to understand what the Maximum Allowable Outage is that can be tolerated, by application.” Liz continued, “Facilities should be evaluating all systems and applications in every department – not just the obvious ones. Anything which enables the provision of care and payment for service needs assessing and serious consideration given to any technologies that move them toward 100% uptime.”

Consultants and industry pundits are speaking about ISV’s (Independent Software Vendors) that provide Healthcare IT solutions needing to meet the changing demands of the industry. Frank Nydam, who leads the Healthcare Vertical Industry practice at VMware adds, “VMware is empowering Healthcare ISV’s with a safe and proven platform for their clinical applications while providing a more flexible and highly available clinical infrastructure for the Healthcare provider community. BayScribe’s virtual appliance solution satisfies the demand for both on-premise and cloud based delivery solutions.”

Choices – Keys to building your DR plan

In Disaster Recovery planning, downtime is measured by two key metrics – RTO and RPO. Recovery Time Objectives (RTO ) defines how long the recovery process should take, from start to finish, before users can access their applications and begin working again. Recovery Point Objectives (RPO) defines how much data could be lost during the recovery process, if any. This is a critical element when determining how a system is to be backed up and evaluating what the failover strategy(s) may be, i.e. tape backup versus SANS/NAS versus RAID.

When creating a DR plan, the RTO for the Dictation and Transcription (D/T) systems is a serious consideration, as both Patient care and Reimbursement are impacted by downtime of these systems. Depending on the system design and the backup schedule, hundreds – even thousands – of dictations may have been authored from the last system back up.

Few D/T systems offer an affordable real-time failover option. If the primary system is destroyed, what would the total impact be? Excessive downtime would certainly impact Patient Care as surgeries may need rescheduling, treatment plans and test results delayed, etc. Reimbursements would, at a minimum, be delayed and potentially lost altogether if the data could not be recovered.

Where does that leave you? At a high level, facilities are faced with three choices: a) purchase enough hardware, no matter how duplicitous and expensive, for the recovery site to handle production capacity; b) implement technology that enables you to prepare without significant additional cost; or, c) choose not to prepare. Fortunately, the availability of web-based applications as well as advances in Virtualization technology is making it easier for facilities to prepare without enormous additional costs and without sacrificing performance.

Virtualization – a Disaster Recovery enabler

Virtualization technology is changing the face of BCP/DRP by making the replication of entire systems and mission critical applications more feasible and more cost effective. By not requiring dedicated servers for each and every application, resources can be distributed across the enterprise and backup systems replicated anywhere in the world. According to an industry analyst, more than 70% of VMware customers deploying disaster recovery are doing so for the first time. The main driver behind this move is the cost savings achieved by customers using virtualization for disaster recovery. 3

There are many benefits to virtualization technologies. Among them is additional flexibility and cost savings in the deployment of a disaster recovery solution. Simply put, virtualization can reduce the amount of hardware required at a disaster recovery site and simplify recovery operations. In many cases, using virtualization allows customers to implement disaster recovery solutions that would be cost prohibitive in non-virtual environments. 4

A new era in Digital Dictation – Virtual Dictation

When it comes to Dictation and Transcription (D/T) Systems, the Disaster Recovery challenges are rather straightforward. For years, D/T System architecture has been comprised of components – multiple servers, even a full rack of servers for very large systems – each performing its designated function, e.g. Voice Server, Voice Database Server, Text Server, Text Database Server, System Interface, etc. Because the systems are interdependent, when one of the components fails it is not unusual for the entire system to be down.

The ‘component-based architecture’ inherently limits the ability to create a viable DR Plan for D/T. The cost implications of creating an entire duplicate system are not feasible for most facilities to incur. The proprietary nature of these hardware-dependent systems further exacerbates DR planning challenges in that these systems are difficult, if not impossible, to run in a Virtual Server environment.

For all of these reasons terms such as Failover, Disaster Recovery & High Availability are not typically associated with D/T Systems.  

High Availability + Disaster Recovery = Business Continuity

Do you consider Dictation & Transcription systems mission-critical? Does your Business Continuity Plan include your D/T systems? If so, congratulations. While you are in the minority, you probably have implemented, or at least begun, a Disaster Recovery plan.

And if Dictation & Transcription is not in the Plan, why not?

What happens when your Dictation and Transcription systems are down? Does anyone really notice? Of course. Is restoring the system a priority? Absolutely, because patient care AND reimbursement are impacted by the Dictation and Transcription systems you rely upon.

You may not have known that there is a viable solution available – good news – there is! For the first time, ‘ports’ are no longer a factor in determining the capacity or scalability of the D/T system. For the first time, Voice Capture, Transcription and Document Delivery are available in a single solution – a Virtual Appliance – without any significant capital expense for proprietary hardware and without any ‘ports’, making High Availability and Disaster Recovery for D/T a reality.

By combining Virtual PBX technology with a 100% Browser-Based application running on VMware ESX(i) Virtual Servers, BayScribe provides limitless throughput, accessibility and redundancy. With BayScribe, ‘ports’ are determined by the amount of RAM and Processors allocated, not voice cards, allowing you to scale the system as needed – by work group, department or Enterprise – and replicate the system as needed… across town or across the country.

With BayScribe, we have eliminated the dependency on hardware, so you can have an entire duplicate system running on a separate server or cluster utilizing VMware’s powerful Infrastructure toolset, which includes Failover, Load Balancing and Backup & Recovery.

Summary

Business Continuity and Disaster Recovery planning are imperatives in sustaining adequate patient care and ensuring timely reimbursement. Virtualization technology, like VMware ESX and VI3, is a key enabler in BC/DR planning, as is performing a comprehensive BIA. BayScribe is the first D/T System to fully run on the proven architecture of VMware ESX(i) Server – the world leader in virtualization. Running BayScribe on VMware ESX Server affords you incredible performance advantages and ensures BC & DR is affordable.

And with BayScribe, you don’t have to sacrifice performance to get a viable DR Plan – you get them both! BayScribe will scale to meet the demands being placed on it at any given moment, without racks of hardware, making it ideal for any size facility. Competing systems would require hardware costing hundreds of thousands of dollars to approach the performance BayScribe achieves with just 1GB RAM and a single 2.3GHz processor without taking into account the costs of a competitor’s backup system.

BayScribe is easy-to-use, cost-effective, and you can literally download and deploy the application (VM) in hours – days, not weeks – months, and then deploy additional VM’s as needed, when needed and manage all of them across the enterprise with VMware Virtual Center. And because BayScribe’s not requiring additional proprietary hardware, you can make the world a little greener too.

BayScribe is a true Enterprise-Wide Solution for Dictation & Transcription and a key element in your BC & DR Plans. Remember, if you fail to plan, plan to fail. If you don’t think your D/T System is mission critical, just try turning it off. We know it is which is why it should be BayScribe on VMware!

References:

1,2 BCPWHO.org http://www.bcpwho.org/presentations/downloads/Track1SkinnerR024008@1pmEM.ppt

3,4 Disaster Recovery Virtualization, VMware White Paper, vmware.com
Disaster Recovery Virtualization: Protecting Production Systems Using VMware Virtual Infrastructure …