1. Nevada Rural Hospital Partners Network Connectivity Overview 2010
Todd Radtke
Regional CIO – NRHP

2. About NRHP Established in 1987 14 Rural Nevada Community Hospitals
NRHP hosts shared applications and provides IT services
NSHE/SCS NevadaNet is our WAN and is critical to supporting our vision
Supporting member viability by implementing shared health information technology solutions

6. Information Management Components: Connectivity
Establish and maintain network security
Provide sufficient bandwidth and redundancy
Maintain control of access and usage
Manage wide area network (WAN)
Monitor and report network usage
Provide for backup and support

7. Information Management Components: Capability and Applications
Process Improvement
Integration, document management, PACS
Shared Radiology Archive
Long Term conversion to EMR
Maintain communications applications
Develop and maintain shared applications
Develop disaster recovery capabilities
Develop clinical applications
Expand telehealth applications

8. Current NRHP IT Services
Provide centralized I.T. expertise
Educate NRHP Board and member I.T. staff
Support IT decision-making re: integrated systems, electronic health records, and health information exchange
Maintain and support a secure Wide Area Network
Host member services
Host central software applications
Integrate members’ legacy software systems
Maintain and support a central electronic archive
Enhance/expand members’ PACS capability, teleradiology functionality, efficiency and support
Maintain relationships that enhance members’ connectivity
Manage the Universal Service Fund discounts for members
Provide I.T. leadership at the State level, helping to shape responses to rural needs
Manage I.T. grant-funded programs and reporting
Assist members with vendor negotiations
Manage NRHP’s I.T. vendor contracts and software licenses

9. Shared Applications that depend on NevadaNet
Hosted and shared calendaring
900 plus users
Spam management
Enhancements – shared calendars, webmail –
Shared HL7 integration
Over 1 million messages a month are processed
Reduces data entry of patient demographics into clinical applications ( lab and radiology )
Sharepoint sites
Risk Management, LiCON, Member CEOs and IT
Web Site Hosting
Hosted at powervps ( not on nevadanet )
Shared Credentialing application
Shared Risk Management
SGMS firewall reporting
Central PACS Archive – 450,000 studies to date
Primary PACS archive is hosted at Pennington with a plan to move to SCS data center
Secondary archive is located at NRHPs offices

10. DISRN Radiology Network

11. NRHP Tele-radiology Archive Overview

12. NRHP Network Connectivity

13. NRHP Network Overview
Redundant Sonicwall PRO3060s provide network security, including intrusion prevention, gateway anti-virus and content filtering services
All site to site traffic is secured IPSEC VPN
Hub ( NRHP and Archive locations ) and Spoke ( hospitals ) topology

15. WAN status
Current T-1s are not sufficient to handle our traffic – recommend 6-10 Mbps for tele-radiology and future applications.
Some sites have upgraded to dual T-1s
NRHP, WBRH, BCH and HGH
Sites that need additional bandwidth
SLMC, MGGH
Sites that need to install new T-1s to isolate from the bundled education circuits
PGH, NRMC, GCDMC
Battle Mountain 10mbps wireless connection to the fiber backbone with a T-1 as a backup is working well
NRHP will develop an infrastructure plan to increase bandwidth and provide redundant links – the issue is funding ( direct or grant )

16. Challenges
WAN - Single and dual T-1s with no out of band backup (DSL, alternate routing, etc)
QOS – priorities critical applications to maximize bandwidth
Lack of bandwidth
Cost of T lines a major barrier
Redundancy is critical to NRHPs ability to host clinical applications

17. Current Issues Last mile connectivity
Opt-E-man might be a solution, 10Mbps $700 per month per end, would need NSHE support / design - Can NSHE support this ?
QOS – at one time SCS proposed a MPLS layer to support QOS – is this still an option ?
Video scheduling – NRHP members require the ability to schedule telemedicine consults – Can we manage our own video calls ?
SCS support – 8x5 only, can members call circuit provider after hours ?

18. Current Projects
SLA with SCS to co-locate one rack at the data center – target July1 2010
Upgrade to 6Mbps at NRHP offices
Humboldt fiber upgrade
Caliente – offered 50M fiber – Need SCS support for video connectivity (T-1 or dry pair)
Reviewing Smith Valley clinic connectivity – possible T-1 to Yerington network

19. Grants update
BTOP
NRHP is involved with 3 applications
NSHE – fiber access points Hwy50 and I80
NHA – fiber network, data centers and shared EMR
DOIT – microwave build-out and last mile
NRHP also has a request into senator Reid for IT infrastructure upgrades including routers, LAN equipment, PCs, servers and additional video equipment

20. Conclusions Expand NRHP members network infrastructure:
Statewide broadband communications will allow healthcare organizations to access and exchange information rapidly. NRHP and SCS have been working to expand the NevadaNet infrastructure and provide a quality of service level to healthcare data
Expand hospital health information system capabilities:
Expand the use of HIT within hospitals to enhance the capture and storage of complete patient health information electronically in a uniform manner. Member hospitals utilize electronic information systems but need to focus on eliminating the paper records and providing access to the electronic data that they do have. The data being captured is frequently fragmented in disparate systems throughout the hospital.
Enhance the use of EMR systems in community-based practices
In order for patient health information to be useful, it must be captured electronically at the point of care.

21. Wrap UP ! NRHPs mission to support members depends on NevadaNet !
Co-locating shared applications to SCS and resolving last mile issues is a top priority
Redundancy is still a concern –
DSL or other broadband would require NAT re-design
Alternate routing via link to nearby facilities
Off NevadaNet options – MPLS cloud, etc