Technology solutions promise to minimize administrative tasks and maximize time, but how can healthcare organizations implement the latest solutions in the most economically judicious manner? Lamprey Health Care, New Hampshire's largest and oldest community health center, surmounted this challenge when it sought to implement 'anytime, anywhere' secure remote access for its physicians.
Lamprey Health Care is a federally qualified, nonprofit ambulatory health center. Administering 17,000 patients a year for more than 65,000 visits requires significant administration for the center's medical providers. To help manage patient charting and provide caregivers with the flexibility to access critical patient information remotely, Lamprey needed a cost-effective system that would simplify their caregivers' workload without straining its already tight IT budget.
Lamprey had a head start through its implementation of Logician[R], an electronic medical record system that tracks patient information from inside the center. But the charting procedure often extended the workday, keeping providers at the office beyond their patient-related duties. This translated to a costly and inefficient use of time.
Lamprey's next step seemed clear: By enabling remote access to Logician, providers could complete their responsibilities from home, limiting hours spent at the center for administrative tasks and enabling physicians to retrieve patient information whenever needed.
But implementing such a strategy introduced a nest of difficulties: How to manage deployment costs? How to handle support for physicians' home computers, each with a range of software and hardware configurations? How to ensure the security of patient information for HIPAA compliance?
VPN Trial
Debbie Bonnell, Lamprey's IT research and development coordinator and HIPAA compliance officer, recognized the benefits that 'anytime, anywhere' access to information would bring, but needed a simplified approach that could provide access to the center's resources without requiring support for every remote computer.
'We needed a cost-effective, easy-to-use solution that didn't require touching the remote PC,' she says. 'We were also leery of adding overhead and complexity to our existing network. Of course, we needed to ensure privacy of patient information over the Internet.'
Bonnell and her staff initially implemented a trial that called for extending the IPSEC virtual private network (VPN) already in place among the five branch facilities. Several caregivers were given VPN clients for their home PCs with which to access Logician through the center's Citrix Metaframe servers.
But installing VPN client software into each remote computer proved a difficult task. Hardware and software complexities and the need for ongoing maintenance introduced new hurdles. 'Our experiment with VPNs to caregivers' homes fell short of our expectations,' says Bonnell. 'For one thing, our IT budget couldn't stretch to support each remote user. VPN client installation, upgrading the PCs and training end users required resources we didn't have. We also needed a solution that would easily fit into any number of PC configurations. That wasn't possible with the VPN client.'
Lamprey's providers are focused on providing the best patient care possible, and Bonnell saw that initiating a VPN, including client configuration, installing service packs, and making the proper connection choices in the VPN client itself created difficulty for caregivers, many of whom were not technologically savvy.
'There were user-driven drawbacks to our VPN experiment,' Bonnell says. 'Initiating a VPN was not as easy as just launching a browser, while performance of the application itself over the VPN was not very good. Our solution had to be extremely fast and virtually transparent to the end user.'
Moving to the Internet
Not satisfied, Bonnell and her team attended a local seminar on remote access alternatives where they discovered the Netilla Service Platform from Netilla Networks, based in Somerset, NJ. The Netilla Service Platform promised to reduce IT maintenance and administration costs through secure, easy-to-use, browser-based access to applications and data.
The single appliance solution is installed in the main network and connects to the application servers already in place. Because the platform utilizes 128-bit encryption built into every modern browser and employs VeriSign digital certificate security, users do not configure anything on their local computers. By relying on a secure Web browser, VPN client issues are eliminated entirely. Access to Lamprey's network would be available for authorized users from any location, not limited to machines with pre-configured software.
'What sparked our interest initially was the simplicity at the user's end,' says Bonnell. 'Users just launch a Web browser and enter the URL of the Netilla platform. It meant if they could connect to the Internet, they could access Logician and we wouldn't need to touch their computers.'
Bonnell subsequently implemented a 30-day evaluation. 'We wanted to see how well users would follow the set-up directions. Seeing them connect with relative ease was a major plus.'
Equally important for Bonnell was the ease of the platform's maintenance, which meant less IT support for her department. 'The maintenance requirements for such a sophisticated technology are surprisingly low. The platform itself installed in a few hours and there was no software to install onto our existing network. We didn't even need to bring the network down. It was quite seamless.'
Bonnell says application performance over the Internet is 'surprisingly fast and better than the VPN.' This is mainly because the overhead of an IPSEC VPN is bandwidth intensive, which can translate into poor application presentation over the Internet.
As Lamprey's HIPAA compliance officer, Bonnell was also concerned about security and privacy as decision-making considerations. 'Netilla's Web-based solution offered us all the security features we needed to meet HIPAA compliance, including session encryption and authentication by digital certificate.' In fact, adding digital certification meant it was even more secure than the VPN,' Bonnell says.
Charting Benefits
The benefits of secure remote access have led to a real improvement in the center's productivity. The Netilla Service Platform offers Lamprey caregivers the latitude to spend more time at home. Now physicians can spend their in-clinic time focused on patient care, not administrative duties. Using this solution, Lamprey estimates each caregiver has saved at least eight hours of in-clinic time per week, conservatively estimating up to 30 percent improvement in efficiency. Not bad for a solution that saves money without straining IT staff and budget, Bonnell says.
Caregivers themselves also were pleased. 'Being able to access patient charts whenever I need to is a tremendous time-saving convenience,' says Dr. Karen Brainard of Lamprey Health Care. 'The Netilla Service Platform is a resource I find myself using every day.'
Bonnell believes this solution has enhanced Lamprey's potential to attract top-flight physicians for future recruitments, including clinicians with young families.
'We offer the flexibility to maintain records and charts at the discretion of our providers, letting them focus on patient care. That in itself creates a very attractive benefit of working for Lamprey.'
SOURCE Debbie Bonnell IT Research and Development Coordinator HIPAA Compliance Officer Lamprey Health Care Newmarket, NH dbonnell@lampreyhealth.org PRODUCT/COMPANY Netilla Service Platform Netilla Networks Somerset, NJ www.netilla.com
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