The infrastructure challenges created by the drive to achieve meaningful use of electronic medical records can be substantial, even for a relatively small facility. Take, for example, York Hospital , a 79-bed hospital in southeastern Maine, where moving toward meaningful use has resulted in a more-than-meaningful jump in infrastructure.

Kevin Foster, the network administrator for York Hospital’s patient information systems department, told me recently that the hospital has seen a spike in its in-house data center hardware. In 2009, the hospital standardized on McKesson’s Paragon software as its primary patient information system. “Over the course of the last year, we’ve been in the process of upgrading those systems to the latest versions to accommodate meaningful use requirements,” Foster said. “As far as the infrastructure goes, those applications have required a significant hardware increase.”

Foster explained that the hospital has replaced close to 60 percent of its servers since 2009. “We only have a handful of legacy servers that are over 5 or 6 years old running,” he told me. “That’s been a pretty positive move.” But the number of new servers required has also grown quickly, as new software has been added and the rollout has moved forward. To manage the expanding fleet, Foster said that York Hospital has begun to deploy VMware virtualization to consolidate servers.

Currently, the hospital’s servers are about 15 percent virtualized, but Foster said the goal is to reach 60 to 70 percent virtualization of server workloads. “Obviously, we look at things like extremely intense SQL Server sols, fax servers, and anything else with modems as not going to virtualization,” he said.

Foster also said that there are a number of legacy applications that won’t work in a virtual environment. He hopes that in the next two to three years, those applications will be phased out, as their data is migrated to virtualization-friendly software.

One barrier to pushing virtualization forward is software vendor support. But Foster told me that’s quickly changing. “[We] still have some applications from McKesson that aren’t officially supported on virtual servers,” he said. That means the vendor will only help troubleshoot a problem if it occurs on physical servers. “That’s been an ongoing battle with them,” he said. “But luckily, over the past year, they’ve started to approve virtualization (on more apps) and see the light, as it were. They’re running this in their own labs and seeing it work, so there’s no reason that their customers can’t run the applications on virtual servers.”

When it comes to storage, the impact is even more significant: Foster said that since the implementation of York’s electronic health records system, storage requirements are up nearly 500 percent. “Right now, we’re running about 96 terabytes of tier-one storage, whereas this time two years ago, we were probably at 20 terabytes,” he said. “And we’re just looking at adding more. For the next release of the Paragon software (to meet meaningful use requirements), they’re telling us that the audit log we’re going to have to maintain is upwards of 1terabyte a month of data change, and that we’re going to have to potentially retain for upwards of 7 years. It has us freaked out a little bit right now.”

originally posted by me on Virtual Integrated System Blog.