Load balancing for mission-critical EHR systems

HITECH compliance

In the US, although the transition was not overnight, the use of EHR has become much more widespread since the passage of the HITECH Act signed into law in February 2009, with adoption rates increasing three to nine-fold depending on the practice setting.

The Act requires the adoption and ‘meaningful use’ of electronic health records (EHR) technology by US-based healthcare providers. ‘Meaningful use’ means that healthcare providers need to demonstrate their commitment to using EHR in a way that can be measured in both quantity and quality.

Data protection and GDPR

In the UK, the Data Protection Act (DPA) and GDPR mean that patient records must similarly be safeguarded.

It is therefore imperative that patient records remain stable and secure to avoid data loss, and ensure high availability.

Using load balancing to protect EHR

Deploying a load balancer makes critical EHR applications stable and highly available – ultimately improving the quality of patient care.

Implementing a load balancing solution in front of an EHR system:

• Ensures reliable access to critical systems for physicians and caregivers
• Helps increase the IT staff’s efficiency
• Can introduce a complementary layer of security
• Supports health centers in provision of an ‘always available’ application environment.

By dynamically interrogating key server elements such as the number of concurrent connections and CPU/memory utilization, intelligent load balancing algorithms mean that load balancers distribute and direct users to the best performing, accessible servers, thus avoiding server bottlenecks and application failure. This ensures EHR applications are available and always running at optimum performance, ensuring instant access to data for clinicians and patients.

In the event of a server failure, application inaccessibility, or scheduled maintenance, a load balancer can take that server offline, while automatically rerouting users to other healthy and functioning servers. By managing the traffic to EHR systems, a load balancer helps avoid system outages and downtime – essential for every healthcare setup delivering 24/7 patient care. Moreover, installing advanced load balancers provide SSL acceleration, thereby dramatically increasing the performance of EHR applications, while decreasing the time and costs involved, and further enhancing the overall user experience.

How can load balancing optimize EHR?

To find out how Loadbalancer.org helped a US government healthcare institution achieve interoperability across its multi-site IT infrastructure, while also getting the most from its critical Electronic Healthcare Records solution, take a look at this Meditech deployment guide.

What interoperability challenges exist in healthcare?

Healthcare interoperability allows applications, databases, and other computer systems to connect, communicate and exchange information with one another readily, even if they are built on different platforms by different vendors.

It is one of the most important pillars of any healthcare IT ecosystem, as care needs to be coordinated across different settings, with access to electronic patient records and test results, anytime, anywhere. In turn, data driven analysis and AI and machine learning are used to back-up clinical decisions and speed up the time to diagnosis. The reduced administration achieved through interoperability therefore improves the patient and clinician experience. But there are significant threats to achieving this. For example, layer-upon-layer of distinct teams exist across healthcare, using different types of data and resources in different ways, to do different things. So it’s not just accessing the data that’s a challenge –  it’s managing, analyzing and ensuring high availability of the data using cross-functional workflows.

Medical imaging interoperability

A critical element in patient care, access to diagnostic images is crucial at all times, especially when demand is unpredictable. Medical imaging provides a non-invasive procedure of taking images with a clinical application, using a variety of imaging modalities to provide a specified diagnostic picture of the body. Various modalities are used, such as CT, MRI, PET, Ultrasound and X-Ray.

To enable access to stored images and associated data, Digital Imaging and Communications in Medicine (DICOM) workstations are used. These connect directly to the DICOM source. Viewer servers are also used which enable client PCs to view DICOM images using a web browser via HTTPS.

The older PACS (Picture Archiving and Communication System) also exists. It has a reputation for being out of date and proprietary, although Loadbalancer.org has seen some great PACS implementations.

For our detailed guide explaining how to load balance medical imaging to solve interoperability issues, refer to the relevant Chapters in the below guide.