Making the “Paperless” Shift

From the October 2006 Issue

Colorado nonprofit agency with 14 locations converts its scattered paper records system to a unified electronic document system.

Arapahoe House is Colorado’s largest nonprofit, community-based rehabilitation and detoxification center. The agency, based in Thornton, Colo., is dedicated to providing a continuum of accessible, affordable and effective services for individuals and families with alcohol, drug or other behavioral health problems. Arapahoe House offers multiple programs for adolescents and adults at 14 different facilities, three of which are strictly detoxification centers. In addition to serving more than 21,000 individuals annually, the agency also provides counseling services in 18 Denver-area public schools.

Streamlining Operations
In 2004, Arapahoe House administrators realized the need to streamline processes between the agency’s 14 facilities. The agency created and maintained paper records on each of its clients and programs. However, many times clients were either moved or readmitted into another Arapahoe House facility, creating the need for record sharing. Unfortunately, there was no efficient way for facilities to transfer existing records, ultimately doubling the time and paperwork involved in readmitting a client.

At the time, each individual facility used a low speed circuit to access the Internet, but these connections proved unreliable, and numerous crashes made it nearly impossible for the multiple sites to communicate. Furthermore, newly enacted HIPAA regulations required all healthcare organizations to guarantee the confidentiality and recoverability of all electronic health information. So, even if Arapahoe House’s facilities were able to connect via the network, they needed a system that would protect and secure all electronic information.

Constraints and Obstacles
Realizing the need to connect the agency’s multiple facilities, along with meeting government regulatory requirements, administrators decided to convert all client records and paper documents to an electronic system. The ultimate goal was to have every client’s record available on this electronic system so employees at any of the 14 facilities could use keywords to pull up all past and present clients’ histories. This would allow clients to be kept on record and readmitted into a different facility, but without duplicating records.

However, making a transition from paper to electronic records posed a major problem for the IT staff: How would the agency make sure records were protected in the event of a system failure? The non-profit agency faced several challenges:

It needed a more reliable network system;
It needed a highly-available solution to protect its sensitive electronic records; and
It needed to carry out this large-scale project on a small budget.

The Solution
The Arapahoe House IT team includes a CIO, a manager of information systems, a project coordinator, a database administrator, a trainer who is also the help desk manager, two help desk technicians and two systems administrators. They manage healthcare IT for 400 users at the organization, supported by 25 servers, and they handle about 4,000 help desk requests every year.

Beginning in February of 2004, the Arapahoe House IT team replaced the existing low speed circuits with a wide area network (WAN) using a Qwest DS3 link at the main location in Thornton, with DS1s connecting to each of the 13 remote sites. Six months after deploying the new WAN, they added a ShoreTel VoIP (Voice over Internet Protocol) system, which eased the burden of administering 13 remote PBX’s, decreased circuit costs and provided detailed reporting on the agency’s telephone usage. Working with a grant of $182,750 from the Colorado Health Foundation in December 2004, the team began deploying a new electronic imaging and document management system from LibertyNet IMS, creating the basis for “paperless” operations.

Nonprofit organizations that employ grant funds are regularly challenged by grant requirements; managing specific allocations for specific purposes, while purchasing the best systems possible, requires diligence and oversight. In addition, the Arapahoe House IT team was dedicated to usability. Information Systems Manager David W. Andersen says, “There is no point buying the right systems and scanning in patient records if the clinicians can’t easily access those records when they need to. We didn’t want to do a lot of training. We wanted systems that worked for the IT staff, but also worked easily for our clinicians.”

After the network and electronic systems were in place, the team had to decide how to backup and protect the agency’s electronic information. At the time, Arapahoe House’s only backup method was saving data on LTO magnetic storage tapes, which failed to address the issues of real-time backup and recovery.

Administrators began looking at failover solutions, including Double-Take from Double-Take Software, plus another alternative. Comparing the two products, they found the alternative product was too expensive and would not support a many-to-one failover. Double-Take, on the other hand, proved to be an affordable solution for Arapahoe House. It provided a many-to-one failover and also offered other synchronization and replication capabilities that the organization wanted.

Installation and Testing
Working on a referral from EMC, Arapahoe House’s IT administrators contacted Double-Take Software to set up an onsite deployment and testing of the product. As part of Double-Take Software’s Professional Services program, a certified engineer visited the agency’s main site in Thornton to set up a new server environment and install Double-Take on each of the servers.

Arapahoe House’s existing server environment contained two Microsoft SQL servers, a Microsoft Exchange Mail Server and a Dell file server. Two additional Dell 4600 PowerEdge servers were on hand but not in use. The IT team had recently replaced these two servers and couldn’t find another use for them. Instead of having to throw out these perfectly functional servers, the vendor’s service professional incorporated them into the agency’s new server backup environment as remote target servers. They were placed at the remote backup site and were used to store replicated information from the source servers.

After mapping out the servers and locations, the vendor’s onsite professional helped the agency’s IT staff install and configure Double-Take on each server. The Microsoft Exchange Mail Server, located in Thornton, was set up as a one-to-one failover, linking to one of the target servers at the remote site. The Microsoft SQL servers and Dell file server were set up as a many-to-one failover, with all three servers linking to the second target server at the remote site.

After set up and installation was complete, the Arapahoe House IT team was ready to transition operations to its electronic document system. But, before taking on the lengthy task of scanning in thousands of paper records, the team wanted to test Double-Take’s failover capabilities on the new server environment.

In August 2006, they took the source servers down one at a time and tested the system’s ability to failover to the target servers at the remote site. Double-Take successfully backed up and recovered the system data to the remote servers, making the IT team confident in moving forward with transferring paper documents to the new electronic record system.

The document imaging and management project officially kicked off immediately following the implementation and testing of Double-Take. Each of the three detoxification facilities, along with the agency’s records department, began scanning in existing paper records electronically in September. Moving forward, each facility will add new records to the electronic system as clients check out, eliminating any further need for new paper record storage.

Looking Ahead
Arapahoe House’s system overhaul is proving to be a huge success. Arapahoe House administrators are confident that the new electronic system will streamline operations between their 14 facilities and eliminate excessive background work on clients who are readmitted into the agency’s programs. Through testing, Double-Take proved to be an extremely reliable and cost-effective solution. It now provides data replication and failover capabilities to Arapahoe House’s remote servers; in the event of a system failure or natural disaster, client records and other sensitive information can be recovered in minutes, if not seconds.

While the Arapahoe House IT team continues to populate its electronic system, it has already accomplished many of its original goals:

Create a basis for a paperless operating system;
Modernize the existing network system;
Find a reliable backup solution that would protect sensitive electronic records in compliance with
HIPAA regulations; and
Conduct this large-scale overhaul within the constraints of a small budget.

Eventually, Arapahoe House will move toward an enterprise electronic medical record, as will all U.S. healthcare organizations. Andersen says the organization is cautiously exploring this alternative, with a focus on the text-intensity of behavioral health organizations’ clinical documentation needs, and is taking its time to identify both IT systems and clinical requirements. However, in the immediate months to come, Arapahoe House administrators expect to completely streamline operations across their facilities, ultimately saving the nonprofit agency time and money. This will help further enable the agency to focus on its mission, clients and community.

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