Dartmouth-Hitchcock (D-H), New Hampshire’s only academic health system, serves a population of 1.9 million across New England. D-H provides access to more than 1,500 primary care doctors and specialists in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, NH. DHMC was named in 2018 as the #1 hospital in New Hampshire by US News & World Report, nationally ranked in gynecology, and recognized for high performance in 14 clinical specialties. Dartmouth-Hitchcock also includes the Norris Cotton Cancer Center, one of only 49 NCI-designated Comprehensive Cancer Centers in the nation; the Children’s Hospital at Dartmouth-Hitchcock, the state’s only children’s hospital; affiliated member hospitals in Lebanon, Keene, and New London, NH, and Windsor, VT, and Visiting Nurse and Hospice for Vermont and New Hampshire; and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-H system trains nearly 400 residents and fellows annually, and performs world-class research, in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, VT.
The Dartmouth-Hitchcock system annually supports 1.7 million outpatient visits, performs over 22,000 surgeries, discharges 28,000 patients, and handles 31,000 emergency room visits in the Lebanon emergency department. The largest private employer in New Hampshire, D-H has approximately 10,000 full and part-time employees around the state.
Today, the performance and availability of a healthcare data center are crucial for day-to-day operations and the future business of healthcare. The changing regulatory landscape, the transformative use of technology, staff increases, larger pools of insured persons, and an aging population are driving the need for world-class data access, compute, and storage. Often cited as one of the best healthcare organizations in the country and a best place to work, Dartmouth-Hitchcock set out to build a new primary data center to provide the best technology infrastructure and services possible for their thriving health system.
Making the Decision to Build On-Premise
Building a new data center was one of the most significant technology-related capital investment projects the organization tackled in recent years. The current data center located in the medical center was landlocked and did not provide capacity for expansion. Also, the need for a disaster recovery/business continuity site was a must for Dartmouth Hitchcock’s highly dependent technology business. The information technology leadership team did extensive research and analysis to cost compare moving the D-H data center to a third-party colocation provider vs. building a new data center near the Lebanon, NH headquarters. A former facility owned by Dartmouth-Hitchcock was available for renovation and would be used to compare costs and solutions.
Technology is critical in supporting D-H’s goals and objectives. It was imperative that the team create a long-term data center strategy driven by the top-level organizational requirements and the increasing needs of user groups and stakeholders across the clinical, staff, and research organizations in the hospital. The D-H information technology team developed a detailed roadmap of their technology profile and the strategy they would use to facilitate both technology growth and the importance of the data center in hospital operations. This profile was used to conduct the ‘build vs. buy’ evaluation with colocation providers.
After an extensive evaluation of colocation options, the team made the recommendation to Dartmouth-Hitchcock leaders to build a new primary data center. The evaluation items key to the decision were as follows:
Since D-H has significant growth plans, the long-term costs would continue to escalate year over year. Building ownership also helped the evaluation and having their dark fiber 100% under their control also helped with long-term costs.
When the sharing of electronic information is vital to patient health, every millisecond of transmission time counts. The best return times charted with the colocation providers were six milliseconds, and D-H could maintain four milliseconds in their current environment.
COOLING & DENSITY
There were also concerns that the available colocation sites would have challenges with cooling and the struggle to support the high-density requirements that D-H was projecting for their technology profile.
Upon approval, the D-H team issued a Request for Proposal (RFP) for data center professional services and engaged with LEDG to help design and build the new data center.
A Data Center Built for the Business of Healthcare
Dartmouth-Hitchcock’s new high-performance, fully-replicated data center uses an innovative N+1 redundancy approach to make sure the data center is 100% prepared for organizational growth, technology advancements, exponential demand for speed and storage capacity, and disaster recovery.
Since most of Dartmouth-Hitchcock is running mission-critical applications, the team created an Active-Active data center architecture. An Active-Active data center architecture provides asynchronous replication of critical applications between both data center sites. For Dartmouth-Hitchcock, this includes the newly constructed data center and the other existing data center at the medical facility. Through the utilization of dark fiber between the sites and the active-active architecture, critical applications are 100% available and able to run at any given time with access to a replicated database. Data can flow between two locations enabling better load balancing and automatic fail-over if one location should become unavailable. As an example, D-H runs EPIC on one data center for six months and switches it to the alternative production data center. This strategy keeps systems running at top performance and allows for testing the impact on users and uptime of switching the EPIC instance between data center sites. The examples of this impact were clear; before the second data center was built, if EPIC went down all outpatient visits and unplanned surgeries stopped until the system was recovered. Now, by combining asynchronous replication between data centers with Active-Active applications, the N+1 redundancy approach provides D-H with continuously available computing and peace of mind.
Though Dartmouth-Hitchcock is expanding locations and technology use through new affiliations, the footprint of the high-density data center is now reduced due to smart use of virtualization and a hyper-converged IT infrastructure. The new data center design employed a pod-based strategy with hot aisle containment with power and cooling infrastructure capable of supporting 14kW per rack at D-H’s highest densities. At lower loads, the cooling system was designed to ramp down to meet actual demand, maximizing the energy efficiency of the data center operation. The efficiency of the design earned D-H an incentive from their utility company for the energy-saving capabilities of the system. Also, the data center infrastructure management (DCIM) system provides visibility into the current state of the data center infrastructure. When the team is presented with new technology requirements, they can look at the expected demands and choose the right data center location for maximum performance without additional physical space.
D-H’s organizational expansion has also increased user storage needs by 30%, and the team sees continued demand to increase the speed to transmit vital diagnostic data from radiology and laboratories. The new high-density infrastructure enables the D-H technology team to meet business requirements and provide high-performance, scalable technology services to the entire healthcare organization.
LEDG Data Center Planning and Design Services Helps Dartmouth-Hitchcock Achieve Success
LEDG provided a wide array of advisory and data center design services for the Dartmouth-Hitchcock multi-year data center project.
Colocation requirements definition and evaluation support
Data center planning and design, including site development, structural modifications, new MEP infrastructure, telecommunications, security, fire protection, and environmental monitoring
Data center technology infrastructure and equipment
“Building a world-class data center is essential for the future of Dartmouth-Hitchcock,” stated Martin C. Purcell, Vice President for IS Operations at D-H. “The team at LEDG provided an unmatched collaborative approach to help the entire team meet our goals on a day-to-day basis.”
Patient rooms of the future, digital health, and Internet of Things (IoT) along with continued collaborations and affiliations will continue to increase the demand for fast, reliable computing no matter the data is generated. Today, the Dartmouth-Hitchcock information technology team and the new data center infrastructure is poised for what the future of healthcare holds for the organization.