How a CIO Prepared Pennsylvania Healthcare Clinics to Serve the Underserved During COVID-19

Isaiah Nathaniel, CIO of Delaware Valley Community Health, explains how modernizing his IT with hyperconverged infrastructure helped to better manage electronic medical records and improve patient care. When the coronavirus pandemic hit, his team was ready to meet increased demand from doctors and caregivers in clinics and those working remotely.

By Tom Mangan

By Tom Mangan May 14, 2020

A medical technology logjam is something no one can afford amidst a viral pandemic that’s spreading illness and anxiety from one continent to the next.

It's happening every day in every setting. The nurse logging into an electronic medical record (EMR) system endures a two-minute delay. The doctor she works with waits four minutes to confirm a prescription electronically. Online portals go unused because patients find them frustrating or confusing.

These issues hit home for Isaiah Nathaniel, CIO of Delaware Valley Community Health (DVCH), a nonprofit group of clinics and medical offices in Delaware County, Pennsylvania, just outside of Philadelphia. His job is to get technology out of the way of more than 70 doctors, nurses and other medical professionals who serve nearly 50,000 patients across DVCH’s eight locations.      

DVCH is a network of federally qualified health centers (FQHCs), which serve low-income populations that might otherwise lack access to health care. DVCH provides a broad spectrum of medical care, dealing with everyday ailments and referring patients to hospitals when needed.

“Our mission is to serve the underserved and we're serving them well,” Nathaniel said in an interview with The Forecast. “We can't do that without technology.”

He led a technology infrastructure upgrade just in time to help DVCH respond to COVID-19 by letting most employees work from home and enabling clinicians to deliver care via telehealth tools.  

Confronting an Aging Medical Infrastructure

Making medical technology more effective has been a personal mission for Nathaniel in his 12 years at DVCH. In 2019, he persuaded his board and executive leadership colleagues that DVCH’s technology infrastructure — servers, switches, software, etc. — didn’t have enough muscle or agility to keep pace with their plans for new offices, more people and expanded digital services for patients. Moreover, he wanted technology that could reduce the stress on health care providers.

He pointed to an aggravating delay: The medication module of DVCH’s electronic medical records (EMR) software placed an extreme load on the system’s aging infrastructure. Doctors prescribing medication through this module lost three to five minutes while the process churned its way to completion.

“So, all that time, a provider is sitting with a patient and not able to do anything on the system other than just wait for this medication to process and go through,” Nathaniel said.

Upgrading DVCH’s technology infrastructure shrank that delay to about 15 seconds, he said, giving care providers more time to confer with patients. He added that internal-medicine providers were expected to serve an average workload of 19.5 patients per day — a goal the medication module routinely tripped up.

“Now they’re able to hit that number and actually exceed it,” Nathaniel said. “They're doing more and asking for more work to do in the midst of a pandemic.”

Finding Solutions in Hyperconverged Infrastructure

The core of Nathaniel’s challenge was straightforward: The old three-tiered system architecture wasn’t cutting it anymore. The EMR system was on 7-year-old-hardware. Seventy-plus care providers were pushing the technology to its limits.

“Every day, we were moments away from an old SQL cluster crashing on us,” Nathaniel recalled. “And we could not upgrade, because it was our production database.”

These limitations forced the organization to face the facts. Scaling to make its growth goals was out of the question with their existing technology. They needed something new.

As he researched solutions, Nathaniel warmed to the potential of hyperconverged infrastructure (HCI), which converges compute, storage, storage networking and virtualization on standardized servers. Software optimizes operations, allowing Nathaniel’s team to easily scale up and down resources to meet changing needs.

Medical technology places distinct challenges on hardware and software. EMR systems require massive databases and tight-as-a-drum security. Backup-and-restore systems must provide fast business continuity. At DVCH, COVID-19 precautions forced approximately 75% of the staff to work remotely. 

Nathaniel completed most of the transition to HCI in Q1 of 2020, just as the epidemic began spreading in the US. His old system had physical clusters running on 64 gigabytes of RAM. Today, his hardware runs database-intensive applications through five cores, two processors and 192 gigs of ram. Nathanial said this has helped speed up everything:

  • An integrated telehealth solution for the pandemic was up and running in one week

  • Disaster-recovery times shrank from 24-48 hours to about six minutes

  • Log-in times were reduced from two minutes to less than 20 seconds

  • A 1.2-terabyte system backup went from 3.5 hours to approximately 30 minutes

  • Remote workers enjoyed faster, more productive user experiences

On the Monday after the new HCI operations went live, Nathaniel asked people in his clinics how well the system was performing. They told him things were running fine, but they expected a slowdown when everybody logged in. The slowdown never came. Most of the staff was already logged in remotely due to the pandemic, but users felt no loss of speed or performance.

Nathaniel and his team implemented an HCI solution from Nutanix, noting that the company’s AHV hypervisor software and HYCU business-continuity package outdistanced the competition. HYCU, Inc. provides application focused data protection and monitoring software to support multi-cloud data centers.

He said these new enterprise cloud technologies make his job a lot easier. 

“I actually sleep a lot better in the midst of a pandemic because I know my workforce can work.”

 It All Starts with Care

Medical technology is more than a paycheck for Nathaniel. It’s part of how he sees the world.

“From a strategy perspective, if I don't have a system that works at the point of care, then I fail at my job,” Nathaniel said.

A former Division 1 athlete, he noted the relentless drive of Kobe Bryant, the basketball legend who died in a helicopter crash in January 2020.

“Kobe was my GOAT (greatest of all time),” he recalled. “I do not fail. Mamba mentality is real for me. So I will do whatever I need to do to make sure when a patient walks in this door, regardless of their socioeconomic status, it's on me to make sure that they can have the proper, safe, secure and seamless experience with their provider regardless of what the specialty is, and then continue on in their life.”

Nathaniel worked in the private sector for four years after college before moving to Delaware Valley Community Health. Savvy parenting advice helped him make the move. “I like serving people before myself. My mother knew this about me before I knew it — as all mothers do,” he said.

She advised him that he belonged in the world of healthcare technology.   

“I am doing what I'm supposed to do,” he said. “And it's all because of what my mother told me 12 years ago.”

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Brian Carlson is a contributing writer. He is Founder of RoC Consulting and was Editor-in-Chief of and EE Times. Follow him on Twitter @bcarlsonDM.

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