Tokushukai has begun real-time remote backups of electronic medical record data as a disaster preparedness measure. Storing data at a centre away from each hospital allows care to continue using past records even if a major disaster affects the surrounding area. Tokushukai Information System, Inc. (TIS), which developed the system, plans to introduce it at all 47 Tokushukai hospitals with EMRs by the end of this fiscal year.

EMRs contain diagnoses, treatment progress, laboratory values, insurance numbers, medication records and other information essential to continuing care. Each Tokushukai hospital saves this data in real time on both primary and secondary servers and also makes daily backups to recording media.

However, TIS President Katsuhiko Ozaki stresses the need for off-site storage: “If everything is kept in one building, a major disaster can destroy all the backups, however many you make.”

Ozaki became acutely aware of this need during the Great East Japan Earthquake. At Ishinomaki Municipal Hospital in Miyagi, servers containing EMR data were submerged and clinical information was lost. Because the hospital had reciprocal EMR backups with Yamagata City Hospital Saiseikan, however, the data could be restored about 20 days after the disaster.

Drawing on this lesson, Tokushukai decided to install real-time remote backup systems at all 47 hospitals with EMRs.

Trial operation began last October at Yao Tokushukai General Hospital in Osaka, followed by Shonan Kamakura General Hospital in Kanagawa. Deployment is planned at nine more hospitals in January, 16 in February and 20 in March, completing installation by the end of the fiscal year, as shown in the table.

Disaster response servers and location are key to rapid recovery

EMR data is backed up in real time over Tokushukai's secure private VPN network to high-capacity data centre servers: two with 31 TB and eight with 10 TB, as shown in the diagram.

In a disaster, data is restored to two separate 5 TB disaster response servers, which are taken to the affected hospital for use. Using these servers directly avoids having to transfer data from hard disks back onto the hospital's own servers.

The data centre in Yamanashi is monitored around the clock by professional security staff. Its building can withstand Japanese seismic intensity 7 and has emergency power capable of operating for four days without refuelling. Alongside reliability, its location near the centre of Japan was the decisive factor. Ozaki notes: “A centre overseas might seem adequate if price and reliability were the only considerations. But network connections may fail in a disaster, and recovery staff need to reach the centre in person to restore data quickly.” Accessibility is therefore important.

A major reason Ishinomaki restored its EMR data in only 20 days was its geographical proximity to the backup hospital, which allowed staff to travel easily between them. Noriyuki Takahashi, Head of Administration at TIS, says: “Our system incorporates many practical improvements. We believe restoration could take about a week, or two or three days under favourable conditions.”

Kenichi Kishimoto, a systems engineer in the system management office at Yao, the first hospital to adopt the system, says with relief: “We take many disaster precautions within the hospital, but having an off-site backup is reassuring when we consider a disaster too large for those measures alone.”

Image backups planned for the next fiscal year; a second VPN connection under consideration

The system currently backs up clinical information but does not store diagnostic images. TIS plans to step up development for image storage next fiscal year and is considering additional data centre servers and dual VPN connections.

The VPN used for backups also carries other TIS services, including BI tools and drug management, and cannot currently handle large image transfers. Shonan Kamakura's clinical information totals about 2 TB, while its images are estimated at more than 40 TB. Takahashi explains: “We would be transferring and storing almost twenty times as much data, so we are considering how to introduce this without disrupting other services.”

After the Great East Japan Earthquake, some people whose EMR data had been lost struggled to receive care because they did not even know their insurance number, or could not continue treatment because they did not know the names of their regular medicines. If clinical data survives, a hospital unable to provide care can still prepare a referral letter, enabling treatment to continue elsewhere.

TIS does not intend to charge for storing the clinical information essential to continuity of care, although hospitals will be charged for image storage. Ozaki expresses the company's commitment as a member of the Group: “We want to provide as much support as we can for disaster medicine.”

Source: Tokushukai Newspaper, 28 January 2013, No. 862