From imaging studies that produce ever-increasing amounts of data to the proliferation of email, storage needs continue to command attention at healthcare facilities. Cost-effective solutions in a variety of formats with both onsite and offsite backup for disaster recovery strategies all are on the table.

Jim Albin, CIO at Mercy Health Partners Southwest Ohio, has been working with Kodak’s Health Group to establish a central storage archive. Currently, he is using a new infrastructure to archive cardiology and radiology studies. Next to come online will be data and images from pathology, lab and other applications.

The infrastructure has been in place since early in 2006. The goal was to consolidate all images in one location to better manage them for storage lengths of time, archiving and disaster recovery, says Albin.


Effective and transparent storage

One of the features in place is the ability to make real-time duplicate copies. With most of the system’s hospitals using PACS and running off one central environment with integrated images, there is a huge amount of data. Cardiology images already have been added to the storage system with plans to add radiology and pathology in place. Users can access the images through the central electronic record. That results in a high-volume archive that lets Albin manage data more effectively and is pretty transparent for the customer, he says.

Albin teamed with Kodak on the archiving project because Kodak is the organization’s PACS vendor. “Naturally, when we started talking about centralizing the management of images, Kodak was the obvious first choice.”

The organization’s electronic health record — a document imaging system — runs on a different platform because of its different use and integration. “We wanted to focus on clinical images in one environment,” Albin says.

Stored data are mission critical, says Albin. “When you don’t have them, you need them.” He likens storage to insurance. “It’s not high visibility and we don’t get any notoriety but we have a professional responsibility to cover storage needs.”

This process of having a duplicate live copy is a practical solution, Albin says. “Recovering data from another medium would take a year.” Access speed, in fact, is a primary concern at this point. As long as it can take to retrieve data in deeper storage, “it’s always faster than retrieving a paper record.” Meanwhile, Mercy subcommittees need to have further discussions about image management include retention timeframes. Albin recommends discussing as much as possible before putting a plan into place.

”When all is said and done, going back is much more difficult.”


Doing it right the first time

Jim Bates, director of radiology at Naples Community Hospital in Florida, has been working with InSiteOne for the past four years to implement enterprise-wide storage. When Bates started looking into PACS, he heard again and again that the big issue was storage. “As different media was introduced, the old storage became obsolete.” Storage was costly and many of the organizations he talked to had an FTE dedicated to managing the storage system. “We wanted something that was less visible, something in the background that didn’t need hands-on management every day.” Bates also didn’t want to implement a system and then continually need to go back to administration to ask for funds for more storage and upgrades.

Bates found that InSiteOne “seemed to have it altogether.” Once an image is acquired by the technologist and approved, it is sent to the PACS. At the same time, they send the images to two offsite locations that InSiteOne has set up. There is redundancy between the two facilities. 

The image also remains on site in the RAID system for one year. “When someone retrieves an image from PACS, it is invisible to us as to where it is,” says Bates. The two hospitals both have onsite storage for films and once that space is full, they go to a warehouse. Before this system was installed, if a physician wanted a study over a year old, someone had to physically go to the warehouse to find it. Of course, that was usually a request that had to be filled by the next day. Now, “even though retrieval from offsite isn’t as fast as RAID, it is a hundred times faster than sending a person to the warehouse.”

The two hospitals of the Naples system are as seamless as possible, Bates says. “They are integrated very tightly.” There also are four outpatient centers that are not under Bates’ control, but the hospital is a part owner. Those centers are on the same PACS so that the same seamlessness can be maintained. “They run the same RIS, PACS and storage,” Bates says. “When they pull up a patient’s name, all the images are available. That is a real plus. The best thing about having offsite storage through InSiteOne is that it is invisible to us and we don’t have to manage it. We don’t have to buy or upgrade hardware or software and no FTE is needed.”

Bates says InSiteOne lived up to its guarantees about functionality and seamlessness. Within one year of implementation, one of the facilities was filmless, and within two years, so was the other facility.

Another important consideration was disaster recovery. Naples is a beachside community and the main hospital is only a few blocks from the ocean — with films stored on the first floor. “I felt comfortable and safe knowing that all the exams are in Arizona and Connecticut, not here onsite next to the beach.”

Implementation went better than expected, Bates reports. “We thought it was going to take longer to bring each modality on board but once we started rolling with it, it happened very fast.” Each modality fell like a domino, he says.

Bates attributes the successful implementation to having “a clear goal of what you’re trying to accomplish. It’s really important that you get everybody on board and on the same page.” Having considered the best options, how to make the process as painless as possible, and determining how to make the system work for a good long time led to IT, administration and radiology working well together to get the system going, he says.


Tiered storage

When Edward Hospital in Naperville, Ill., decided to install a PACS several years ago, a closer look at storage was required. Laura Bagus, director of infrastructure and telecommunications, said the facility partnered with EMC Corp. because EMC’s equipment could handle the demands of a PACS and MEDITECH, the hospital’s HIS provider, validated compatibility with its system.

Edward Hospital now has a tiered networked-storage infrastructure of EMC Symmetrix and EMC Centera platforms. The results have been impressive. EMC Symmetrix offers real-time synchronous remote replication, and images also are sent to an EMC Centera content-addressed storage system. Images that are not available in the secondary cache of the EMR Symmetrix are still available in milliseconds from the EMC Centera. Rather than waiting for studies to load, users now have access to images, regardless of where they are stored, within seconds.

The facility also uses EMC’s TimeFinder application which does “moment-in-time” snapshots of data that serve as a reference if there is a corruption.

A full backup used to take days, says John Ciarlette, network engineer. When it was time to do the next full backup—scheduled for once a week—the system wasn’t done with the last backup. That has been reduced to about one day. He also went from 12 tape drive servers requiring four hours for backup to a 20-minute backup and no tapes with the move of the MEDITECH system to SAN.

The hospital plans to become a fully electronic facility, Bagus says, with a strong focus on information lifecycle management (ILM). “Once you go electronic, there is no such thing as data not being available,” she says. With the storage infrastructure now in place, “data are always available.” That is essential since “ILM will be the cornerstone in our eventual goal of a paperless, electronic medical record as well as business continuity for the enterprise.”


Clustered storage for expansion

David Haber, IT director at Fletcher Allen Health Care in Burlington, Vt., recently moved to NetApp for clustered storage. The facility now is running a clustered database server for its PACS.

“It’s going very well,” Haber reports. He has already added some storage. “We’re running at about 24 terabytes a year and just added about a year and a half worth of storage based on that rate.” Now he is trying to decide whether to keep everything on disk or implement a hierarchical storage solution — moving data off of disk to tape based on age.

Haber has been impressed with the various storage options NetApp offers. “There is a whole list of features we could be using. It’s very flexible — any of those options is relatively easy to install and maintain.” One is SnapMirror software, which can mirror data from FC storage to ATA storage, reducing storage costs. To reduce network usage, SnapMirror works with NetApp Snapshots to send only changed data blocks to the disaster recovery storage. A cost-effective solution, SnapMirror offers efficient storage and network bandwidth utilization, and lets users put the DR site to active business use.

Haber feels comfortable with his enterprise-wide storage efforts. “Enterprise-wide storage was the goal when we started working with NetApp. We wanted a single vendor solution, minimum backup and recovery times, and reliable disaster recovery. NetApp has allowed us to do just about all of that.”