Images & Information: Enterprise Storage Strategies

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Creating the right strategy for managing patient images and information is as unique as the data being managed. Five healthcare facilities tell why they've chosen a variety of approaches - from an enterprise approach with a storage area network and network attached storage to fixed content storage to a focus on disaster recovery and storage virtualization.

Enterprise-wide image and information storage is rapidly gaining traction in the healthcare arena. Hospitals and health networks have become data warehouses with more and larger files to be stored. Larger volume imaging studies in the radiology department such as CT and MR are driving storage needs with files up to one gigabyte, but cardiology and other 'ologies' as well as electronic health records (EHRs) and other healthcare datasets fuel storage needs, too. Many facilities cling to a departmental model with disparate silos of information running on distinct management protocols. This month, Health Imaging & IT explores the ins and outs of enterprise storage through five healthcare facilities that have tackled various aspects of the storage challenge.

The Pioneering Enterprise

Daniel Morreale, Chief Information Officer
North Bronx Healthcare Network, New York, N.Y.

North Bronx Healthcare Network (NBHN of New York City) consists of Jacobi Medical Center, North Bronx Hospital and affiliated community healthcare centers. NBHN relies on a variety of EMC Corp. storage solutions, including Centera content addressed storage (CAS), Symmetrix storage area network (SAN) and Celerra NS600 network attached storage (NAS), to comprise an enterprise model. Chief Information Officer Daniel Morreale conceived and oversaw the network's transition to an enterprise storage model.

Q: Why did you turn to the enterprise storage model? How did you approach the process? Why is enterprise storage a smart decision for healthcare facilities?

A: We approached enterprise storage almost out of desperation. Three years ago, a series of storage systems ran out of space. We had to scramble to buy storage for various systems - and financing storage on an unscheduled basis is tough. At that point, we realized an enterprise solution could better meet our needs.

We really did not know what we needed, so we hired a consultant to complete a storage assessment and provide guidance and education. It was no surprise that we needed everything - a SAN, NAS and an archive as well management.

Enterprise storage is proactive rather than reactive and simplifies management.

Q: How have your storage needs evolved over the last few years?

A: NBHN successfully built and deployed an EMR with imaging, and we store all transactions online. Consequently, our storage needs have increased logarithmically. The EMR consumed one terabyte of storage in its first seven years; in the last three years, storage needs for the EMR have doubled. In addition, NBHN is filmless, and we are seeing very rapid growth in image storage needs.

When we decided to consider an enterprise approach, we wanted to create an environment with a growth path. We knew our needs would continue to grow as we add functionality to the EMR. Cardiac cath is another major storage consumer with cath studies measuring up to one gigabyte. Other radiology devices, such as multislice CT scanners, need significant storage space. Finally, initiatives such as a teledermatology program will impact storage. After looking at all of these factors, we decided we wanted to deploy a model that could provide three to five years of storage.

Q: How have storage options changed in recent years? Have these impacted your approach?

A: Lifecycle data management - migrating data to less expensive storage models as it ages - is key. Our consultant revealed that 85 percent of the data we store is stagnant; it's not used after it's created, thus it does not require an expensive SAN.

We also wanted to get out of the tape back-up business. The odds of successfully restoring a clinical system from tape seem slim. Plus, it's a 30-year-old technology that can be replaced with tapeless solutions.

Q: What challenges have you faced in the enterprise storage arena? How have you overcome these?

A: We expected that back-up to disk would be a seamless process, however, it does require daily oversight. The IT staff is working to automate the process more.

Another challenge has been implementing lifecycle data management on clinical systems. We have not been able to move clinical systems to the