Lost access to healthcare data can affect cash flow leading to reduced revenues; and more importantly, negatively impact patient care, according to John S. Koller, president of KAI Consulting. Citing a study by Sunquest Information Systems of Tucson, Ariz., Koller says that when a hospital billing system went down, the manual recovery process for data lost during that period was equivalent to about 8 hours for every hour of system downtime. Koller spoke at the 2008 Digital Healthcare Information Management System (DHIMS) conference in San Antonio, Texas.
“Donald Holmquest, MD, president and CEO of CalRHIO [California Regional Health Information Organization], stated that missing information affects patients by delaying care 59.5 percent of the time and is judged to adversely affect patients 44 percent of the time,” Koller says.
High availability of healthcare data is key, given these sobering statistics.
“All data must be protected and recoverable,” Koller advises. “There must be a plan to respond to an event that interrupts the access to data and restore access.”
This plan must address business continuity—the people, processes, and technology required to continue to deliver the mission of a department or enterprise during an event—and disaster recovery—the people, processes, and technology required to recover operation and data access after an interruption from an event, he says.
“No organization is static; the plans need to change as the organization does,” he notes.
Edward M. Smith, ScD, professor of imaging sciences at the University of Rochester Medical Center in Rochester, N.Y., recommends that diagnostic imaging practices apply availability metrics on a need basis.
For example, storage media and network hardware should have 99.999 percent availability while storage, servers, the RIS, and the PACS broker should achieve 99.99 percent availability, according to Smith. Critical-use diagnostic workstations should have 99.9 percent availability while clinical review and teleradiology workstations can suffice with 99 percent availability.
“None of us have unlimited funding when we’re dealing with implementation projects,” Koller says. “[Smith’s recommendations] will probably give you the best balance between the cost and the availability you can achieve with the money.”
One of the means by which high availability can be achieved is through the use of a virtual storage network. Virtual storage allows the access of data across an enterprise through a single interface, which sends user requests for information to the data repository independent of its physical location—such as spinning disk or tape—and delivers that data to the user regardless of the operating system platform from which the request was generated.
Storage virtualization can be accomplished with file-based systems, such as network attached storage (NAS), via a distributed file system across a redundant array of independent nodes. It also can be used for in-box systems such a storage area network (SAN) by virtualizing heterogeneous disks behind the system.
“Virtualization provides better performance, scalability and redundancy,” he says.
According to Koller, the benefits of virtualization in healthcare are lower costs and faster response to change. In addition, it allows non-disruptive upgrades and migrations as well as faster recovery from unplanned events.
Citing a Gartner Group study, Koller notes that by 2010, virtualization will be the most important technology in IT.
A new storage virtualization technology enjoying some currency outside the healthcare archive environment is multi-system capacity recovery. This schema aggregates and recovers unused disk space across application servers and in some cases other systems into a network storage grid. Koller notes that multi-system capacity recovery’s performance with diagnostic image archives is unknown.
The critical elements in deploying a virtual storage system are standards and standardization. “When you start dealing with proprietary anything it starts closing your options,” Koller noted. “You need to have a management environment that understands virtualization so that you can take advantage of automation. That allows you to be more responsive to your user community and minimize the downtime. The last, most critical piece is that you need to get buy-in (for virtualization) from your clinical application vendor. That, unfortunately, is why we’re one of the slower adoptees of this