Image Storage: When an Enterprise Strategy Works Best

Forward-thinking healthcare providers are confronting the explosive growth and volume of digital information throughout the enterprise by consolidating electronic storage onto one unified platform. Ensuring that no storage sits idle, the approach also allows users to more dynamically and cost-effectively increase storage capacities. Factor in the advancements vendors have made to their storage hardware and software systems and hospital staff members are guaranteed real-time access to mission-critical digital information - thus improving the speed at which patient care is delivered.

Image storage in healthcare is clearly being consolidated into consolidated storage environments. The approach allows multiple data types from multiple clinical systems, such as PACS and electronic medical records, to be archived on one unified platform. Storage systems are therefore utilized and shared enterprise-wide, rather than restricted to use on a by-department basis.

While one healthcare provider's storage strategy, hardware and software differ from the next, successful implementations reap a common benefit - effective data management. Consolidating storage optimizes the IT support and also maximizes IT investments. Enterprise storage, once conquered, is easier to manage as it allows users to buy storage as needed and dynamically increase the archive's capacity.

In the driver's seat

Some healthcare providers that store different types of radiology, and sometimes cardiology, imaging studies on a unified storage platform are isolating different storage management solutions for different modalities. A critical factor that determines where the imaging study will reside is the age of the study.

Boston-based CareGroup, the healthcare system made up of Beth Israel Deaconess Medical Center, Beth Israel Deaconess Hospital-Needham, Mount Auburn Hospital and New England Baptist Hospital, is a large, multi-site healthcare system affiliated with Harvard Medical School. The healthcare system recently adopted an information lifecycle management (ILM) approach to enterprise-wide storage that augments its storage platform and efficiently manages online medical data, including PACS images.

"Enterprise-wide storage means to me that no longer do you store mission critical or clinical data on a machine under your desk," says John Halamka, CareGroup's CIO. "In fact what you are doing is putting storage, on a lifecycle managed fashion, in a centralized data center where it is available as a utility." CareGroup's 40-terabyte storage architecture allows mission-critical patient images to be kept on high performing, highly available storage for real-time access, while less critical data are stored on a lower costing, mid-tier level system.

The tiered storage supports CareGroup's PACS (GE Healthcare's Centricity PACS) that generates more than 5 terabytes of data each year. Radiology images migrate across multiple channels of storage throughout its lifetime. "With ILM, users can actually shuttle data over its lifetime between expensive, moderate, cheap - and even onto tape where it can be kept for 30 years," says Halamka. "Then if I need to shuttle it back, I can move it around different classes of storage as needed to for the optimized, cost-effective use of the infrastructure."

When medical imaging studies are first acquired, they go right onto EMC's Symmetrix DMX Series networked storage platform. Images stored here can be retrieved by radiologists and clinicians within seconds. After several months, images are moved to EMC's Centera content addressed storage (CAS) system. The last tier of storage is a tape archive, which houses older patient studies that are not as clinically useful.

"What is the value of an x-ray acquired today," poses Halamka. "It may be pretty high since the patient has a cough and a fever and the doctor is looking to rule out pneumonia. What is the value of the [same] x-ray in a year? Well, probably not a lot unless it is used as a comparison. What is the value of that x-ray in a decade? Probably none, but the state of Massachusetts requires us to keep all digital records on file for 30 years. So when I go out to buy storage, I am going to want to buy very fast reliable storage for the data that the doctors need to get to today. When the information gets older, then it can be moved to a less expensive class of storage."

Halamka advises that healthcare providers migrating to an online, enterprise-wide storage architecture carefully consider what can be done to ensure that their systems are highly reliable while also forecasting the risks of tomorrow. "Hospitals do not want to loose any image data so they must create an infrastructure that is reliable and secure even under the worst of conditions," says Halamka.

Consolidated storage is more cost effective for the hospital. "Now we can manage storage across all of our users," says Halamka. "That means that instead of having all of these unused hard drives that only have 10 percent of their space used, I am sharing a very large quantity of storage across a very large number of users."

Share the wealth

As storage vendors continue to make hardware and software improvements to their systems, the task of developing efficient, cost-effective storage platforms - where no storage sits idle - has been made a little easier. The wealth of storage data can easily be shared in an enterprise-wide configuration. Just ask Mark Schmidt, CIO of SISU Medical Systems, who understands that a high priority for IT departments is to constantly monitor how much storage is being used on a daily, weekly and monthly basis.

In a consolidated storage environment, users deal with storage on an aggregate level, where as the past consisted of individual server storage where users were restricted to archiving on an individual, by-department basis. "When you can aggregate storage requirements, you are going to benefit in general," says Schmidt. "By having more servers of databases feeding off of the same pool of storage, you are going to maximize your ability to use your storage to its most effective level. By putting the servers on an enterprise storage system such as a SAN [storage area network], you can now take all of your storage and [parcel] off what is needed to each of the servers. If server A needs more storage, you can just tell the SAN to give it some more space."

SISU is an application service provider (ASP) and the IT department for 14 different medical facilities dispersed throughout Minnesota. Before consolidating its storage, SISU was running separate servers to perform tasks and had no centralized storage, no centralized back up and recovery, multiple brands of technology with multiple service agreements, and less-than-desired management capabilities. To consolidate storage, Minneapolis, Minn.-based Evolving Solutions helped deploy a server consolidation system that uses an IBM Bladecenter via a fibre channel-based SAN.

The storage helped consolidate and centralize SISU's Meditech EMR application. Schmidt says SISU is now working with Evolving to develop a plan for long term PACS archiving. SISU is in the very beginning stages of installing a PACS within each medical facility, since most centers also have to initially upgrade to computed radiography. While the PACS will be installed at each facility, the images will be sent to SISU for long-term storage. "Electronic images will be sent to the same SAN [as Meditech], it's just going to be a larger SAN," says Schmidt.

"We are running approximately 160 servers in our data center right now," he continues. "Forty of those servers are dedicated to database server activity and are connected to our SAN for storage. In the past, we had individual storage silos for each of those things - a disc array was attached to each of those servers. The problem was that server A could reach its storage capacity and server B was using a fraction of its storage. The two could not be combined. By moving to the SAN, we are able to very easily consolidate all of our servers onto one centralized storage platform, which allows us to maximize our usage of the available storage."

In the end, this approach to storing clinical information allows SISU to buy storage for its medical centers as it is needed. "You are buying as-needed based on all the needs of all your servers at one shot," explains Schmidt. "It's much more cost effective and easier to manage."

No more empty storage silos

The Kodak DirectView PACS System 5 rollout at the 225-bed Good Samaritan Hospital in Puyallup, Wash., included the implementation of Kodak's Carestream Enterprise Information Management (EIM). Carestream EIM is powered by a storage management software platform (Versatile Intelligent Patient Archive - VIPArchive) that provides centralized, enterprise-wide management of images and information. The new approach to storing images and data has mitigated many of Good Samaritan's past IT problems associated with storing information in individual storage repositories.

Kodak's Carestream is designed to help users manage digital information by setting up content management of electronic images. "The software reads the image header," says Mary Kasal, vice president of IT at Good Samaritan. "Automatically the software understands what the image is. Therefore, if the data contain an MRI study, the software knows it must apply the MRI-specific rules. The software enforces whatever rules the customer may have in place depending on the type of study."

The entire EIM architecture runs in conjunction with Good Samaritan's SAN. Right now, the healthcare provider has dedicated 5 terabytes of the SAN to medical images. Instead of having to go out and buy a new SAN when it wants to bring on a new modality, such as the multislice CT scanner slated for installation this month, the IT team will calculate the retention period of the images and if needed, purchase more disc storage for the SAN.

EIM is the intelligence that rides over any image data stored on the SAN. "These are not just PACS images or radiology images, anything that can be digitized and stored in a file can be managed intelligently in the software," explains Kasal. "For example, there are certain legal requirements for keeping documents for a period of time based on finite data components. With EIM, you can set those up before you start your operation. From day one, the EIM manages the retention and delivery of those images. If we say we want to keep pathology images on PACS, we can set up a different plan for the retention and distribution of those pathology images separate from what we do with chest x-rays or cardiology images."

Kasal says the advantages of implementing an enterprise-wide storage strategy are many: the ability to use existing IT platforms, the ability to use the same resources to manage images across the continuum from one location anywhere throughout the organization and the ability to use EIM not just for radiology PACS - but cardiology and document imaging, too. Good Samaritan's next project will entail taking cardiology images off a tape archive and running them through EIM to get them on the SAN so that clinicians can view the images enterprise-wide.

How does the enterprise-wide storage system impact workflow for radiologists and technologists? "Doctors no longer have to worry about a physician coming into radiology requesting a film," says Kasal. "The physician has full access to see the images anywhere in the world. It takes that administrative burden away from the radiologist and technologist."

Costs savings, another advantage to the system, are mainly derived from savings in staffing and the speed of results to physicians. "I can have one group of people trained on EIM and the architecture that we have deployed and they can use that in multiple different scenarios," says Kasal. "I do not have to train another set of staff to do something different with cardiology than I do with PACS and document scanning. I can use that pool of resources over and over again. We are a small hospital and we do not have a lot of resources. We must be multi-tasking and multi-purpose."

Maximizing investments

University of Pittsburgh Medical Center (UPMC) comprises 19 hospitals and a network of other care facilities across a 29-county service area. The large, multi-site healthcare provider is implementing a combination of IBM enterprise and mid-range storage systems.

Producing 1.4 million imaging studies annually, UPMC stores its PACS images on a separate online archive. "The decision was made to separate the storage of high-end clinical images as the PACS was being developed and grown at UPMC," says Joe Furmanski, lead technology architect at UPMC. However, digital information - including electronic medical records, the migration of management materials and human resources payroll - are being stored on the newly resurrected storage platform.

UPMC's tiered storage environment consists of three IBM TotalStorage DS8300 storage servers with two systems located at a main data center and one system at a remote disaster recovery site. The DS8300, offering high capacity storage, is responsible for the organization's most critical systems, including electronic medical records. Two IBM TotalStorage DS6800 storage servers will serve as the second tier for mid-range applications, as well as other development and test environments.

Furmanski says that UPMC's compounded storage growth year to year has been about 59 percent. "What we are doing now with IBM and integrating our SANs together, we actually expect to continue to support that kind of net growth for our end-users, but with an integrated SAN and virtualizing our storage. We actually expect to cut what we have to pay for down into the 20 to 25 percent range," he explains. "We will at least get that amount of savings in terms of pooling storage together and not having a lot of idle storage pools out there with different capacities. We will put our idle storage in one pool and share it and it will be fresh also. In the old way of having separate pools, a lot of storage could get stagnant if people did not use it."

What are the clinical advantages of an enterprise-wide storage strategy? "A consolidated environment is an on-demand environment," says Furmanski. "When looking at the adoptions of any clinical technology for information systems, one of the most critical things is responsiveness. We have to make our clinical systems very responsive to our users needs."


In today's data and image-intensive healthcare environment, electronic storage systems must be designed so that they are easy to manage and easy to accommodate growth. Healthcare providers are relying on enterprise-wide storage systems to house myriad digital information across one unified platform.