Although data and image storage needs for healthcare facilities are increasing at an exponential pace, vendors are meeting those needs with faster, more efficient solutions—and keeping costs down. Traditional storage methods have given way to un≠orthodox setups and payment structures that might just prove to be ideal. Meanwhile, providers are planning for increasing storage needs thanks to tremendous jumps from technologies such as 64-slice CT.

Virtues of virtual

With price a premium concern, Todd Burress, director of IT for Peachtree Neurological Clinic in Atlanta, found what he needed in Neurostar's Virtual Radiology Network (VRN). The VRN is a complete clinical image distribution, reporting, and archiving solution, providing secure and timely access to images with minimal maintenance, IT staffing, and space requirements based on a monthly subscription fee. The VRN is based on Neurostar's proprietary software backed up by a central bank of servers in a redundant data center. This provides long-term storage and makes images and reports available over the web to authorized users.

For Peachtree Neurological, with nine neurologists and five internal medicine physicians who typically perform 400 studies a month, the arrangement meets both their current and anticipated needs. "Their platform is built for us to expand up without having to replace anything existing," says Burress. "It's built to handle as much as we could send out there."

Neurostar's offering is not an off-the-shelf system. "You can expand and make it as glorified as you want or as simple as you want it," says Burress. He arranged for offsite archiving and PACS all at once. "Fortunately, we were able to switch overnight from film to filmless and have everything archived offsite." Now, after less than three years of using the VRN, none of the practice's data are purged from the current archives. "The data are all real time and searchable. It doesn't matter if the scan was done in 2004 or yesterday," he says. The practice will reach a point, probably in five to seven years, where some of the data will have to be removed from the first layer to a deeper archive.

Shared costs, expertise

Another unconventional setup to meet variable storage needs is that of Inland Northwest Health Services in Spokane, Wash. The company provides storage for 38 hospitals in the Pacific Northwest. That allows each facility to develop a strategic storage plan and then take advantage of the infrastructure Inland already has in place. "The critical mass of infrastructure is already there," explains Mike Smyly, chief business development officer. "We own it; they just pay for the right to use it." Inland does all the support, implementation, maintaining, and upgrading. The setup lets hospital customers plan around the fixed costs.

Aside from the ability to share certain storage costs with other institutions, customers also can benefit from Inland's expertise. Inland has buying power and implementation expertise that allow for a very low risk, says Smyly. "We get better through practice and lessons learned. We see people getting very interested in that. In healthcare, IT projects aren't known as being successful in many cases. If you can go to a group, see it first, try it, and talk to users, it's pretty amazing."

Smyly isn't the only one who thinks so. Inland has been growing at about 40 percent a year for the past five or six years. Recently, the company standardized on IBM's DS8300 storage server. The rapid technology changes have allowed Inland to use a common platform, and their experience with IBM's service over the years drove the decision to use IBM products exclusively. For the most part, all the data storage is done at the data center in Spokane. "A number of independent hospitals have our PACS, and they manage their own storage locally," says Smyly. "We have a central PACS solution as well, and with that strategy, local storage is needed for staging while the images are streaming to our data center storage."

Scalable for now and the future

Change is in the air for other hospitals as well. Lorraine Guillet, PACS administrator at Prince George Regional Hospital in Prince George, British Columbia, Canada, is in the process of migrating from tape to disk. The facility has been a Network Appliance customer since March as a result of its strategy of a storage system they could build onto and add to as needed. "We have allowed for 10 terabytes," she says. "That's lots of space for our needs, and we won't have to increase for a year or two."

Meanwhile, some studies are still on tape. Until they are put on disk, it is slow to retrieve them. If the study is stored on a tape in the jukebox, the system automatically retrieves it. For those studies that are not in the jukebox, Guillet has to manually retrieve them. That can be a challenge, since she must regularly check the job queue to see if a retrieval order is waiting for her. Unfortunately, some of the physicians don't understand how the system works, so sometimes she'll find that several jobs were ordered over the weekend. "Once this is all on HSM [hierarchical storage management], it will be so much more convenient for the users."

Guillet's site is set up as a data center that works with several other regional locations. "We need our images available off the data center for radiologists and orthopedic surgeons at different sites," she says. "As soon as they are on the data center, they can be viewed anywhere." It will take another several months before all the sites are stored on HSM. "It takes time to transfer all these studies," Guillet says. When the migration is complete, none of the spoke sites will have long-term storage on old, basic servers.

On the path to enterprise storage

Bassett Healthcare, an independent delivery network based in Cooperstown, N.Y., had some bad experiences with storage. But a decision to upgrade with new systems led them to EMC's Symmetrix 8730 high-end networked storage system and Centera content addressable storage (CAS) system. CIO Kenneth Dean and Manager of IT Systems Engineering William Greco appreciated EMC's forward-looking approach, storage efficiency and scalability. "When you move the old way of doing healthcare to everything is real-time electronic, you've got to make sure the infrastructure is all that it can be and all that you need it to be," says Dean.

Bassett Healthcare consists of four hospitals and 23 clinics in eight counties covering a 5,000-mile area. That results in half a million patient encounters a year as well as clinicians who regularly travel throughout the region. When they travel, they can use the same applications and tools on any workstation. All data are connected to the server at the main campus.

And replacing deep-tape archives and jukeboxes with Centera means the user doesn't need to know if a study wasn't stored on the fastest storage available. "For them, it just pops up. For us, it's a less costly medium of storage. We have the benefit of archive cost, but we maintain the benefit of speed as you would with a SAN [storage area network]," says Dean.

Having already been an EMC customer made the transition smooth, says Dean. But, "anytime you put in a platform, you want to learn about it." Education was included in the package deal, says Greco. "We held a series of ëlunch and learn' sessions, and several engineers have taken classes. Now we're going into a new phase where we'll have an EMC resident on site to help guide and direct in building the next series of components." Bassett is currently looking at EMC's CLARiiON Disk Library, a second SAN, and a second Centera.

An essential ingredient to success, says Dean, is having "a partner that can offer everything from the appropriate level of education and service to coming in and overseeing what we're doing. In some areas, we have specific ideas, and in others, we want them to save us from ourselves." Dean and Greco are continuing on the path to enterprise storage. "The intent over the past few years has been to consolidate from internal storage systems from miscellaneous servers to an enterprise storage solution," says Dean. "That gets us closer to business continuity. Once we're consolidated on the SAN, we can replicate our data."

As various applications are upgraded, says Greco, "at that point we'll look at the infrastructure that they were made up of and look to migrate to EMC infrastructure."

Speed, security, & cost drive decisions

Radiological Associates of Sacramento Medical Group has 16 outpatient imaging centers in the Sacramento, Calif., area and uses InSiteOne to outsource the storage of diagnostic images. Each imaging center has an archive on a local cache. "That provides quick access to patient images and information at each local imaging center," says CIO Craig Roy. "Once a patient study is committed to that storage system, it also forwards to the long-term archive at our data center in Sacramento."

Roy considers data security his single largest risk. "That's why we use InSiteOne and tape. The images are not only backed up to tape but also stored offsite with InSiteOne."

The group started out using InSiteOne for basic archiving before moving to full-blown PACS, says Roy. "By nature of design, what we started out with was always being backed up with InSiteOne and kind of grew from there. For us, there has been very little required IT support." InSiteOne added a server, upgraded disk space, and proactively met other needs without impacting the group's day-to-day operations, he says.

Cost remains a primary concern, Roy notes. He must weigh the cost of the current outsource model against the cost of purchasing the equipment to replicate the archive and build a data center specifically to house these data. Meanwhile, "our goal is to keep physicians reading," he says. "We do all we can, but we're not always successful because it's a world fraught with risk. Circumstances arise where physicians aren't as productive as they can be, so we do whatever we have to do behind the scenes."

Installing a dual solution

Camiar Ohadi, MD, is medical director of Millennium Imaging Medical Centers, a radiology practice with two locations in southern California. After opening the second site in 2005, he realized they needed more data storage. They were seeing 500 to 600 patients a month. Ohadi consulted with Candelis about possible solutions. "It was costing us man hours and manpower to maintain the old system," he says. "The volume got to be too much to handle." But Ohadi didn't necessarily know all the options. "We didn't know what we were dealing with. [Candelis] offered lots, and we heard them out." Those discussions led Ohadi to decide that it was time to implement a PACS to meet current and future archiving and memory needs.

Ohadi decided on the ImageGrid 1000 to store, manage, and route its digital medical images. The DICOM server appliances speed digital image access and routing, simplify image management, and provide reliable, cost-effective storage. Ohadi deployed an ImageGrid 1000 at both Millennium locations so that users could route images directly from each modality for immediate storage and to diagnostic workstations.

What Candelis had to offer fit all of the practice's problems and needs, he says. The memory capacity can be used as a PACS archiving unit and is expandable. ImageGrid's embedded PACS capabilities prevented Ohadi from having to invest in more complex and costly PACS appliances. "We went into this for the dual solution," he says. The system offers both PACS and archiving. The system's rule-based, bidirectional replication capability ensures that images from each location are replicated daily at times and frequencies determined by the system administrator. Now, each center is backing the other up overnight. Retrieval of images has been very easy. The solution "has taken us leaps forward in terms of data management," Ohadi says.