There is a storage technology that lurks in the background at many healthcare facilities that is running the show and performing amazing data management “magic.” But unlike the Wizard of Oz, users of storage virtualization software could very well never have a (metaphorical) Toto that reveals the man behind the curtain, or in this case the software that makes everything happen seamlessly.
Newcastle Upon Tyne Hospitals NHS Trust in Newcastle, England, is a healthcare behemoth of sorts as a 2,200-bed hospital with 11,500 employees. It is the third largest healthcare facility in England. Their enterprise-wide storage system currently includes approximately 100 Terabytes (TB) of data, including the management of about 8.5 million images each year. This information is coming from some 21 departments, managed by 21 clinical directors and 12 supporting directors. That’s a lot of information coming from every type of clinical modality, too.
To help them manage it all, Newcastle contracts with Ferrania Life Imaging for the technology used to manage and store medical images and patient information. The system includes a PACS and RIS which were installed about two years ago. About 16 months ago, Ferrania integrated Acuo Technologies software — AcuoMed Image Manager and AcuoStore Digital Asset Manager — which helps to virtualize the data storage on the network level from the back end.
The Acuo software could be likened to a “black magic box” that quietly grants information access in a transparent fashion from the user perspective, says Robert Shaw, head of Information Management & Technology, at Newcastle.
“We couldn’t achieve the business benefits we have without it. The size and the volumes we shift through would not be possible,” says Shaw. About two years ago before they installed these systems, the image flow was “dreadfully slow” and it could take up to three hours for a film to be located. “Now with three clicks of a mouse, it’s there,” adds Shaw.
Every Newcastle employee has an active account with certain permissions and a personal login via web browser. To gain access to certain types of information — for instance PACS for radiology — a user goes to a web browser ‘Favorites’ where links to the different applications are located. The user is able to walk up to any one of the 6,500 laptops and PCs at Newcastle and with their account details, click on the system they want, and away they go. This simple process is supported by Acuo which sits beneath this scene feeding image requests and retrievals, speedily granting access regardless of where the information is actually being stored across the network.
Shaw believes that the system is so easy “that expectation has risen. Whereas before if it took three hours to find a film packed in the film library, the response was ‘hey ho that’s the way it is.’ Now if it’s not available in three seconds they are on the phone demanding to know where it is.” On the flip side, however, the complaints demonstrate that the system is being used, and also how dependent users have become, Shaw says.
High demand and use would likely bring on a major data jam were it not for the Acuo software. It is able to dynamically manage system traffic so that it does not slow down the network overall, which is highly important given the “kinds of volumes and file sizes that we are shifting around,” says Shaw.
Also, the software provides for access to all data across the network at any of its three main sites throughout the city of Newcastle, as well as any of the hospital’s peripheral sites through the network. Web-based access also is possible through a VPN or via any of the hospital’s more than 200 wireless access points.
Being a major tertiary care center, Newcastle has seen an influx of images sent from other hospitals in the U.K. To handle the inbound images, they created the “Foreign Film Archive” which is where images generated by other facilities reside for 90-days. These images can be viewed and used as needed until the 90 days is up. However, if it is necessary for images to be kept longer, the data become part of Newcastle’s records and are placed into the deep archive.
Beyond easing information access, and efficient information network management, storage virtualization has been good for the hospital’s bottom line. “We’ve already achieved our return on investment, and we achieved that about four months ahead of plan,” says Shaw. “We make net savings on an annual basis. We’ve been able to release those savings back into the business, which we’re pleased about.”
Controlling existing assets, boosting capacity
If virtualization software provides a sort of information access magic, among the other wonders it offers are ways to more efficiently use storage assets that would otherwise be more difficult to utilize due to hardware logistics, or go unused due to compatibility issues.
Care New England encompasses a number of healthcare facilities throughout Rhode Island — including Providence-based Women and Infant’s Hospital and Butler Hospital, as well as Kent Hospital in nearby Warwick and Care New England Home Health — and uses a variety of IBM storage systems to store and manage data between its two core data centers. In all, about 6,000 employees are using the system.
The Kent facility is the main center, and the mirror site is at Women and Infants. At these locations, they have deployed IBM ESS (or Shark) storage, FastT storage systems, and Tivoli Storage Manager. Everything is backed up to an IBM automated tape library, and also IBM’s Total Storage Productivity Center (an umbrella storage management software), and virtualization product SVC (SAN Volume Controller). Each facility is unified through a High-Speed SONET giant fiber optic ring.
Information can be accessed from both data centers and the data can be accessed by all the facilities which feed data from accounting, patient management, human resources, clinical and financial information systems. All these critical systems are supported by the storage area network (SAN) and SVC. In June, Care New England installed the Cerner Millennium clinical system, including RadNet, PACS and other modules, but these systems are not currently available via the SVC — although they hope they will be in the future.
They initially deployed the virtualization software to assist in migrating information from three older data centers to the new data centers, says Howard Rubin, chief technology officer of Care New England. Over a period of about 10 weeks they were able to move information from about 150 servers.
“We needed a way to migrate the data from the live systems in the old centers to the new data center we had built without impacting our users,” says Rubin. “We were able to basically create a giant virtual storage pool between the existing systems and the new hardware we had installed at the data center. This allowed us to relatively seamlessly move the data over to the new center without requiring a lot of down time for users.”
Since this initial shift, Care New England has significantly expanded that environment with additional storage pools as well as a network attached storage (NAS) environment. All of this is under the control of SVC. Overall, use of virtualization software enables Care New England to more easily add capacity to their storage, and also to conduct testing.
“As we need additional space for test systems, it’s very easy for my storage administrator to basically create new pools of storage for tests and then blow them away without having to do a lot of work,” says Rubin. Otherwise they would have to actually purchase dedicated storage for testing.
“Frequently in the past we had disks sitting on servers that were unused because we had an application sitting on a different server,” says Rubin. “Using SVC, I can move it around to where I need it.”
The basic process involves the SVC looking at all of the various groups of hard disks. An administrator can point applications to groups of disks where there is open space. “And using the SVC software you can move — logically, not physically — disks to different applications without having to physically move a disk. No matter what box a disk is in, the SVC can see it.”
If an application is in Box A, for example, but there is no storage space available there, SVC knows there is free disk space available elsewhere and can make use of it for the application to add capacity.
“That allows me basically to utilize the disk even if it’s not in the correct location. This is true even if it’s not the right kind of disk. SVC doesn’t care. It just looks at it as a bunch of hard disks,” says Rubin. “It makes an application think it’s looking at the same box. It’s kind of smoke and mirrors.” And Rubin adds, “systems don’t have to be shut down which saves time also on the user end.”
SVC also is able to provide virtual vendor neutrality as well. Although Care New England uses IBM storage systems, the software is able to access storage technology from other vendors as well to put it to use and further extend capacity as needed.
Virtually tiny
Clearwater Cardiovascular and Interventional Consultants (CCIC), a specialty practice group located in Clearwater, Fla., is one of the largest cardiology group in Pinellas County, operating a total of three offices. The group uses an EMC Centera storage system purchased from CDW Healthcare in mid-2005 to support its PACS. Currently all of the echocardiography, ultrasound and nuclear images produced at Clearwater are on the EMC Centera. They plan to add more modalities such as Holter monitor data and digital EKG data to the Centera, as well as cardiac cath lab images which are currently stored on CDs.
“The physicians want to work fast and they don’t want to waste their time,” says CIO Connie Kleber. “They don’t want to be waiting on computers. They don’t like to even have to click a mouse three times. This is exactly what doctors want. They don’t care where it’s stored, they just want it now.”
Such is the expectation in medical imaging now: high speed. Nothing that slows up the process or gums up the works is tolerated. Thus, to keep humming along with access to all images through the same interface, storage systems do a sort of short-term virtualization for new images that have yet to make it to long-term storage. These images, which reside on the local modality’s storage, can be yanked over and accessed by the larger storage system — in CCIC’s case Centera — so that they sit side-by-side with older images.
At CCIC, ultrasound images managed by a Philips Xcelera PACS are continually at the ready via the EMC systems regardless of their location. “If a patient had a study done three days ago, that study is residing on the Philips Xcelera server. It’s so new it is still residing there. So, when a physician pulls a study from a few days ago, it is really pulling from the local server and not Centera,” says Kleber. On the other hand, “if you wanted to look at a study that is three months old, that study is coming from Centera. Now, the user would not know where those two studies were coming from. That’s the way the two servers interplay, and it’s the Philips server that makes that decision. If the image is not on the local server, the Philips system sends the address to Centera and it pulls the image from there. But the speed at which it does that makes it so the user doesn’t notice a difference,” adds Kleber.
Conclusion
Storage virtualization is a largely invisible back-end technology with very visible benefits. These benefits are experienced by unknowing users who have their work greatly simplified and sped up because data from so many different sources are at their fingers so easily. For a CIO or storage administrator, the benefits can also be seen through user feedback, and also in the ways they can stretch storage assets and boost workflow across the enterprise.