As electronic health records (EHRs), interoperability and value-based care have grown more important in healthcare, an increasing number of providers are tasking IT departments with developing, implementing and managing complex enterprise imaging (EI) strategies. And one of the biggest components of any EI strategy is its ability to properly store the massive amounts of data the provider produces on a daily basis.

Having optimal storage architecture in place is a “key enabler” to EI success, explains James Whitfill, MD, CIIP, chief medical officer for Innovation Care Partners in Scottsdale, Ariz., and chair elect of the Society for Imaging Informatics (SIIM) Board of Directors.

“In the old days, you would go to, say, the dermatology department to see dermatology images and the radiology department to see radiology images, but they were all in different places and you had to log in separately,” says Whitfill, who is also a co-founder of the HIMSS-SIIM Enterprise Imaging Workgroup. “Now, with an enterprise imaging infrastructure, all of that is in one place. That consolidated storage unlocks the ability for ‘one-stop shopping’ and seeing all of a patient’s images at one time. Storage is critical to making that happen.”

Another way to consider the significance of storage comes from Ken Persons, IT architect of enterprise imaging systems at the Mayo Clinic in Rochester, Minn., and a member of the HIMSS-SIIM Enterprise Imaging Workgroup. Persons compares the role of storage in EI to the wireless network in your own home. You may not necessarily notice it when everything is working correctly, but when issues arise, it can result in an unsatisfactory performance you notice immediately.

“Think about if you’re at home and your Internet connection isn’t working well or your router is having issues,” Persons says. “When you’re expecting data to move, you need sufficient, reliable bandwidth available in your network. In the same way, you need sufficient, reliable capacity and bandwidth in your storage mechanisms to have a system that can respond appropriately.”

Managing Massive Data Sets

Most EI veterans agree that storage has become easier to manage in recent years as solutions have evolved and the market has evened out. Challenges still persist, however, including the larger data sets associated with advanced imaging modalities such as digital breast tomosynthesis (DBT), also known as 3D mammography. And while the nation’s largest healthcare providers have had enough time to figure out storing DBT without issue, systems at smaller facilities struggle to properly access, display and share the bigger files. “For sites that have just done traditional imaging, DBT is a real challenge to them,” Whitfill says. “It’s what is pushing their boundaries.”

Whitfill adds that something else entirely is currently pushing the boundaries of those larger providers: the “absolutely massive” data sets being used in digital pathology, which are now becoming a “core part of enterprise imaging.”

“If you look at the different departments creating images that go into EI, there’s no doubt that radiology is still one of the big contributors,” Whitfill says. “But digital pathology is the elephant in the room, so to speak. It’s the next overwhelming source of data.”

To give a sense of just how much storage space is required to successfully implement an EI strategy, Persons shared a few numbers from the Mayo Clinic’s sites throughout the Midwest. In 2006, the sites saw 50.11 TB of radiology data and 16.17 TB of non-radiology data received by its VNA. Ten years later, in 2016, those numbers were 104.48 TB of radiology data and 90.22 of non-radiology data received by the VNA. The percentage of of non-radiology data has grown so significantly, Persons noted, because of other departments now being more involved in EI.

Considering a Future with Flash Storage

While newer modalities such as DBT and incoming data from departments outside of radiology are keeping IT specialists busy, they represent just some of the pressures storage solutions are feeling around the clock. There’s also the push to image-enable EHRs, for example, and the increased popularity of server-side rendering to consider.

The combination of these various factors has today’s providers turning to flash storage solutions more than ever before, says Esteban Rubens, Global Enterprise Imaging Principal at Pure Storage, a data storage company based out of Mountain View, Calif. Hard drive technology got the job done in the 90s and early 2000s, he explains, but it plateaued years ago, leaving users longing for a faster, more reliable product.

“While flash storage is much faster than traditional, hard-drive based storage, the most important difference is that it has extremely low latency, even under heavy loads,” Rubens says. “This is a huge deal to IT departments, because EI workloads can be very up-and-down in terms of input/output. When a big jump occurs, a lot of storage solutions respond by slowing down, but not flash storage.”

Rubens adds that this lack of latency can make a significant impact on the productivity of radiologists and any other physicians accessing images on a regular basis.

“The faster delivery of larger datasets means users can react almost instantly,” he says. “As soon as the radiologist can click a case to read, for example, they can start scrolling through the image stacks and dictating the report. They’re reading more studies and spending less time waiting or the system to catch up.”

Flash storage also takes advantage of the latest cloud technologies, meaning providers no longer need to upgrade their storage platforms or install new equipment every few years. At Pure Storage, for instance, the storage infrastructure can be changed in an instant; disruptive changes are now a thing of the past. Instead of worrying about the costs of downtime, migration and training, management can instead focus on the future of their enterprise.

Another reason healthcare leaders appreciate relying on flash storage, Rubens adds, is the simplicity of the product. Instead of making several specialists exclusively in charge of storage, those individuals can assist in other areas and serve the team as IT generalists.

At the end of the day, every provider’s EI strategy is going to be unique to the needs of its employees and customers. But as the science improves and technologies evolve, one consistent requirement is going to be owning enough storage space to take on a growing amount of medical data. Whether you’re a smaller practice trying to stay independent in an increasingly competitive marketplace or a large corporation looking to get bigger and bigger, flash storage might just be what the doctor ordered.

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