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C O M E - B O O K
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TIERED STORAGE
FOR HEALTH CARE
As the number of doctors and hospitals using electronic
health records and digital images grows, so will the
demands on storage. These strategies will help health
care IT professionals meet those storage needs.
Storage NHIN
Strategies STANDARDS
for Hospitals WILL EASE
Going Digital STORAGE
n BURDEN n
STORAGE STRATEGIES
FOR GOING DIGITAL
Health care CIOs who need to upgrade or expand
Storage
Strategies for storage infrastructure have several options to consider.
Hospitals BY ELISABETH HORWITT
Going Digital
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NHIN Standards
Will Ease
Storage Burdens
Using Tiered
Storage, Sans
for Images
SAN Speed,
Flexibility
Rule the Day
W HEN GREG JOHNSON
became chief tech-
nology officer four
years ago at the Vir-
ginia Common-
wealth University Health System,
attached storage devices, the mem-
bers of VCHUS’ small IT staff spent
most of their time fighting fires and
“trying to get things to work together
that weren’t designed to,” Johnson
said. The setup was “wasteful, ineffi-
VCUHS was, in some ways, a techno- cient and ineffective,” he added. “We
logical pioneer among health care were constantly losing data because
organizations. The system has used it wasn’t being backed up properly,
electronic medical record (EMR) we had drive failures, you name it.
software since the 1990s and com- It was a disaster.”
puterized physician order entry In addition, backups were done on
(CPOE) software for another decade two separate tape systems. Neither
before that, Johnson said. worked very well, Johnson said. Data
Unfortunately, the organization’s archiving was outsourced to Iron
storage and backup systems were Mountain Inc., and it generally took
anything but state of the art. three to four days to locate and
First, with no way to centrally man- restore requested files from tape.
age the mixed bag of storage area The final nail in the coffin came
network (SAN)-attached, dedicated, about two-and-a-half years ago, when
server-attached and network- VCUHS was migrating applications
Using Tiered
A
Storage, Sans
for Images con-
CCORDING TO A for long periods of time.
gressional confer- As part of the HITECH Act, Congress
ence report released appropriated $1 billion to the SSA—
SAN Speed, Feb. 12, 2009, the $500milliontoreplacethe30-year-old
Flexibility
Rule the Day Social Security SSA National Computer Center and
Administration (SSA) “has a vital $500 million for health IT resources to
interest in exploring how health infor- facilitate the adoption of EHR systems
mation technology can be integrated in disability claims. Fifteen percent of
into the disability process through SocialSecuritytaxesareallocatedtodis-
the widespread adoption of electron- abilityclaims,makingtheSSAoneofthe
ic medical records.” Congress may largest disability insurers in the world,
not have known it at the time, but as well as the keeper of the world’s
Nationwide Health Information Net- largest medical image repository.
work (NHIN) standards are playing In the past, when X-ray film was
an increasingly important role in the lost or damaged there was no choice
way the SSA and other health care but to duplicate the procedure; that
providers share electronic health would delay the availability of infor-
records (EHRs). That, in turn, is mation and leave patients frustrated.
reducing the need to store hard On the other hand, it is very difficult
copies of images and paper records to lose an image stored in a picture
national levels using Health Level health-related missions, but it’s now
Seven International (HL7) and NHIN available to any organization for
standards. Connect was originally set health information exchanges that
up for federal agencies to support use national standards. In fact, the
If you’re faced with any of the following problems… …solve them with Healthcare Storage Virtualization (HSV)
∂ Controlling data management costs HSV creates a service platform for healthcare data, giving
∂ Keeping up with exponential growth you more choice, flexibility and control over the way data is
accessed, protected and managed. Ultimately, HSV lets you
∂ Digitizing paper records quickly enough break free from tactical decisions about storage and, instead,
∂ Enabling access to patient records provides a cost-effective and long-term strategy for managing
∂ Safeguarding privacy future data growth.
∂ Ensuring availability
Why BridgeHead Software?
∂ Migrating patient data Because over 1,000 hospitals use our software—so we
∂ Managing all types of data understand your data and we understand healthcare.
©2010 BridgeHead Software, Inc. All rights reserved. Other trademarks appearing in this document are the property of their respective owners.
k CHAPTER 3
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
NHIN Standards
Will Ease
Storage Burdens
Using Tiered
Storage, Sans
for Images
SAN Speed,
Flexibility
Rule the Day
I health
F YOU’RE A
care CIO trying to
understand your
organization’s future
storage require-
ments, you have to consider some
mately 400 births each year. Some
of these births require extensive
medical imaging diagnostics such as
a computed tomography (CT) study.
Typical CT studies are made up of
256 slices, each a 500 KB image. A
data points that CIOs in other indus- single study would require 128 MB of
tries would never worry about. For data storage. For a single infant born
example, what is the age of majority in New Hampshire in 2009, this 128
in the states in which your organiza- MB would need to be retained until
tion operates? seven years after the infant reaches
According to legal dictionaries, the the age of majority, which is 18 in
age of majority is set by statute as New Hampshire. Therefore, as
the age a person first gains the legal required by the Health Insurance
rights and responsibilities of an adult. Portability and Accountability Act
But for health care CIOs, it also (HIPAA) and New Hampshire state
marks the end of the legally required law, the image study must remain in
data retention period for patients storage for 25 years. How many non-
born in your facility. health care CIOs do you know who
The New Hampshire medical cen- worry about storage requirements
ter where I work services approxi- out to 2035?
Now, take the same patient and of video storage for approximately
increase the electronic health record six to eight months of patient visits.
(EHR) storage requirements for the These types of health care video
patient’s EHR, which could include and image storage requirements are
multiple diagnostic images, physician substantially different from the data
orders, prescription lists, progress retention and storage requirements
notes, X-rays and MRI and lab results for banking, tax returns and credit
for every clinical visit. All of a sudden, cards records.
Storage the EHR storage requirement is
Strategies for
Hospitals measured in gigabytes. Multiply this
Going Digital by the number of patients born each HEALTH CARE VIDEO
year, and the number can quickly
move to terabytes. AND IMAGE STORAGE
NHIN Standards
Will Ease
For many health care institutions, REQUIREMENTS ARE
Storage Burdens that’s a long-term problem. My hos- SUBSTANTIALLY DIFFER-
pital, for example, began with digital
storage of radiology images only.
ENT FROM THE DATA
Using Tiered Now we have image storage require- RETENTION AND STORAGE
Storage, Sans
for Images ments for cardiology, neurology, can- REQUIREMENTS FOR
cer, obstetrics, cosmetic surgery, the
spine center, orthopedics, the lab and
BANKING, TAX RETURNS
SAN Speed, the trauma center—with more and AND CREDIT CARDS
Flexibility
Rule the Day
more departments requesting image RECORDS.
storage.
The largest image storage require-
ment that my institution manages is So where does a health care CIO
for the neurology center. Our neurol- keep all this storage? Three places:
ogy center has a process that syn- tiered storage, tiered storage and
chronizes patient video monitoring tiered storage. Image storage is static
with electroencephalography imag- storage. Once the image is captured,
ing captures, allowing the neurologist it will not be modified. Typically, the
to study a patient’s physical symp- process is to capture the image on
toms as the EEG records neurological tier 1 storage and keep it there tem-
events. Some of these studies use porarily during clinical review. At
continuous monitoring for up to four some point, usually within a month,
days. These video images require the images are moved to tier 2 stor-
significant amounts of disk storage. age. After six months, the images
We are managing 8 terabytes (TB) are then moved to tier 3 or higher
Using Tiered
H
Storage, Sans
for Images stor-
EALTH RECORD Care in Salt Lake City, said data at
age needs are tax- his institution is “not quite doubling
ing the ingenuity of every year, but [it's] close.”
SAN Speed, health care IT pro- For many hospitals, storage area
Flexibility
Rule the Day fessionals faced with network (SAN) technology is the best
their institutions’ ballooning quanti- way to marry fast performance with
ties of data. Storage makes for a chal- expandability. Utah Health Care, for
lenging conundrum. Data sets includ- example, is relying on Fibre Channel
ing huge image files must be SANs and Brocade SAN switches to
available rapidly for a time, then handle its burgeoning data.
stored securely for years, all accord- SAN technology is virtual storage,
ing to HIPAA regulations. If that which means the logical units of stor-
weren’t enough, hospitals and med- age are separated from the disk drive
ical practices face tightening budgets arrays that physically store the data.
that rule out the easy answer, which Logical units are allocated to different
is to simply mount more and more applications but can be expanded
disk drives to handle their rapidly quickly across storage arrays, should
proliferating data. the need arise.
John Fagg, manager of storage “You can grow a [logical unit] on
services at University of Utah Health the fly and spread it across multiple
RAID groups,” explained Jeffrey Had- Health. “It’s very resilient. It doesn’t
don, storage administrator at Utah really go down. It’s highly redundant
Health Care. Using the technique of and failovers are seamless.”
thin provisioning, it’s possible to The institution has redundant Fibre
assign an application a 1 TB logical Channel SANs in its primary data
unit that utilizes only 200 GB of disk. center and its secondary data center,
“It’s easy to grow it in the back- located 12 miles away. The centers
ground” as needed, without affecting are connected by redundant fiber
Storage end-user performance, he added. links, and data is mirrored.
Strategies for
Hospitals Despite the appeal of SAN technol- The setup was tested when an
Going Digital ogy, some medical software vendors accident severed one of the fiber
either do not support it or are reluc- links. On another occasion, a Fibre
tant to do so, according to Steve Channel switch failed. “In both in-
NHIN Standards Huffman, vice president and CIO of stances, our Fibre Channel redundan-
Will Ease
Storage Burdens Memorial Health System in South cy worked flawlessly, and we never
Bend, Ind. incurred any downtime,” Apsite said.
“Some applications are still not on The hospital recently completed a
Using Tiered our SAN. Some vendors say they’re major storage upgrade from 120 TB
Storage, Sans
for Images not comfortable with the SAN envi- to 254 TB using a Hewlett-Packard
ronment,” Huffman said. Nonethe- Co. StorageWorks XP20000 series
less, he has implemented SAN-based disk array, with an HP StorageWorks
SAN Speed, health record storage wherever pos- Enterprise Virtual Array 8400.
Flexibility
Rule the Day
sible and has moved a significant
portion of Memorial Health’s applica-
tions, including those from Cerner FLASH DRIVES
Corp., Oracle Corp. and McKesson OFFER FAST RETRIEVAL
Corp., to the SAN. Although Fibre Channel SAN per-
formance suffices at many institu-
tions, Wausau, Wis.-based Aspirus,
FIBRE CHANNEL SAN a network of hospitals serving north-
CUTS DOWNTIME ern Wisconsin, has turned to flash
Fibre Channel SAN technology, which memory to provide extremely fast
is ideal for connecting servers to response time in its health record
shared storage devices, has proved storage system.
its worth at Metro Health in Wy- In Aspirus’ data center, EMC Corp.
oming, Mich. “We have been a Fibre enterprise flash drives are housed in
Channel site for years,” said Aivars a Clariion CX4 Model 960, which is
Apsite, technology manager at Metro known as “tier 0” in Aspirus’ tiered
DEDUPLICATION:
STORE DATA ONLY ONCE
Left unchecked, the sheer quantity Tiered Storage for Health Care
is produced by CIO/IT Strategy Media
of data in long-term archives could © 2010 by TechTarget.
Storage break the health record storage budg-
Strategies for
Hospitals ets of some organizations. To fight Jacqueline Biscobing
Going Digital back, many hospitals use data dedu- Managing Editor
plication technology to avoid storing Linda Koury
the same information many times— Art Director of Digital Content
NHIN Standards in some cases, tens or hundreds of
Will Ease Al Gallant, Stan Gibson, Elisabeth Horwitt
Storage Burdens identical instances. Contributing Writers
Utah Health Care is implement- Scot Petersen
ing both NetApp Inc. and EMC Data Editorial Director
Using Tiered Domain deduplication technology
Storage, Sans Brian Eastwood
for Images to justify storing the data on disk for Site Editor
longer periods, thereby assuring it
will be accessible faster than if it Anne Steciw
Assistant Site Editor
SAN Speed, were archived on tape. Deduplicated
Flexibility
Rule the Day
data is encrypted and transmitted Jean DerGurahian
to an off-site storage facility. Once News Writer
there, it is “un-deduplicated,” or Don Fluckinger
“rehydrated,” so the full record of all Features Writer
data instances can be stored for
Rachel Lebeaux
archival purposes on tape, Haddon Assistant Managing Editor
said.
Similarly, Community Health is FOR SALES INQUIRIES
Stephanie Corby
using VMware Inc.’s vSphere to per- Associate Publisher
form deduplication of the data within scorby@techtarget.com
its health record storage system, (617) 431-9354
Grey said. ■ TechTarget
275 Grove Street, Newton, MA 02466
Al Gallant is director of technical services at Dart- www.techtarget.com
mouth-Hitchcock Medical Center in Lebanon, N.H.,
©2010 TECHTARGET. ALL RIGHTS RESERVED.
and a contributing writer to SearchHealthIT.com.
Write to him at editor@searchhealthit.com.