Building Continuity

June 24, 2011
Joseph Maune Healthcare facilities are investing more than ever on IT-related expenses. Hospitals are expanding and upgrading clinical
Joseph Maune
Healthcare facilities are investing more than ever on IT-related expenses.

Hospitals are expanding and upgrading clinical information systems and image management systems while simultaneously building electronic health records. Securing these systems from unauthorized access and establishing disaster recovery and business continuity (DR/BC) requires additional funds.

In most cases, there simply isn't enough money to satisfy all the needs. Getting the job done requires strategic planning and the use of technologies that can satisfy several objectives.

Kevin Wezelis
New middleware and enterprise-wide storage technologies make it possible to create a central imaging archive that simultaneously reduces equipment and personnel expenses related to independent imaging systems while also expediting DR/BC for all managed data.

We all recognize that the easiest and least expensive way to achieve disaster recovery is to write data to tapes and store them offsite. The problem is that while the data exists, it cannot be easily viewed.

In fact, it would normally take a week or more to reconstruct 30 days of data for a small healthcare facility, and it could take months to rebuild 30-60 days of studies for a major regional medical center.

Evaluate the business losses of downtime

The driving force behind DR/BC should not be HIPAA regulations but the facility's needs. Healthcare IT staffs need to approach DR/BC as they would their personal insurance policies. You insure what you cannot afford to lose.

If a fire or flood wipes out the data center, can you continue to provide inpatient and/or outpatient care? Can you perform surgeries, oncology treatments and imaging services? What would it cost if your facility is unable to provide patient care for several days, several weeks or a month? That cost determines the level of DR/BC that should be implemented at a site.

With this in mind, many facilities have turned to optional mirroring software that builds redundant archives. This makes it possible for healthcare systems to use satellite and remote facilities as part of a disaster recovery plan — thereby using the distance of these sites to their advantage.

Unfortunately this software usually requires that the mirrored device be exactly the same model as the primary archive. That gets expensive and there is no effective way to prioritize image storage.

All of these issues support the need for an enterprise imaging storage solution that is much more cost-effective than individually managing disparate systems, and also offers the ability to use a single middleware layer to prioritize images based on clinic needs and deliver DR/BC at the same time.

The middleware found in innovative information management solutions can be a workhorse for healthcare IT staffs. It can be used to manage a variety of vendors' storage devices located throughout the enterprise as well as centralized archives and storage area networks. It automatically retrieves information from a secondary copy if the primary copy is not available. It can mirror images to near-line archives at a secondary data center or alternate servers located in remote satellite locations. It can also write data to tape for long-term storage as a third level of disaster recovery.

Intelligent middleware migrates data automatically

Best of all, this middleware can provide intelligent management of images. Where most software operates by file attributes (file name, save date, last access and file size), intelligent middleware software can prioritize images and select the most appropriate storage device based on clinical relevance. It does this by reading the DICOM header descriptions and following instructions identified in a user-defined storage plan.

These plans address both the clinical need and HIPAA regulations, and vary according to the type of imaging study: cardiology, oncology, mammography, general radiography, pediatric and others.

The storage plan can dictate the length of time each type of study is stored at the primary online server (and its backup) and then move the study to a near-line server and then off-line storage.

This management structure reduces backup expenses by moving data that becomes less valuable to less costly storage systems (and less costly backup systems).

If secondary (offsite) servers are part of the business continuity plan, this system will efficiently migrate the most important studies first. In fact, it can be commanded to reproduce studies in a specific order by changing the storage plan. Instruction changes can be immediately programmed and applied retroactively to all existing studies.

This middleware layer also provides the flexibility to accommodate the clinical needs of all types of healthcare facilities from small to large hospitals, imaging centers, teaching facilities and regional healthcare networks.

An imaging center, for example, may only need to provide online or near-line storage for 30-45 days, while the requirements of hospitals and large healthcare networks vary widely.

Legal liability can be costly

We saved the worst for the last — the legal liability of lost patient medical images. A few years ago a large medical center paid $4 million in a malpractice settlement for being unable to reproduce a patient image. In this case, no natural disaster was involved. But the same ramifications could apply regardless of the cause for the missing image.

It's time for healthcare IT staffs to take a serious look at their disaster recovery plans and make sure the facility could continue to function. New storage management technologies have evolved to automate DR/BC and make it more affordable. But the ultimate question remains the same: how costly will it be to your hospital to lose critical patient data or be unable to provide inpatient and outpatient care?

Joseph Maune is manager, product management, at Rochester, N.Y.-based Carestream Health Inc., and Kevin Wezelis is commercialization manager

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