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June 24, 2011
With its up-to-date electronic medical record (EMR) and picture archiving and communications system (PACS), Palmetto Health, Columbia, S.C., is

With its up-to-date electronic medical record (EMR) and picture archiving and communications system (PACS), Palmetto Health, Columbia, S.C., is experiencing a data surge. The 500-bed community hospital in Columbia, 600-bed teaching hospital in Richmond, S.C., and 100-bed community hospital in Easley, S.C., that make up Palmetto Health are already at a total data volume of 70 terabytes but face what appears to be a nearly universal challenge in healthcare these days: ever-increasing storage needs.

"The biggest challenge is the management of the data," says chief technology officer Walter Hutto, "coupled with defining the information involved itself so that we understand retention policies and the cascading of data from high-level to less-expensive storage." Palmetto decided that storage virtualization (see "Virtual Storage of Real Data," below) was the only efficient long-term approach to managing such voluminous data stores and is using a virtualized solution from StorageTek (now part of Sun Microsystems, Santa Clara, Calif.).

"We've just completed a roadmap process to understand where everything is and are looking at a few different virtualization solutions" to be used in a coordinated way, Hutto reports. His goal is implementation before next fall.

Similarly, enterprise storage team leader Chris Painter reports that 1,300-bed, eight-hospital Carilion Health System in Roanoke, Va., already has 55 terabytes of data and could accumulate up to 100 terabytes in the next few years. Just five years ago, he says, "we were probably at no more than seven terabytes."

The tremendous pace of growth in data and images has convinced Painter, too, that virtualization is the only smart long-term solution. Carilion uses a system from Data-Core Software Corp., Fort Lauderdale, Fla.

The same kind of data explosion is occurring in the military's TRICARE health system, which is administered by the TRICARE Management Activity office within the Office of the Assistant Secretary of Defense (Health Affairs). Christopher Morgan, a San Diego-based systems consultant who until May was the project engineer and regional systems engineer for the TRICARE regional office-west, says the data storage issues are essentially the same everywhere and for everyone--health plans and providers, civilians and the military.

Based on overall growth in care-related data and an ongoing reorganization of offices and sites, TRICARE realized its storage requirements were not in scale with its data warehousing projects. "We had to come up with a storage solution that would allow us a greater means of flexibility," Morgan says. TRICARE engaged Xiotech Corp., Eden Prairie, Minn., to help create a solution.

"Originally, all of our storage servers had huge arrays attached to them," Morgan says. When TRICARE outgrew that configuration, storage became a big problem. "No matter how much storage we bought, we ran out fast." The organization decided to use a storage area network (SAN), which creates a high-speed pathway between data on shared storage devices and end users via servers on local and wireless area networks. "We wanted to run diskless, to boot from the SAN and operate completely off it," Morgan says.

Headwaters of data stream
What is happening at Palmetto Health, Carilion Health, and TRICARE is being replicated nationwide as IT executives realize that their storage capabilities are not sufficient to meet their organization's needs. Several factors are pushing the growth in data, among them the increased use of EMRs, PACS and regional health information organizations (RHIOs) on the provider side, and of disease management, population health management, and other initiatives on the insurer side.

As storage demands grow, organizations face an increasing shortage of attached disk space and are looking at SANs and a variety of virtualization strategies to help them simplify management of overflowing and hard-to-manage server-based storage. This strategy also offers the opportunity to free themselves from proprietary storage vendors.

The time has certainly come to do something, industry experts agree. For years, when it came to storage capabilities, healthcare has tended to lag behind. There were "financial services, and a little further back was manufacturing, further back was retail, and even further back was healthcare," says senior analyst and founder of the Nashua, N.H.-based Data Mobility Group John S. Webster, who consults across numerous vertical industries.

But regulatory modifications, including the Health Insurance Portability and Accountability Act (HIPAA) and new demands from the Joint Commission on Accreditation of Healthcare Organizations, have changed that, Webster says, through requirements for information system reliability, security, and privacy. In addition, physicians' acceptance of digital images, as PACS-supported digitization has delivered more diagnostic images to them faster, has compounded data growth.

"You have this incredible burgeoning of need for capacity," Webster says, "but you also have an incredible burgeoning of need for longevity: the need to store data over time, and the need to migrate data over time. And that can be tricky." As he points out, "There isn't a storage array out there that's designed to last 10 years." Migration of data from one array and application to another will continue well into the future, he predicts, as software vendors develop more advanced platforms and solutions.

Prolonged and plentiful needed
The challenges are many, says Joe Marion, executive director of Dearborn, Mich.-based ACS. "From the hardware point of view, the biggest issue is reliability and scalability." Once the volume of electronic data grows to a certain point, its management in terms of human resources, staff skill sets and rapidly evolving technology becomes a major concern. And, he notes, the HIPAA security regulations that became final this spring require not only documented creation of a disaster recovery plan for patient data but also testing of data recovery.

"It's like with the advent of digital photography," Marion reflects. People taking personal photos "have gotten pretty sloppy and have a lot of digital images on their hard drive. So they burn digital images on their CD or DVD and think they'll be able to reliably retrieve those images a year from now." Will they be able to find what they want? he asks.

In the case of healthcare requirements, "The government says you have to be able to routinely retrieve the data from storage," Marion continues. But the reality is that many healthcare IT executives are not in a position to guarantee that their organizations' migrated data can readily be retrieved in the future. Another big challenge is the need to be able to automatically migrate data from high-end storage to lower tiers of storage over time without having to expend massive amounts of staff time doing so.

Steve Rogers, director of technical marketing at Milpitas, Calif.-based Adaptec Storage Systems, agrees. "The retention requirements for healthcare organizations, particularly for hospitals--10 years, 50 years--are so demanding," he says. "How do you keep the data safe through multiple generations of products?" Migration of data across multiple technologies over time is the biggest problem in need of a long-term solution that the industry faces, he says.

Another major problem, according to Rogers, is "just raw space, not only at the main site, but to remote offices, like in doctors' offices." Companies such as his, across not only healthcare but all business fields, are deeply engaged in the effort to address these challenges, he says.

Cost is also an issue, says George Teixeira, CEO of Data-Core. "The hospitals keep trying to get lower-cost solutions, but the vendors right now are not very prepared for that. They're typically selling through some of the PACS vendors or application support folks. And those folks are still selling some of these pretty high-end storage devices, and typically the cost is not cost-effective."

Teixeira believes that the next few years will bring a vigorous demand for low-cost, PC disk technology and low-cost storage networking. "Frankly," he says, "the solution has got to be a cost-reduction solution and a reduction in the burden on administrators." He urges IT executives to look into solutions based on Internet protocol (IP) and small computer serial interface (SCSI), commonly known as IP-SAN-based and iSCSI-based solutions.

Smaller and mid-sized hospitals that don't have huge IT staffs with the latest IT skills "should demand from storage vendors solutions that are possible to administer and to manage," says Jitu Urankar, global healthcare solutions manager at StorageTek. Flexibility and scalability for future needs will be particularly important for smaller hospitals, he predicts.

A data-filled future
Forward-looking healthcare IT executives say they are happy their organizations are coming to grips with the storage problem now, because they see it getting nothing but worse as time goes on. "For us, the level of urgency is about a 7 on a scale of 1 to 10," says Palmetto Health's Hutto. "Having an enterprisewide EMR and enterprisewide PACS, it creates an impetus, because it makes us aware of the size of our data load. We fully expect our EMR to grow at 100 gigabytes a month. And imaging will continue to grow because the better modalities will increase the need for bigger storage."

Fortunately, Palmetto is moving into virtualization of storage, in which concerns about what device the data is on are removed. "We can manage it as a seamless tool of storage. We can allocate it across arrays to the appropriate types of disks for optimal cost-effectiveness, and we can figure out at what point we can move data from one place to another," Hutto says. "Otherwise, it's out of control, and you just keep adding data."

Carilion's Painter says that "The challenge with storage is managing it all. And in bringing on new arrays, you're trying to keep things as functional as possible." That means constantly moving data around, including across disks. But "In a virtual environment, you can perform all this back-end movement of data to different arrays," Painter continues. "Our vendor provides that ability for us to move things around nondisruptively in the background, without impacting our hosts." For Carilion, and for other organizations that have gotten control of their escalating data, "this has been a big thing."

Mark Hagland is a contributing writer based in Chicago.

Virtual Storage of Real Data

In storage virtualization, data from multiple network storage devices is pooled and presented as a single entity. This strategy simplifies and speeds archival, backup and recovery tasks. Usually accomplished by software applications that are deployed above the operating system, storage virtualization presents a logical abstraction of multiple physical storage devices and systems. The technology masks the complexity of these devices as well as their system requirements.

However, there are diverse methods of storage virtualization, creating their own questions for potential customers. Two variations are virtualization hosted directly on the storage controller, a common strategy for storage array vendors, and applications ported to servers of storage area network appliances, a typical approach for software vendors.

A detailed explanation is available in Storage Virtualization: Technologies for Simplifying Data Storage and Management by Tom Clark, Addison-Wesley, June 2005.

Charlene Marietti is editor of Healthcare Informatics.

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