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Space Hogs

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In the paper hospital, data storage is synonymous with bulging files in the HIM department. In the digital era, the files are even bigger—you just can’t see them.

Take Baptist Medical Center South, a recently opened facility that has embraced information technology. With paper charts nowhere to be found, the Jacksonville, Fla.-based hospital stores all its clinical information digitally. Within 16 months of the $93 million hospital’s opening in February 2005, Baptist’s storehouse of electronic clinical data—which includes radiology images—had grown dramatically. By then, the hospital had amassed some 22 terabytes of data, says Roland Garcia, chief information officer and senior vice president. The 120-staffed-bed community hospital has been running at capacity since day one, he explains. “We did not expect the volume of patients we have had. But we have plenty of digital storage to accommodate them.”

Like other hospitals that have ventured into clinical IT, Baptist has learned just how voracious clinical applications can be. By themselves, picture-archiving and communications systems are enormous data hogs. Add other clinical and administrative components to the mix, and you’ve got a data storage challenge—one made more complex by system backup needs. Without some careful planning, those seemingly innocuous e-mail attachments could be the straw that breaks the data center’s back—if not its budget. “The unit cost of storage keeps coming down,” observes Eric Yablonka, vice president and CIO of the University of Chicago Hospitals and Health System. “But we are using so much more.”

U-Chicago epitomizes just how much more. Running a wide array of clinical applications, the multi-hospital academic medical center has accumulated about 120 terabytes of data across its various storage environments, according to Todd Hollowell, executive director of information technology. The health system expects that to grow by 15 percent during the next 12 to 18 months, but longer forecasts are pointless, says Yablonka. “It is virtually impossible to predict,” he says, noting that the medical center added clinical applications about a year ago that overwhelmed its storage capacity. “Now we are adding a new financial system. So we avoid saying what data storage capacity we will need in 2010. It would be interesting, but not conclusive.”

Storage solutions

To handle the load, many hospitals are deploying storage area networks, a common networking approach to data storage in other industries. Simply put, the SAN enables the transfer of computer system information to other devices, such as disks or even tape libraries.

Syracuse, N.Y.-based St. Joseph’s Hospital migrated its digital storage to a SAN two years ago. Prior to that, it supported its electronic medical record system with an optical disk “jukebox,” says Chris Snow, coordinator of IT engineering. The optical disk system was too slow in retrieving information, sparking complaints from physicians, he says. “It took up to 30 seconds to get a lab value,” he says.

Enabling near-instantaneous data retrieval, St. Joseph’s SAN, from Armonk, N.Y.-based IBM, feeds to three tiers of varying speed and capacity, Snow explains. The clinical systems and enterprise databases run on the fastest tier, with St. Joseph’s picture-archiving and communications system supported by a second, interim-speed disk. Archive data is moved to the slowest disk roughly one year after its creation, Snow says.

Combined, the SAN houses about 17 terabytes of data. St. Joseph’s bought plenty of capacity, as the SAN can accommodate 96 TB, Snow says. The storage hopper, however, is steadily filling. By itself, St. Joseph’s PACS is generating nearly 400 gigabytes a month, or 4.85 TB annually, Snow says. “You need to buy as much storage as you can to give you time to plan the next purchase,” he says.

The data storage equation is a trade-off between speed and cost, Snow says. Due to its configuration and redundant connections to the servers that feed it, a SAN is far more reliable than other storage options, he says. But as Hollowell points out, hospitals must be choosy about what data they allocate to their high-speed—and costlier—storage devices.

U-Chicago plows some $1.5 million annually in new storage, and must be judicious in how it allocates it. One way to do that is to meet in person with big-volume data users, like the echocardiology department, and hash out priorities, Hollowell says. “We ask: Is this a 24-7-365 application you would need restored within seconds, or minutes, or hours?”

U-Chicago allocates its data among three tiers of storage devices from Hopkinton, Mass.-based EMC Corp. It reserves the fastest—and costliest—tier for crucial applications and current data, Hollowell explains. “The users asked why we needed to store information on different places. But from the user perspective, it is a micro-second difference in retrieving it.”

Vendor relations

It’s critical to explain the hospital’s data storage strategy to IT staff who work with vendors in adding new applications, adds Hollowell. Some vendors may want to build applications with their own storage devices, he says. “We need to leverage our enterprise data storage capacity,” Hollowell says. “We ask vendors how they play within this approach.”

Sometimes application vendors can help address a hospital’s storage issues, however. Garcia says Baptist Medical Center South’s EMR has a built-in safeguard to ensure access to current clinical information in case of downtime. The feature is a proprietary application from Kansas City, Mo.-based Cerner Corp., Baptist’s EMR vendor. The system feeds current information about patients to various hospital workstations; in case of system downtime, the local workstations enable access to any data generated about the patient during the current visit, Garcia says.

Although Baptist’s system has virtually no downtime, the hospital had to shut down the EMR for 10 hours to accommodate a server upgrade. Having current patient data stored on the local workstations provided an abbreviated view of the full record, easing the burden of the upgrade on clinical IT users, Garcia says. “We cannot afford data outages.”

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.