From the August 2006 Issue

Building a Safety Net

A Final Farewell to Paper: What Works

What Is Application-Attached Storage Costing Your Facility?

Revving Up the Revenue Cycle: Case History

Weapon of Choice

The Cure for the Fatally Flawed EMR Software Model

What Is Application-Attached Storage
Costing Your Facility?

As electronic healthcare databases grow, traditional backup systems may become inadequate. Is information lifecycle management the future of data storage?

By  Ken Rosenfeld

Ken Rosenfeld is worldwide general manager, information management solutions for Kodak’s Health Group.

There is a story of a family that wasn’t satisfied with having all their food in the kitchen. First, their 16-year-old son demanded a refrigerator in his room for his sport drinks, snacks and fruit. Then, their 13-year-old daughter wanted a refrigerator for milk and sandwiches. Of course, the parents then decided to keep wine, cheese and fruit in a refrigerator in their bedroom, and who would be without a refrigerator in the garage for beer and soft drinks?

However, instead of making life easier, the family soon discovered that this room-attached food storage plan had major flaws. Electricity bills went up. Grocery bills also escalated since items were stored in multiple places and many items spoiled before they were used. And the refrigerator in the garage had to be replaced twice—first due to mechanical problems and then because it was too small. The family soon realized that this might not have been a smart plan after all.

This story is somewhat far-fetched but serves to illustrate what is happening in healthcare institutions today—having multiple application-attached archives complicates management and increases costs. In addition to the initial capital cost of the equipment, service agreements and media, application-attached storage creates the following expenses:

• Maintenance and training expenses for each of the dozens of archives at a healthcare facility go up as equipment ages;
• Long-term media storage costs, such as incurred by data protection service bureaus;
• Overhead of having multiple racks of archival equipment in the data center: Space, cooling, power and UPS have been estimated at over $5,000 per month per rack;
• Data migration expenses both for replacement applications and for technology obsolescence;
• Costs of unused storage capacity, which has been analyzed at up to 70 percent in direct-attached environments.

The key driver leading to the need for healthcare institutions to pay attention to storage and archival resources is the dramatic growth in healthcare digital information. Frost & Sullivan estimate that healthcare digital data is doubling every nine months. As a result, data will soon cease to be measured in gigabytes and terabytes and will be reported in petabytes and exabytes. This unparalleled information explosion creates a significant burden on the storage resources deployed in a healthcare environment.

Evolution of Storage Technology and Management
Direct-attached storage (DAS) is the most common way to attach storage to applications, and has been the default approach in all industries. That is because as facilities add applications, the required application storage can be simultaneously installed. There is also a legitimate need to provide dedicated storage to boost performance, particularly for medical imaging applications.

However, cost-conscious healthcare facilities are now implementing enterprisewide storage architectures to manage archives that serve all departmental systems. This architecture can expedite management of storage resources, enhance the ability to share application data with other systems, and facilitate automated data backup and redundancy/continuity. It also can automate data migration through the use of user-defined storage plans. These storage plans not only govern the movement of data for current clinical needs, they also can automate migration of data to new storage technologies in the future.

The first stage of storage consolidation involves utilizing networked-attached storage (NAS) and storage area networks (SAN). Network-attached storage allows facilities to share storage systems over a local area network and can provide flexible storage space for multiple applications. Storage area networks are dedicated storage networks that provide high-speed access to shared storage from application servers. These technologies can boost storage utilization to the 90 percent level and simultaneously unify administration, maintenance and backup procedures.

Clinical Information Lifecycle Management
As facilities move toward NAS and SAN technologies for online and archival storage, they are poised to take the next step in optimizing their storage environments: Information Lifecycle Management (ILM). Traditionally, stored files are either backed up via tools like Legato and Netbackup software, or they are managed with hierarchical storage management software, which moves files to slower and cheaper storage devices based upon the age of the file.

ILM takes this idea to the next level by creating specific policies regarding the lifecycle of the data, which is specific to the data or file attributes. In the healthcare space, clinical information lifecycle management (CILM) allows patient information to be managed based upon its true clinical value over time. CILM delivers the following benefits to healthcare facilities:

• Improved storage utilization by moving data that for clinical reasons no longer needs fast access to slower and cheaper storage systems. For example, a normal chest X-ray can be moved quickly to a slower access system;
• Ability to store only what is needed by implementing retention policies (e.g., seven years for standard medical images);
• Improved protection and security of data through implementation of policies that make duplicates of data so that the duplicate copy can be viewed automatically if the primary copy is inaccessible;
• Technology obsolescence can be managed gracefully by automating movement to new storage devices through simple revisions to each facility’s storage plans;
• Multidimensional scalability, or ease of growth in both storage capacity and storage throughput, without downtime.

Designing a Long-lasting Storage Solution
Several additional items need to be considered when designing an enterprisewide storage solution that will survive the test of time.

The first is implementation of healthcare standards. To realize the benefits of storage consolidation, the ability to accept data into the storage environment through standards-based interfaces is incredibly important. These standards include DICOM, HL7 and XDS. As more systems are moving to service oriented architectures , Web services interfaces are becoming more important, such as those provided by the DICOM, WADO and IHE RID standards. And for applications that cannot utilize these standards, file system interfaces such as CIFS and NFS can be used.

Healthcare standards play an important role when considering the proposed national health information network (NHIN). Imagine having to create interfaces into every system that is generating digital data in order to integrate a healthcare organization’s systems with the community requirements of the NHIN. By leveraging standards and storage consolidation, that process could be simplified, allowing administrators to focus on one system providing this information, versus the many systems found in institutions today.

The second area to consider is flexibility in consolidating all types of storage devices: Disk/RAID, content addressable storage, NAS, SAN, digital tape and DVD. The ability to add new storage technology and provide automated migration to these new technologies should also be part of the implementation.

Disaster Recovery/Business Continuity Takes Center Stage
Recent natural disasters have made disaster recovery top-of-mind. A 2005 survey of 2,100 companies in healthcare and other industries found that over two-thirds did not have a comprehensive plan to preserve electronic records.

Disaster recovery plans that involve tapes and/or CDs stored in a warehouse are not sufficient. Healthcare facilities are held to a higher standard that involves business continuity in the case of a disaster. Business continuity ensures that if data is inaccessible in one place due to equipment failure or a disaster, it will be still available from another location. Considering solutions that can leverage duplicate data located in data centers that are geographically removed from the primary institution will help ensure continued access to vital patient information. This process can be made more transparent by using ILM or CILM to automate duplication of data to these data centers.

The return on investment for redesigning a facility’s storage architecture will vary greatly. But there is no question that reducing application-attached storage will create significant savings, even when considering costs associated with professional services for design and implementation.

The torrent of data growth at healthcare facilities makes enterprisewide storage management a pressing issue—and one that must be addressed soon, considering the daily rise in complexity and expense of existing systems.

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