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January 1, 2006
by Mark Hagland
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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.