Enterprise Archival is Not Well Understood
I am currently engaged with a number of clients that are in the midst of wrestling with imaging requirements in a number of service areas. In one particular facility, the radiology PACS is rapidly running out of long-term archive capacity and the physical storage is on an obsolete DVD Juke Box. Cardiology is just initiating a PACS, and of course, it is a totally separate vendor from radiology. In this case, IT is struggling with whether to implement updates separately, or consider an enterprise archive solution.
In the course of my consulting experiences, it is increasingly obvious to me that the industry in general is in its infancy in understanding enterprise image archival, and its value to the Electronic Health Record (EHR). I thought it might be helpful to share some viewpoints about enterprise archival, and perhaps raise the awareness level a bit.
There are multiple approaches to addressing image archival, including service area specific, virtualized enterprise archive, and middleware applications. In the case of service area specific archival, each service area solution manages its own archive. There may be operational advantages to this approach in terms of performance, particularly when the data is managed in a proprietary format. The downside is that multiple devices need to be managed, including disaster recovery approaches.
Many facilities have recognized the limitations to this approach and have worked to create an enterprise solution that accommodates multiple service areas in one physical storage solution. Each service area can maintain its own data if the virtual storage is partitioned. The storage media can range from simple storage devices like a SAN, to more complex approaches like Grid Mass Storage solutions. Such an approach addresses the limitations of a service area exclusive solution in terms of economies of scale and disaster recovery management, but it does not address a true enterprise view to the data as each PACS still manages its archive separately.
The alternative is to uncouple the individual PACS from the storage environment by introducing some form of “middleware” that can manage the archive device and service each PACS. In this case, all of the benefits of a centralized storage are achieved, with the addition of the added benefit of managing a central image repository that is accessible by enterprise applications such as an EMR.
Which approach is the right one for your facility? Among factors to consider:
§ How many service areas are currently managing digital images, and how many additional service areas are likely to do so in the near future?
§ At what point are you in implementing an EMR, and is imaging an important element in your EMR plan?
§ Are there reasons to consider accessibility to the information outside of the individual PACS applications?
§ Are there limitations to an independent archive, such as service area PACS vendor restrictions on 3rd party device validation or support contract limitations?
§ If changes are planned, how much data will need to be migrated from existing vendor solutions, and who will take ownership for migration?
§ How important is it to be able to independently manage the archival data, such as for patient demographic updates, or managing patient record retention rules?
Enterprise Archive Benefits
If any of the above considerations are important, an enterprise archive approach may be worth considering. Among the benefits to be derived:
§ Improved image storage economies of scale: By consolidating storage to a single approach, it may be possible to significantly reduce the cost of overall storage for both the physical media, as well as support costs. Additional savings may be achieved through elimination of older storage technology that may be obsolete and expensive to maintain.
§ A centralized archive can buffer applications from external users: Many facilities are interested in expanding outreach services as a means of growth. IT may have reservations about allowing external physician access to its applications, due to the risk of security breaches and malware intrusion. Also, how does one create an environment where an external facility can manage its data independently, but also allow access to referral studies done at a central medical center facility? The concept of an enterprise image archive can help by buffering individual applications from external users, yet provide a convenient access methodology to diagnostic results. It may also be easier to restrict accessibility to information without proper authorization.