James Venturella, CIO of the Hospital and Community Services Division at 20-hospital University of Pittsburgh Medical Center (UPMC) Health System, is no stranger to volume. “We're producing about 2 million radiologic images a year,” he says. And what's more, according to Rasu Shrestha, M.D., medical director of digital imaging informatics for the system, and chief of UPMC's Division of Radiology Informatics, is that the system already has 300 terabytes of diagnostic images in some form of storage, with a growth of 60 to 95 terabytes per year.
By anyone's standards, such data volume is huge, and as Venturella points out, it's still growing. “We've got concerns with the sizes of the images growing over time, and the numbers of images. So we ask ourselves, what kinds of images do we need to store more immediately, or less? Because, from our standpoint, the current architecture of image storage is not going to work over time, especially with 20 hospitals.” And, he adds, “To make it even more complex, we also have pathology digitized; and the sizes of the pathology images are 10 times the sizes of radiology images.”
As a result, Venturella, Shrestha, and their colleagues have been developing an overarching digital image storage strategy for their behemoth system, focused on system-wide approaches to image access, storage, and communications. Of course, all this must fit a highly dynamic, multi-hospital environment, one that has already been digital for several years. “We want to focus on the architecture, on all the ‘ologies’ out there, and to work with our PACS vendor to get there,” Venturella says.
In fact, the folks at UPMC are working with Chalfont St. Giles, U.K.-based GE Healthcare through their Omnyx LLC joint-venture company (established in 2008) on what Venturella calls a “pathologist cockpit” solution, among other things.
As for the volume of diagnostic images washing over large hospitals and health systems these days, Shrestha says, “I call this the tsunami of data sets. I use that term to help people realize that this is what we're dealing with; we're just seeing the beginning of the wave right now.” What that means is large institutions like UPMC need to act fast. Beyond what Venturella estimates as an organic growth of 5 to 8 percent a year in diagnostic imaging study volume, and a population growth of about 5 percent a year, the emergence of 64- and 256-slice CTs and advanced MRIs is really driving diagnostic imaging storage planning, he says. “Whereas we continue to talk in terabytes in terms of digital image storage, soon we'll be talking about petabytes.” (A petabyte equals 1,000 terabytes, or 1,000 trillion bytes.)
Planning for layers
Across the country, CIOs, PACS administrators and clinician leaders are struggling to keep up with advances in modality capability and output, as well as demographic and other changes that are increasing the volume of radiologic studies. They face a web of challenges, including the need to expand and reengineer storage infrastructure; the need to strategize enterprise-wide for growth; the need to address physician concerns over speed of image access; and the countervailing need to be fiscally prudent during difficult economic times.
So what are the smartest hospital organizations doing? Joseph Marion, principal with the Waukesha, Wis.-based Healthcare Integration Strategies consulting firm, and an HCI Blogger says, “As a start, they're beginning to leverage the existing IT infrastructure. Many facilities today have already implemented a SAN or NAS strategy, a common storage device that's shared by different applications.”
In fact, Marion believes that in the long term, hospitals and health systems will have to create rich, three-layered systems to support all these diagnostic images. The first, or bottom, level in such a system is the infrastructure layer at the foundation, involving core disk storage capacity. The third layer, at the top, he says, is “the working storage that's part of the (PACS) application.” And, in the middle is what he calls “the brains in between” - some kind of mechanism that can communicate diagnostic images and facilitate their sharing, without overburdening the working storage in the immediate PACS application.
Most CIOs are grappling with these very challenges today. “Like many organizations, we have had to plan both for image conversion from old systems, as well as to project new, annual growth,” says Linda Reed, R.N., vice president and CIO of the Morris Plains, N.J.-based Atlantic Health. “And as storage typically becomes less expensive over time, we want to make sure that we do not over-buy and end up with unused, expensive capacity sitting around.”
At the two-facility Atlantic Health, Reed says, the strategy has been “to minimize the amount of storage required as we move from one digital system to another.” Meanwhile, as Atlantic Health pushed ahead on advanced modalities - the organization recently acquired a 320-slice CT - “We have to continually educate our clinical coworkers that the expense of these new modalities is not just the machine, but also the cost of the storage it will require,” she says.
Pat Zinno, Atlantic Health's director of infrastructure, services, and support, confirms that the health system has created a three-tier storage program (SAN-based on all three tiers) to optimize performance for radiologists while also maximizing economies of spending and scale.
Helping IT executives to better satisfy radiologists' and referring physicians' need for speedy image access is the continuing advance in storage technologies, says Shawn Wiese, application development manager at the two-hospital, 600-bed Nebraska Methodist Health System, based in Omaha.
Nebraska Methodist, a community hospital system, has two 64-slice CTs and an advanced MRI. “Five years ago, it was much harder” to balance economic imperatives and the need to please physicians, Wiese says. “But today, with the demands on the radiologists to read studies and produce reports faster, we've simply got to go to the faster spinning technologies, the fiber-based technologies, rather than relying on tape- or optical drive-based archive storage technologies.”
Like UPMC and Atlantic Health, Nebraska Methodist has moved toward multiple-tier-based storage, and is working closely with its PACS and EMR vendor, the Kansas City-based Cerner Corporation, to continually improve image access speed, Wiese notes. And, he says, thinking strategically about disaster recovery and business continuity demands will only become more critical over time.
“You cannot overstate that the data sets we're dealing with today are ones that have not been traditionally managed in the hospital environment, and they're so much larger. The disaster recovery and business continuity issues are huge,” Wiese concludes. “And you have to move toward some kind of solution that you define with your radiologists” and referring physicians in order to balance out all the issues around image access speed, storage, and communications.