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Zero-Failure Option

March 23, 2011
by Mark Hagland
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One Tennessee Hospital System Benefits from Creating a Fully Replicated Set of Data Archives


The five-hospital Saint Thomas Health Services, anchored by Middle Tennessee Medical Center in Murfreesboro, Tenn., several years ago became one of the very first multi-hospital systems in the U.S. to create a fully replicated set of data archives, rather than simply a mirrored configuration, to support the continuity of its PACS and other capabilities. That organization's leaders have derived great benefit from their innovation.

When it comes to the storage of diagnostic and other medical images, these days, the race is on to find solutions that make sense for cost-conscious patient care organizations, at a time when the imaging capabilities of MRs, CTs, and other diagnostic imaging modalities are leading to an explosion in study sizes and volumes.

Indeed, healthcare IT leaders at many hospitals, medical groups, and integrated health systems report that their stored caches of diagnostic images are exploding in size, even as the volume of actual diagnostic imaging studies begins to slow. (According to the federal Centers for Medicare and Medicaid Services (CMS), the growth rate for diagnostic imaging services under Medicare was 3.4 percent in 2008 and 2.2 percent in 2009.) This is, of course, because of the increasing sophistication of the modality machines capturing those images, combined with the technological capabilities unleashed by the shift to digital viewing in PACS (picture archiving and communications systems) solutions, meaning that volumes of images can be produced from individual diagnostic imaging studies that would have overwhelmed film-based viewing systems.

Dan West
Dan West

One hospital organization that has blazed a major trail in this area is Middle Tennessee Medical Center, the anchor hospital in the five-hospital Saint Thomas Health Services system, itself a division of the St. Louis-based Ascension Health. Middle Tennessee Medical Center, based in Murfreesboro (located 35 miles southeast of Nashville), and its sister facilities were apparently the first organization in the country to create a fully replicated set of data archives, not simply data centers mirrored to each other.


Dan West, ITS director, Imaging Informatics and EHR Architecture, for the health system, spoke recently with HCI Editor-in-Chief Mark Hagland regarding the storage/connectivity innovation, and the lessons learned from its implementation.

Healthcare Informatics: What exactly have you put in place?

Dan West: It's an integrated platform involving a fully replicated set of data archives, not just mirrored archives. They each have their own set of Oracle running. To explain the difference, what most organizations have is SANs [storage area networks] with mirrored storage at a disk-to-disk level of matching. In our case, what we've created, using enterprise content management (historically known as replicated content management), is at the DICOM [Digital Imaging and Communications in Medicine standard] engine-to-DICOM engine level. In other words, this is actually a DICOM transaction, as opposed a raw-data transaction.

HCI: When did everything get put in place?

West: Our first site went live in January 2004. The five sites we brought up in sequence-the fifth site went live in April 2005.

HCI: What elements of your technology configuration do the different facilities in your organization have?

West: We have five care sites-one pair of two hospitals, the two large hospitals in our chain, and each of those contains one of these nodes. The other three hospital facilities have a merged facility image cache-the same DICOM engine as the larger hospitals, but only 60 days' worth of storage. The maintenance cost for maintaining this configuration is $425,000 a year.

HCI: That sounds relatively reasonable.

West: We think it's quite reasonable.

HCI: What kind of storage volume is involved?

West: Right now, each of our archives has 52 terabytes, and we have 38 terabytes used, and we're burning 1.5 terabytes a month, and 575,000 radiologic studies a year.

HCI: Every one of your four hospitals has imaging?


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