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The latest challenge is genome data. As the healthcare industry turns to genetic data to tailor specific treatments to individual patients, an EMR will need to contain an individual's personal genome data. "If a person's genome is going to be part of the treatment, then the EMR certainly has to have that data," says Vince Kuraitis, principal and founder of Better Health Technologies LLC, a Boise, ID, consulting firm.
According to the Human Genome Project (HGP), it takes 3GB to store a patient's entire genome. But there's a caveat, says HGP. This number "includes nucleotide sequence data only and does not include data annotations and other information that can be associated with sequence data ... These annotations associated with the sequence data will likely dwarf the amount of storage space actually taken up by the initial 3 billion nucleotide sequence." So, prepare to store more than 3GB of data.
"We don't include genome data, but we probably will in the future," says Bob Pappagianopoulos, corporate director, technical services and operations at Boston-based Partners HealthCare System Inc., which was founded by Massachusetts General Hospital and Brigham and Women's Hospital. Partners HealthCare System includes just about everything else in its EMR, such as links to images in multiple PACS. Its EMR contains about 40TB of data in a Cachet database stored on an EMC Corp. Symmetrix DMX.
In addition to preparing storage for EMR, the network may need an upgrade. "Many hospitals still use 100Mb/sec for the backbone," says Lightfoot at Orion Health. PACS usually gets Gigabit Ethernet (GbE), he notes, adding that 10GbE will probably become standard at large hospitals in the future.
As described by the HL7 committee, HL7 addresses the interface requirements of an entire healthcare organization by specifying a set of data exchange protocols that encompasses the requirements of installed hospital and departmental systems, some of which use mature technologies. The Continuity of Care Record (CCR) standard, based on XML, also aids data transportability and interchange, adds Shahid Shah, a healthcare IT consultant in Silver Spring, MD.
Another solution is to apply data-retention and lifecycle management practices to reduce the amount of EMR data kept online. "The healthcare industry doesn't apply retention policies in an organized way," says Gartner's Runyon. "Basically, they keep everything forever."
Partners HealthCare System, which installed its EMR system in 1998, retains data forever. "We don't purge any patient data. We periodically purge related non-patient data, such as schedules," says Pappagianopoulos. Partners has talked about a retention policy, but hasn't established the criteria.
This was first published in July 2008