The storage capacity needed for electronic medical records could be big ... real big.

"WITHIN 10 YEARS, every American must have a personal electronic medical record," said President George W. Bush in his State of the Union address on January 20, 2004. With that declaration, the federal government, led by Medicare and Medicaid, began the charge to electronic medical records (EMRs). The impact of EMR on IT, particularly storage, could be huge ... or not, depending on whom you ask.

"I don't think people are making special IT plans," says John Lightfoot, CTO at EMR technology vendor Orion Health Inc. "EMR requires about 2MB of data per patient on average. For 1 million patients, you're talking about 2TB of storage." At that rate, a neighborhood clinic could buy two 1TB disk drives at its local office-supply store, connect them to the server via the USB port for approximately $500 and support more patients than it would ever handle.

But other observers say EMR's impact on IT will be huge. "We are on the verge of a crisis," says Barry Runyon, research VP at Gartner Inc.'s healthcare provider practice in Tucson, AZ. He expects the healthcare industry to get hit by a data tsunami that many medical IT departments won't see coming. Many healthcare providers are a long way from having the IT infrastructure, storage and network bandwidth to accommodate the widespread use of EMR, says Runyon.

Complicating the problem is a considerable amount of confusion in the healthcare industry as to how encompassing a patient's EMR should be, what data it should include an...

For example, should an EMR simply be a patient's clinical data record--the electronic equivalent of the paper chart that hangs at the foot of a hospital bed--or should it include every X-ray, CAT scan, EKG, diagnostic image and medical test? What about explanatory notes, documentation and copies of all emails? How about a DNA profile? Until questions like these are resolved, there's no telling how big an individual's EMR will be (2MB, 80MB or larger), and how much storage and IT resources will be required (see "How big can an EMR become?" below).

How big can an EMR become?

• Less than 1MB for a relatively healthy adult patient


• 1MB per page for scanned, paper-based data in TIFF format


• 40MB without images for a patient with major medical issues


• Approximately 300MB per image if picture archiving and communication system (PACS) images are included


• 3GB minimum (no annotations) per patient if genome data is included

Some healthcare storage managers aren't waiting to find out. "We've had a fully implemented EMR for over a year," says David Whiles, director of information systems at Midland Memorial Hospital in Texas. But Whiles is a distinct minority. "Of the bigger hospitals, maybe 15% to 20% have an EMR," estimates Runyon.

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