Electronic medical records present challenge to healthcare industry

The healthcare industry is struggling with vendor offerings, records-retention policies and other technologies needed to implement electronic medical records.

With the American Recovery and Reinvestment Act (also referred to as the U.S. economic stimulus package) slated to include $19 billion for electronic medical records (EMR), the role of data storage in the healthcare industry is gaining more attention than ever before.

But the healthcare industry is facing the same challenges as most other vertical industries: dealing with an exponential amount of data growth at a time when compliance, regulations and increasing types of media-rich files are putting added pressure on storage professionals.

Michael Sullivan, a managing director at Los Angeles-based Sinaiko Healthcare Consulting Inc., has found that many healthcare providers lack transparency into their information technology systems. In addition, IT professionals struggle in a culture that puts a big emphasis on software applications, rather than on hardware and a holistic view of the computing environment.

"When you talk to IT departments at hospitals, it's rare to actually talk to someone in charge of hardware," said Sullivan, who has consulted on healthcare IT operations for more than a decade.

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Despite often having input from chief information officers (CIOs), many of the purchasing decisions at the hospitals where Sullivan consults are left to board members, he said. "These purchases are often made without thought as to whether a new system can talk to other systems and what the storage implications are," he said.

Brian Babineau, a senior analyst at Milford, Mass.-based Enterprise Strategy Group (ESG), said hospitals often have end users (doctors) that are used to long-standing legacy systems. "No hospital believes that there is no benefit in digitizing records, and they all understand that they can get a significant reimbursement or even paid to implement electronic records," he said.

"The initial cost isn't the problem," Babineau noted. "It's the operational burden of convincing baby-boomer doctors, who are very unfamiliar with the technology, to welcome new technologies, processes and ways of doing things."

Derek Woo, who's also a managing director at Sinaiko Healthcare Consulting, said the healthcare clients he's met have typically inherited a mix of systems that aren't well integrated. They're now faced with the pressure of digitizing healthcare records and establishing a comprehensive records-retention policy.

"If you look at what these healthcare organizations actually have installed, it's really a hodgepodge of things that are primarily file-server-based," Woo said.

Vendors offer wide range of products

Some storage vendors offer very specific products designed for the healthcare industry, including BridgeHead Software Limited's PACStore and Bycast Inc.'s StorageGrid line. Both of these product lines support Health Level Seven (HL7)-developed standards as well as Digital Imaging and Communications in Medicine (DICOM), which is a standard for handling, storing and transmitting medical imaging information.

But ESG's Babineau said this approach is rare, as most storage vendors don't support these standards; instead, they let the application handle them. "So these vendors pitch why they're the most cost-effective at handling medical images because healthcare providers care about cost," he said.

Many hospital information system (HIS) manufacturers, like Cerner Corp., Eclipse Solutions Inc. and Epic Systems Corp., have partnered with storage vendors like EMC Corp. and Hitachi Data Systems, which has led to a heterogeneous mix of systems and a wide range of products in the healthcare space.

EMC, NetApp and Symantec Corp. have made a big push in the area of compliance and data security, Sinaiko Healthcare Consulting's Woo said, but he believes storage vendor activity has slowed on this front. "It seems like their foot is off the pedal and they're trying to figure out what the healthcare vertical wants and needs," he said.

Storage vendors and users in the healthcare industry should be concerned with operational measurements, since many healthcare providers will have to quantify their IT progress to receive stimulus funding.

"Providers should measure how much EMR they have online now vs. how much they could have by implementing a retention strategy that incorporates archiving and lower cost storage," he added.

Healthcare providers can also leverage storage technologies to enhance their electronic medical records efforts with data archiving and data management software, ESG's Babineau noted. One software category has the capability to move a primary data application environment to a low-cost environment, just like the Bycast and Bridgehead offerings do.

Another type of software stores a large amount of capacity for long periods of time while facilitating reasonable access, Babineau said. Products in this area include EMC's Centera, Hewlett-Packard (HP) Co.'s Medical Archive Solution (MAS), Hitachi Data Systems' Hitachi Content Archive Platform (HCAP), IBM's System Storage DR550 and Nexsan Technologies Inc.'s Assureon.

Editor's Podcast: Want to learn more about data storage in the healthcare industry? Chris Griffin sat down with Brian Babineau from the Enterprise Strategy Group to discuss using storage technologies to improve clinical outcomes, enhancing electronic medical records (EMR) efforts and the purchasing strategies of CIOs in the healthcare space.

Beth Israel Deaconess Medical Center's push to digital healthcare

Michael Passe, storage architect at Beth Israel Deaconess Medical Center in Boston, has been developing electronic medical records functionality in his environment for the past five years.

Beth Israel's push to digital healthcare started five years ago with online medical records (OMR) and provider order-entry forms. "For us, it was really efficiency and quality of care; the same thing that the federal government is now trying to enforce," Passe said.

With the exception of backups, which are done with Data Domain Inc. products, the IT department at Beth Israel houses an all-EMC shop that runs Atmos, Celerra, Centera, Clariion and Symmetrix DMX platforms.

"We have everything from Symmetrix down to [EMC's] latest cloud computing platform, which is Atmos," Passe said. "I see Atmos as a place where we're likely to put a lot of our medical imaging stuff, which previously would have resided in Centera."

Given the cost per gigabyte, and because he doesn't need the compliance capabilities Centera provides, Passe said the cloud offering is a better fit for his environment.

Passe has roughly 500 TB (half a petabyte) of storage at Beth Israel Deaconess Medical Center. And while data storage capacity isn't an issue, storing medical images is.

Passe isn't directly involved in the policies and procedures surrounding the retention of electronic medical images, but he believes he will become involved in their storage. It's easy enough for Passe to go into one of his storage systems and identify a set of records to purge, but electronic medical images storage is currently handled by General Electric, which has been the hospital's Picture Archiving and Communication System (PACS) vendor for the past seven years.

But this creates a disconnect because the two systems are part of the same echo system. The inability to purge medical records internally is creating a stream of data that's being kept longer than its mandated storage lifecycle.

"Over time. I believe [IT] will start to manage the long-term archive storage for the departments," Passe said. "Long-term archive storage will become like a service [using cloud storage], and the end users don't need to know or be concerned about storage management from day to day."

Passe's department hasn't had to purchase more storage as a result of the Picture Archiving and Communication System, but the various radiology and cardiology departments using the archives stored in EMC Centera have, to the tune of several hundred thousand dollars a year.

"We're currently in the early adopter stage of cloud storage," Passe said. "But we're very confident that [cloud storage] will help us decrease the cost of storing PACS images."

Because the cost of implementing electronic medical records systems and the training involved can be overwhelming for independent physicians' offices, Beth Israel was able to kick in seed money to help its community member doctors.

"I believe cloud storage will be increasingly important for the hosting of secure electronic health records and for the exchange of healthcare data in support of safer and higher value healthcare," said Dr. John Halamka, CIO at Beth Israel Deaconess Medical Center.

Halamka said stimulus dollars will be tied to results. "Doctors will not be paid for hardware and software; they will be paid for meaningful use of technology to improve quality and efficiency," he said.

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