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Hospital admin talks shop

Hal Weiss of Baptist Memorial Healthcare talks to about data growth, maintaining patient confidentiality and learning to forecast storage needs the hard way.

Baptist Memorial Health Care is network of 15 hospitals spanning Tennessee, Mississippi and Arkansas, including metropolitan area and rural hospitals alike. The Baptist system also includes more than 2,700 affiliated physicians; home, hospice and psychiatric care; minor medical clinics; a network of surgery, rehabilitation and other outpatient centers; and an education system.

Director of IT Hal Weiss has been in IT for more than 40 years. In addition to healthcare IT, Weiss has experience in the government sector and has also taught computer science.

So what do you have in your storage environment?

Hal Weiss: Primarily, our environment is HP [Hewlett-Packard Co.]. We went from older EMA [enterprise message archiving] cabinets to EVA 5000s and, more recently, XP 12000s. We have 98 terabytes (TB) raw space on our HP storage with 73 TB used. That's just our primary storage in the data center -- we also have 48 TB on a secondary EMC [Corp.] Clariion SAN.

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We use EMC storage for our PACS system -- picture archival content storage. Things like CT scans, MRIs, ultrasounds and medical images. We have diagnostic quality radiology images -- our radiologists read them directly from that storage.

On our HP SAN we store some medical image files as well, and patient records. Basically, what's on that storage is replacing what a doctor or nurse used to carry with them in a manila folder; things like prescriptions, a doctor's transcripts of patient visits, a nurse's notes on a patient's temperature and blood pressure, things like that. It's all in an electronic file. Our patient information alone takes up 12 TB on just four servers.

Is your environment so big because of HIPAA (Health Insurance Portability and Accountability Act) requirements?

Weiss: HIPAA doesn't really have as much to do with it. The big thing with HIPAA is that it mandates that when regulators want to know something, we have to tell them right away, and usually what they want to know is who touched a record, when and what they did with it. It's more about patient confidentiality and rights than retention periods. It mandates an audit trail for seven years -- our audit warehouse grows by 800 GB a year. We already have 7 TB dedicated to this system on the XP 12000.

So it's not a cheap 800 GB per year either.

Weiss: No, it certainly isn't. (laughs)

But our priority for storing everything and keeping it isn't really about HIPAA, per se. It's really about patient safety. For example, we have an RFID [radio frequency ID] tag for every patient, as well as on every medication. The computer system will check both and give warnings if there's a medication being given to a patient that shouldn't take it, or to the wrong patient. That data is huge, too.

Something that hasn't really hit us as hard as it will ultimately is our PACS system, because of the way CT machines work. Right now we have four-channel CT machines, which basically means it takes four 'slice' images -- cross sections of the body, basically -- a second. So the total image size of a 200 slide study for that, compressed, is 100 MB.

Right now, though, we're putting in newer CT scan machines that are 64-channel machines. So the same study on those will take up 1,000 MB. We do 350,000 studies a year in our metro hospitals -- if you replace every four-channel CT with a 64-channel CT for all those patients, I mean…you do the math. Right now, we're already looking at a little over 32 TB a year growth with lower-resolution machines.

And now on the horizon, we're hearing about 128-channel CTs already. Compressed, those will take up a gigabyte and a half per study.

Healthcare storage is very explosive -- it's just the nature of the beast. No one grows faster than healthcare. Over the last four years, Baptist has grown an average of 24 TB a year. We'll be real close to a petabyte by 2009 -- the information is just mind-boggling. We served 45,000 patients in the past year, and we don't get rid of any data.

So how do you plan for that?

Weiss: Guesstimation, really. Trial and error. Experience -- learning the hard way … the fact that I've been at this more than 40 years. If we're good, we guess high. If not, and we guess low, we have to go request money to buy more hardware, and coming by money for storage is difficult. It's coming up against appropriations to buy the organization a new ambulance or new patient rooms. IT is no match, priority wise, for the clinical side of the house.

But it is getting better. A lot of healthcare organizations have come to realize that it's a necessary evil. They're coming around to the idea that without good IT information, they can't do some of the clinical things they need to do. But you still have to make sure to do forecasting as well as you possibly can. And right now it's just basically by the seat of your pants.

Aren't there any tools out there that could help with it?

Weiss: Well, the closest one is AppIQ [Inc.], but I don't think it's developed to the point it needs to be developed. It doesn't even talk to all the HP products yet, and it doesn't talk well with, say, EMC storage at all. [Editor's note: HP acquired AppIQ in 2005.] SMI-S, in my opinion, is still very vendor driven and vendor specific. Every storage vendor needs truly open APIs [application programming interface]. It should be open source like Linux is, where anyone can just write programs to it.

What about Aperi?

Weiss: Well, they just started that. I hope they do better, but I'm seeing the same people buying into it that bought into SMI-S. I would like it to be like Linux, but I don't know that it really will be.

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