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Archive integration woes dog healthcare providers

Healthcare providers are getting up to speed with networked storage, but say integration of new storage systems with medical applications is still rocky.

CAMBRIDGE, Mass. -- Healthcare is a late bloomer when it comes to data storage. But the sector has been making up for lost time over the past year as the digitization of medical records has caused its storage needs to explode. At a recent IBM Healthcare Summit, storage pros from healthcare firms said they still need better integration between their new storage systems and the software applications that generate medical data.

"Healthcare application vendors typically only support [DAS] systems," said Tom Fricks, chief information officer of Harbin Clinic LLC. Fricks said that the vendors of his Picture Archiving and Communication System (PACS) and Cardiovascular PACS (CPACS) have been working to better integrate these systems with newer technologies, such as blade servers attached to storage area network (SAN) storage.

But other applications in his IT environments, such as practice management and document imaging systems, still have a way to go. "It's not particular to the vendors I use, it's just the state of the industry," he said. "It's easier to support an application if it's always running on the same hardware."

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Another speaker at the IBM event, Mark LaBelle, manager of servers and storage for Spectrum Health, said that in some cases he backs up applications twice because of a lack of integration between these systems and his Tivoli Storage Manager backup software. "A lot of these systems rely on triggering backups internally to reset pointers within the application," he said.

LaBelle said Spectrum put in a disk-based backup system after radiologists complained about 20- to 30-minute delays to access patient records on archival tapes. The disk-based backup system is only a temporary fix until Spectrum puts in IBM's Grid Medical Archive Solution (GMAS), but that will open another can of worms.

Spectrum uses McKesson Corp.'s PACS application, which certifies storage systems in tiers it terms Cache 1, Cache 2 and archive systems. Cache 1 is usually internal disk, Cache 2 high-performing external disk and archive is the lowest performing tier. The McKesson system puts files into tar format (a holdover from tape) to send to archival storage. Currently, the GMAS system is only compatible with the McKesson application as an archive, which LaBelle said could lead to further performance problems with radiological images. IBM officials at the event said IBM is working to certify GMAS as a Cache 2 device with McKesson.

Vertical integration between applications and storage is only part of the problem with digital archiving for healthcare applications, according to IBM speakers at the event. Richard Bakalar, chief medical officer for IBM's healthcare and life sciences division, said that PACS systems currently rely on both unstructured image data and structured metadata, typically using the Digital Imaging and Communications in Medicine (DICOM) standard to transmit metadata between imaging systems.

However, although DICOM can be used to open a medical image in one system that has been made by another, differences in how each application produces metadata mean that data from different imaging systems can't share the same archive and also can't yet share an archive with other types of data, such as electronic medical records.

"IBM and healthcare IT organizations, like the Healthcare Information and Management Systems Society (HIMSS), are working to integrate the DICOM standard into archives -- that's the next wave of innovation for this space," Bakalar said. "After that, the next wave will be the ability to have a single archive for the entire environment."

According to a presentation by Joseph Jasinski, IBM's program director for healthcare and life sciences research, IBM also has products in the pipeline meant to combine medical archives that span regional distances and organizational boundaries, as well as different applications and storage systems. Prototypes already being demonstrated in the lab and in the field with alpha testers include compliance enforcement middleware based on DB2 version 9 and the beginning of what IBM terms the National Health Information Network (NHIN), essentially a version of GMAS on a national scale for correlating medical records and pandemic prevention.

Clod Barrerra, IBM distinguished engineer and chief of technical strategy for system storage, said that with the changes taking place in healthcare and other vertical markets, such as Web 2.0 and video-on-demand, storage vendors will start to realign products accordingly. "You're going to see more and more specialization from storage vendors on behalf of large verticals."

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