Storage & Archiving

Spectrum Finds that Seconds Count and Installs GMAS
Placing Your PACS Archiving Cares into the Cloud
PACS Archive Buzz: Vendor Neutral

Spectrum Finds that Seconds Count and Installs GMAS

The cheap workhorse of PACS archiving media is undoubtedly the tape-based imaging archival system. While tape archives are seen as being reliable and inexpensive, the down side is that it is slow compared to more modern digital storage techniques.

Spectrum Health?one of the largest health care systems in Michigan?says switching from tape to IBM?s Grid Medical Archive System will save $3.4 million over 5 years in IT costs.

But does a radiologist waiting 30 seconds to multiple minutes to call up a prior exam really cost anything compared to inexpensive archiving? Spectrum Health, Grand Rapids, Mich, discovered how a radiologist waiting 30 seconds to multiple minutes can add up. By mostly letting go of tape and switching to IBM’s Grid Medical Archive System (GMAS), Spectrum estimates that it will have saved $3.4 million over 5 years in IT costs with a payback period of 1 year.

Spectrum Health is one of the largest health care systems in Michigan with five hospital campuses and dozens of outpatient and urgent care centers. All of those campuses and outpatient centers generate more than 600,000 new studies a year, adding steadily to the 45 terabytes of faster (and more expensive) online disc storage, sometimes referred to as the “tier 1 cache.”

Spectrum’s tier 1 cache was programmed to store 2 years of imaging data. Anything over 2 years went to Spectrum’s 80 terabytes of tape to be stored for 5 additional years or more. But 60 radiologists put a great deal of stress on their enterprise Tivoli Storage Manager (TSM) tape archiving solutions. Although the older imaging studies were not accessed often, their retrieval time was painstakingly unpredictable.

Steve Lawrence, manager of clinical systems engineering, Spectrum Health, explained, “If a radiologist were to open a study, it became somewhat random whether that study would open in 3 to 5 seconds or 5 minutes or 10 minutes or 15 minutes or 20 minutes. Whenever you pull a full study off of tape, especially a tape system that’s an enterprise TSM infrastructure, you can run into contention with other backup jobs or other request jobs that are happening simultaneously.”

Even allowing for pre-fetch protocols, there was still a cost factor. By pulling prior studies into the tier 1 cache, the more expensive tier 1 storage hardware had to be purchased to accommodate the brand-new exams as well as the priors being pulled from tape.

Spectrum realized that over the course of a year, if each radiologist waited 30 seconds to a minute for a prior, it added up to an average of 125 hours of wait time per year and the loss of millions of dollars in productivity. Even worse, patient care could be at risk if a stat prior exam could not be reliably accessed in a short amount of time.

Enter GMAS: Grid Medical Archive Solution

When Spectrum searched for a solution to replace their overwhelmed enterprise medical archive system, they ultimately settled on IBM’s Grid Medical Archive Solution.

GMAS is a redundant grid archiving system that is both a hardware and a software solution. When an imaging study is sent to the GMAS, it is essentially digitally fingerprinted, copied, and stored in two separate locations. In fact, the fingerprinting function and grid architecture allow GMAS to store imaging data in one location or multiple locations, or multiple nodes at one site, or multiple nodes across multiple sites.

The process also allows older studies to remain in a unique “cache 2” archiving system that allows instant access to older prior studies.

In addition to increased efficiency, GMAS has an intelligent data recovery system. By digitally fingerprinting each study, files are automatically monitored 24/7 for corrupted data and automatically repaired by the second copy on the grid.

Lawrence said, “If anything happens to that file to corrupt it, GMAS can repair it from one of the other copies on the grid. So, you get a lot of redundancy, and it’s smart enough to know when a file has been corrupted and do something about it.”

In the process of migrating to the GMAS system, Lawrence also realized how tape archives, the workhorse of the PACS industry, were not as reliable as he thought.

“Everyone thinks that tape is sort of this end-all for archival,” said Lawrence, “but we had two tape systems, and they were both having the data written to each, independently. When we started retrieving data off of one tape system, we found that out of the 600 hundred tapes, there were six or seven tapes that were corrupted. We said, no problem. We’ll go over to the second system and we’ll pull the same studies off of that one. Well, it turns out there were several hundred studies that happened to be corrupted on both systems.”

Though it was less than a 1% failure, each tape held hundreds of gigabytes of data. He said, “If we’ve got a tape archive holding 5 years of data and here we do about 500,000 or 600,000 studies a year, even a 1% failure translates into thousands of studies that could be lost.”

The Bottom Line

The economic and efficiency benefits of GMAS were also substantial. It now takes less than 2 seconds to retrieve any study—about 95% faster than before—translating into annual productivity savings of about 7,140 hours for the 60-person radiology staff.

Analyzing conservative estimates of radiologist costs and the productivity impact of reduced downtime, Spectrum estimates that over the next 5 years, the radiology labor savings will add up to approximately $2.9 million.

On top of that, Spectrum’s storage hardware costs will save another $1.73 million and the reduced administrative and IT labor requirements save $772,000. Finally, GMAS has built-in migration software that will streamline migration to new hardware and cut down migration costs by $882,000.

Lawrence said that it will be difficult, but that Spectrum will eventually retire their old tapes. With GMAS, the tape systems are redundant and not being utilized for any disaster or data recovery or pre-fetching.

—Tor Valenza

Placing Your PACS Archiving Cares into the Cloud

One way or another, modern PACS/RIS systems are utilizing “Thin” or “Zero” client architecture that enables medical images to be accessible from any computer anywhere, anytime. Often these systems are referred to as being “in the cloud.” But what if a radiologist needs a prior CT cardiac study, stat? More than likely, a 5-year-old imaging study is not going to be in the cloud or a local cache. Instead, it will be stored in an inexpensive, slow, tape archive bunker and can take many minutes to retrieve.

Kenneth A. Rubin

Moreover, all of that bunker imaging data must be housed, managed, maintained, kept secure, and expanded as necessary. It must also be duplicated somewhere to guard against data corruption and unexpected disasters, such as fire, flood, earthquakes, etc. All of this is expensive. Can the recent trend in cloud-based archiving lift that burden?

Traditional Grounded Archiving

While image processing and the reporting data have certainly gone to the cloud with RIS/PACS, the long-term archiving of those images has largely remained on various types of digital media, such as automated digital tape drives, optical hard drives, and other types of storage technology.

Kenneth A. Rubin, senior vice president and general manager, Digital Healthcare Solutions of Boston-based data archiving company, Iron Mountain, explained that more utilization, more PACS systems, and more multislice scanners are creating volume requirements that are increasingly difficult to manage. “That volume has caused hospitals problems [with expense] and access to capital dollars to house the storage systems. It’s also created a more complex environment for them, in terms of managing their backups.”

From Rubin’s perspective, medical image archiving challenges can be boiled down to cost, complexity, and disaster recovery with risk management. The cloud, said Rubin, is now ready to address all of these issues.

The New Cloud

Cloud archiving is not all that new, but it is only in the last 5 years that radiology, CT volumes, and Internet infrastructure have evolved to a point where it is technically and financially feasible for medical imaging archiving.

InSite One is perhaps the first archiving solution to get on the medical imaging radar. Its InDex? product offers long-term storage with all of the necessary medical communication standards, including IHE, DICOM, HL7, and XDS, and provides secure, off-site archive management with a service-based model.

Iron Mountain has offered cloud storage to other industries for a decade and entered the medical archiving market 2 years ago.

Rubin defines the cloud archiving this way: “It’s a service in which the customer has access to the storage without buying hardware or software, which means all of that capital is subtracted from the process; it’s paid for on a pay-as-you go-basis, tightly integrated with PACS applications, and is seamless. So, there’s 100% utilization and users are unaware of our data center in our cloud.”

Not everything is stored in the cloud. Often systems are hybrid. Like ground-based archiving, 18 months to 2 years of imaging data is stored locally on-site in a “tier 1” cache of servers. At the same time, newly acquired studies and older archival studies are securely stored in another server on-site, while a duplicate set of data is sent over high-speed Internet lines to the cloud bunkers many miles away.

Both the local and cloud archives are managed and maintained by the service provider. Other cloud options can have two long-term archives in the cloud, leaving the 2 years of cache as the only data on-site.

When radiologists want to retrieve an old study, the system will either pull from their tier 1 local cache, or, if older, pull the study out of one of the two archives and directly into the PACS system.

Cloud Benefits and Drawbacks

The benefits? In a sense, all archiving and disaster worries have been lifted off the IT department’s shoulders, freeing them to focus on implementing electronic health records, for example. Iron Mountain and other cloud vendors manage the data gateway, the local archive, and the off-site cloud archive. They also provide all the data and disaster recovery duties.

There are many price structures possible, but plans are typically based on a price per gigabyte per month. Unlike ground-based systems, if more long-term archiving space is needed, there is no need to go server shopping. Like the sky, cloud-based storage—and its management—is almost limitless.

Rubin said, “The real benefit of the cloud is that it’s a great deal less expensive than managing storage on your own. There’s about a 4 to 1 ratio of the management costs versus hardware acquisition. So, for every dollar you spend on acquiring terabytes of capacity, you spend three to four dollars on storage management. Data center space, power cooling with utility costs, maintenance contracts, staffing, backup—it all builds up.”

Drawbacks? If one has multiple PACS systems from multiple sites, it adds a layer of complexity and could slow retrieval down. In addition, one must trust the vendor to perform archiving duties as promised. Ultimately, the radiologist will be yelling at the local IT person if something goes wrong, not the cloud.

In addition, you may have to sacrifice a little bit of speed, admitted Rubin. “Speed is a function of bandwidth,” explained Rubin. “Generally, a 40 megabyte study with a 20 megabyte pipe will take 5 seconds or 3 seconds. And if an organization is using pre-fetch in their PACS, then the whole point is moot. So, if I can save 25% or 60% of my cost, I’ll put up with a 5-second delay on access for studies that are seldom retrieved.”

—Tor Valenza

PACS Archive Buzz: Vendor Neutral

As we move into the next generation of PACS for radiology and the rest of the health care enterprise, it is increasingly becoming cumbersome to archive and manage all of that imaging data in a system that is secure, accessible, and cost efficient.

Charles Mallio

With the decrease in cost of a gigabyte of storage, efficiency is perhaps the biggest money loser in PACS archiving today. Part of the efficiency solution is what some call “Vendor Neutral” or “PACS Neutral” or “Enterprise Imaging.”

Here is the issue: Despite industry IT standards such as DICOM, HL7, and others, one archiving system cannot easily communicate with another. Consequently, archived image data in one hospital—or even in one department of a hospital—cannot seamlessly and quickly be retrieved, shared, stored on the same server, or migrated to another archive or another PACS system without cost and time.

As a result, many PACS and archiving companies at RSNA 2009 were touting their version of vendor neutrality in their new PACS offerings.

At the same time, “middleware” companies such as BridgeHead Software Inc, Boston, are offering solutions that allow disparate PACS and archiving systems to act more seamlessly and efficiently.

The Quest for Archiving Vendor Neutrality

As a middleware company representative, Charles Mallio, vice president of business development and corporate marketing at BridgeHead, has a bird’s-eye view of archiving today.

“Vendor-neutral archives divorce the clinical functionality of the PACS from the underlying storage and give hospitals the ability to own all of their data on the storage, while letting the PACS vendor focus more on the clinical value that they’re providing through that PACS system.”

Mallio said that the “black box” architecture that forces hospitals to infinitely expand their storage on the same type of media needs to be more flexible. As an example, he cites a client in Texas who has 1.2 pedibytes of imaging data and who must buy an additional black box of storage media every quarter.

“It doesn’t make sense to keep all old data on fast spinning disk in the archive,” said Mallio. “It may not even make sense to keep it on slower spinning cheaper disks. So do you keep it on tape? Tape is still the cheapest, most transportable medium you can use. Do you send it to the cloud?”

Without some kind of vendor neutrality, those choices are not possible. There’s no shopping around or switching to a less expensive archive media for older, rarely accessed imaging studies. Often, the data on a particular storage system will outlive the technology where it is being archived.

“I think you’re going to see a movement away from those black box solutions to more of an open solution that allows the IT department to use a better mix of storage assets that will evolve over time as that data grows,” said Mallio.

PACS vendors with PACS neutral solutions and middleware companies like BridgeHead can now use intelligent software that abstracts the storage layer and allows the hospital to expand or replace any archiving system and make it seamless to PACS applications—and most importantly, to the radiologists and other clinicians in the hospital.

Politics and Cost

The good news is that the cost per gigabyte of archive media is going to go down, while performance metrics of speed, reliability, and security are continuing to improve. Mallio also sees very fast solid state drives (SSDs) that are currently expensive per gigabyte coming down dramatically in the next few years. “They’re going to become the new standard,” said Mallio, “especially for near term storage where you really need those images for the first 90 days.”

So why hasn’t vendor neutrality happened sooner? Aside from the time to develop such solutions, Mallio said it could often come down to control within the hospital. The chief information officer wants to have all of their systems under one control, but the radiology department doesn’t want to give up their archiving system that is tied to their PACS vendor.

“Eventually, there’s going to be a happy medium where IT will control the storage infrastructure and make it really a service to the radiologist. Then, the radiologist can focus on the clinical functionality of the system and doesn’t have to worry. They just have to be able to call for an image and know that it’s there and let IT figure out the rest. That’s how I see it evolving.”

—Tor Valenza