The process of storing and archiving medical-image data is no longer just about moving files from being paper- and film-based to digital. (Of course, that’s still happening; indeed, the pace of transfer to digital is accelerating, if anything.) But the main move today, experts say, is to consolidate data- and image-storage activities?which are primarily digital these days?all over a facility into a single hospital-wide department. That development is due in part to the mandates of HIPAA as well as to the spread of digital storage and archiving technology to more and more departments within large hospitals and clinics?and to smaller and smaller facilities.
“We see a growing consolidation of storage and archiving within healthcare organizations under some sort of central information-technology [(IT)] organization,” explains Andy Richards, VP of Plasmon (Englewood, Colo). “That’s helping to dissolve some of the Balkanization of information among different departments.” The company recently released its Ultra-Density Optical (UDO) Archive Appliance, a preconfigured device designed to meet the growing PACS, HIS, and RIS needs of facilities.
Jitu Urankar, healthcare ILM solutions manager at Sun Microsystems (Louisville, Colo), agrees. “PACS caught on about 10 years ago,” he explains. “[PACS solutions] are very well-adapted, and more and more facilities want to store more and more data digitally?that is for sure.” At most hospitals, cardiology and radiology departments jumped on the bandwagon first, but the rest of the facility’s departments lagged far behind. Their hesitance? “Once you go digital, you change your entire workflow,” he explains. “Over the past 10 years, we saw that radiology and cardiology were using PACS, but when you look at the overall picture of a hospital’s IT, those solutions were departmental solutions. Decisions were being made by department heads.”
Then came HIPAA. “Now, those decisions are starting to move from department heads to the facility’s IT head,” Urankar notes. The two major aspects of HIPAA are privacy and security. And security, he says, is especially critical in light of the devastation in the Southeast caused by Hurricanes Katrina and Rita. “If you have a disaster, what happens to your data?” he asks. “So hospital CIOs started realizing that there needs to be a central facility to manage digital information.”
Trend 1: Consolidating Storage
“The number-one trend in medical imaging is consolidation of storage, so that there’s one IT department managing storage for the whole hospital,” Urankar says, noting that this trend is a good thing. “If one department takes care of the image-storage technology for the whole hospital, you benefit from one centralized department developing skill sets that would go a long way in overall planning of the hospital’s IT needs, for one thing. Also, you can save costs and use your available image-storage capacity more efficiently. And a hospital should be specializing in patient care, not image-storage and -archiving technology. Having a centralized department doing that makes sense.”
When hospitals do consolidate image storage and management, they often include an off-site element to enhance the data security mandated by HIPAA. Hunt Russell, director of business development at Evolving Solutions (Hamel, Minn), notes that image storage is a fast-growing area because with technology improvements, modalities are producing more digital images. “Such modalities as CT, MRI, and PET have been producing digital images for many years and were the main modalities to do so,” he explains. “But over the past few years, modalities that used film?such as mammography and chest X-rays?are now able to produce digital images. It will be many years before all the physical X-rays are gone, because they’re too costly to digitize and save on disk. But as more facilities incorporate more digital modalities and save the output to disk, the new location for storage will be the computer room?not the filing room.”
Thus, he reports, “the trend today is to store at least several months of archived images in-house and then move it to an off-site organization to store the images on low-cost disk, tape, and DVD.”
Trend 2: Inside Job or Outsource?
“Another big trend in medical imaging is the decision whether to keep data in-house or outsource it,” Urankar says. “Based on the size of the facility, some larger hospitals will want to maintain their data in-house. Even some medium-sized and small hospitals are finding that having full-time IT administration in-house is not that difficult.” He adds that lately, he’s seen hospitals on the lookout for “pay-as-you-go models for storage financing, and others are looking at a combination of in-house and outsourced. They want the technology in-house but want administration outsourced to a third party.” As a result, he says, medical-imaging managers should expect remote monitoring to grow “big time.”
According to John Pearring, president of STORServer Inc (Colorado Springs, Colo), a key motivating factor in the move to outsourced image storage is the need for security?which the recent destruction along the Gulf Coast has brought into sharp focus. “Physical image storage on film and paper are slowly, but completely, migrating to digital,” he explains. “Few, if any significant portion, of the existing images, however, will be converted?simply due to the existing problem of capturing new images to digital. Historical records of old film archives in libraries, for example, are a reminder of how long those transfers will take.
The Downside of Digital
Tips for finding the right solution for your storage needs
As enthusiastic as its proponents are, digital storage and archiving of medical images is not a magic bullet. Like any technology, the benefits it brings are tempered by the challenges it poses.
“One drawback is the need to maintain adequate safeguards against data loss or theft,” says Andy Richards of Plasmon Inc. “That’s partly a function of expertise and partly a function of technology. Technology will evolve to address those requirements, and expertise is available in the market. The obsolescence of specific products is, for the most part, not a nefarious manufacturer’s scheme. Rather, it reflects a drive to provide faster, bigger, and better solutions through technology development?although there is a cost to moving to new technologies. Still, the overall outlay for digital storage is less than that for paper or film storage.”
Of course, that’s not the case if you overspend?which can be a problem, notes Jim Sherhart of PowerFile. “In our market research, we mainly see customers who purchase products that are greater and more expensive than their requirements,” he explains. “Customers who do not completely understand or research product requirements and technical specifications are at a disadvantage in that area.”
The opposite also happens, notes Jitu Urankar of Sun Microsystems. “Be sure to ask if the solution you’re buying is flexible and scalable,” he advises. “Many times, a smaller facility will buy a cheaper solution. Then, as the department grows, they find the solution isn’t big enough, and they have to upgrade to a new solution. You could run into system and performance problems?not to mention quality-of-care problems.”
Still, not everyone shares the view that obsolescence is not planned. Ask Sherhart if manufacturers’ planned technological obsolescence after a considerable cash outlay is a problem with digital systems, and his answer is clear. “Absolutely,” he says. “That’s one of the main reasons my company promotes a solution built on industry-standard technology. All CDs and DVDs written in a PowerFile unit can be read in any CD or DVD drive. And even though some competitive formats?such as UDO?are written in standard formats, they still require a proprietary drive to read the data.”
For that reason, Sherhart says, “Anyone considering purchasing technology for long-term storage should really consider the ramifications and costs associated with proprietary solutions. Hidden costs, such as power consumption, proprietary media, maintenance, and data migration, can quickly make a low-cost solution much more expensive over time.”
Finding the right vendor is a challenge as well, Urankar cautions. “Say you decide to outsource to a third party,” he says. “Be sure that company will stay around. Don’t outsource to a company that will be bankrupt in a year. Make sure you use a solid player.” And, he stresses, imaging managers must ask vendors what kind of assistance they can expect in solving problems.
Patient specificity can still be a problem, Urankar adds. “With film, you know a file belongs to a certain patient,” he explains. “Now, with digital, there is no sophistication yet to isolate data based on the age or type of procedure done. All the data just sit next to each other. There’s no way yet to isolate and shred the data. That’s a challenge.”
But despite the drawbacks, Hunt Russell of Evolving Solutions is sold on the concept of digital-image storage. “With technology proving to have a long shelf life,” he says, “images can be kept as long as a patient is alive. There are no real pitfalls to storing digital images as long as it is done correctly.”
“Eventually,” he continues, “all important public reference images will probably be transferred, though it could take several decades. Private and nonessential public reference information will move to digital sporadically, I imagine, but the opportunity for effective, automated storage-capture devices will be an ongoing source of revenue.” However, Pearring emphasizes, “One of the large motivating factors isn’t the actual digital image, but the opportunity to have a backup copy and a disaster-recovery duplicate in a safe location. Duplication of digital information is practically free, compared to duplication of a physical image.”
The need for a disaster-recovery plan has spawned an interesting side trend, Urankar notes. “All the major hospitals in New Orleans were under water,” he explains. “What happens to those data if they’re not backed up? Hospitals are looking more closely at new types of business-continuity solutions?such as several facilities combining their often-limited image-storage resources. Say there’s a hospital in Florida and another in Minnesota with similar storage needs?and similarly restricted finances. Because they don’t compete, they could become each other’s disaster-recovery sites. And you could have satellite facilities outsourcing their disaster recovery to a major hospital or group of institutions at a site where all of the consolidated data could be stored.”
Trend 3: Handling Old Films
Interestingly, the federal law that has medical-imaging executives scrambling for data-security solutions has little to say about all of the existing film that hospitals have amassed over the years. “HIPAA is unclear regarding older information,” Pearring comments. “Most analysts steer clear of interpreting its actual effects on legacy or grandfathered data in physical image states. I doubt if federal law will have any meaningful impact on the migration from physical to digital beyond the more practical motivations of storage costs, duplicating costs, and content-management requirements.”
What the law does, Plasmon’s Richards adds, is impose “specific requirements that deal with ensuring the confidentiality, integrity, availability, and longevity of medical images. That requires a solution that is not only durable and robust, but that also possesses a technology road map to guarantee access for many years to come as well.”
Jon Mello, a former hospital administrator and director of the global healthcare marketing group at EMC Corp (Hopkinton, Mass), stresses that HIPAA specifically requires a business-continuity plan. “It must be created by each individual organization. But whether it’s paper-based or digital doesn’t matter as long as you have a plan,” he says, adding, “most hospitals are taking it very seriously that their data have to be continuously protected.”
Overall, though, Mello believes that HIPAA has had a positive effect on digital image-storage trends. “It has really increased the attention of healthcare organizations to give a hard look at what they plan to protect and how,” he comments.
Evolving Solutions’ Russell agrees. “It actually helps facilities understand that patient information, whether in the form of patient text or patient images, needs to be safeguarded securely today,” he says. “But HIPAA might hinder some organizations if the budget is not there to put in a new storage area network as well as the servers and software needed to manage it.”
It’s just not black and white, says Jim Sherhart, director of product marketing at PowerFile (Santa Clara, Calif). “Whether HIPAA regulations help or hinder storage and archive activities depends on the audience,” he notes. “But the fact remains that there is a need for cost-effective, long-term storage in the medical industry.” He does point out one specific item in the massive law: “Although HIPAA does not require medical organizations to keep patient records for a specific period of time, patients can pursue litigation for seven years after a procedure. If the patient is under the age of 18, he or she can pursue litigation until the age of 25. Because of that liability, malpractice carriers typically recommend keeping patient records for at least 10 years.”
Trend 4: Several Solutions
HIPAA compliance, the experts note, can be accomplished through a burgeoning array of digital-storage solutions. Digital archives require a storage system that can deliver data in a timely fashion, guarantee delivery of the data in a mission-critical fashion, and secure the longevity of the data to match the organization’s specific business needs, Richards notes. With today’s options, these goals often can be achieved with a mix of storage technologies. Solutions generally include software, connectivity, and hardware elements. The three main types of storage hardware are hard disk-based systems, tape systems, and optical storage systems.
“Each has its strengths and weaknesses,” he explains. “Disk-based systems have rapid access times and are best for online storage.” Sherhart agrees that disk- and content-addressable storage systems offer “excellent performance,” but notes that images are “still stored on volatile magnetic media. Hard copies do not address the long-term storage needs of the imaging industry.”
Tape systems, Richards opines, “have low media costs and large bandwidth, making them a good choice for backup applications, although disk systems are increasingly eating into the backup market.” They are relatively inexpensive to acquire, Sherhart adds, and they do offer excellent density. “But information is offline,” he adds, “and its sequential nature makes accessing files difficult and time-consuming. Also, changing formats and magnetic media require frequent and costly data migration.”
Optical storage, with access times almost as good as hard disk drive-based systems, lowers the cost of acquisition and the total cost of ownership, Richards says. Those systems “also offer far superior durability than either disk or tape and can guarantee absolute authenticity at the physical level.” Sherhart notes that the technology also “offers random, near-line access to files within seconds, true write-once-read-many?or WORM?media, and the lowest total cost of ownership for long-term persistent storage.”
Unfortunately, Pearring adds, the only cost-efficient way to transfer old images into storage in the first place is hand scanning, with minimal automation. “Labor is very expensive,” he explains. “Space is still less costly than image transfer, however. As new technologies develop to automate the process and lower the actual image-transfer cost, data will be migrated more readily.” But, aside from the need to duplicate images for backup and disaster recovery, he says, content-management software could drive that effort before any other technology does. “That is,” he says, “good filing-system tools that make digital-storage capture and organization more in tune with logical lifecycle-management policies will speed up digital transfer of old data.”
Trend 5: It’s a Must
Of course, the only constant in technology is change?and image storage and archiving is no exception. “Digital storage is indeed the future for medical-image storage,” Richards states. “It will not be obsolete anytime soon, but will evolve continuously. Capacities and performance of existing technologies will increase, such as UDO, which will double in capacity every couple of years and increase access speed by at least 50 percent with each generation. There also will be new digital-storage technologies introduced, some of which will ultimately displace existing technologies.”
A complementary technology on the horizon, which Pearring calls “sexy,” is content-management tools, as database improvements enhance both the performance and the efficiency of access to digital storage. “Virtual storage will remove the problematic direct link between data and media,” he says, “but most users won’t care about the cool factor. Eventually, actual media will be transparent to almost all users. Only ‘techno-geeks’ will be wide-eyed over the new hardware technologies, which will continue to be amazing. That’s the trend for success in any technology.”
Sherhart adds that traditional storage systems were designed for about 90 days of online data and offline archive for disaster-recovery purposes. “But the need for low-cost, persistent storage available online that can last for a minimum of 10 years is challenging the traditional storage technologies,” he says. “That’s why PowerFile has leveraged the unique attributes of DVD media with intelligent software to offer a storage solution specifically designed to address the long-term needs of the medical industry. Some amazing technologies on the horizon will increase density and performance without adding significant costs. Current DVD technology uses red lasers, but such formats as HD-DVD and Blu-ray use blue-laser technology to double performance and triple density this year. Blu-ray already has demonstrated 150 gigabytes on a single DVD-sized disc, so the road map for blue-laser optical technology is very compelling.”
Despite the rapid pace of change, though, Sherhart allays imaging managers’ concerns that their often budget-busting investments in storage and archiving technology will not be money wasted when manufacturers’ planned obsolescence rears its less-than-pretty head. “Despite the amazing advancements in imaging technology?such as 3-D echocardiography equipment and
32-/64-slice CT scanners-most of the customers we have spoken with expect their current equipment to last for five to ten years before becoming obsolete,” he reports. “Modality manufacturers will continue to push the technological envelope, but the pace of adoption will continue to lag.”
At the end of the day, of course, storage is storage?from paper files in rooms full of metal shelves to digital images stored off-site. “It always will be about making sure you’re storing the right thing,” EMC’s Mello says. “You’ll always have to decide what to store, what to keep safe, what should be in a disaster-recovery plan, and what kind of business-continuity approach you should have to get the information you need from an archive platform. Yes, all of this great, sophisticated stuff is coming to market, but it’s still a question of how much redundancy you want.”
Russell A. Jackson is a contributing writer for Medical Imaging.