|Data collection increases as technology advances, with imaging alone generating terabytes of data.|
From the moment of hospital admission to discharge, patients generate data. As hospitals go increasingly digital, so does information—not just patient demographics, but also imaging, diagnostic, monitoring, and treatment data.
“If you want to look at what IT has for our location, it’s hundreds of terabytes of information,” says Greg Herr, BSEE, MBA, CCE, director of imaging support/technical assessment for Masterplan Inc at the Health Alliance, a six-hospital system, and The Christ Hospital, Cincinnati. Headquartered in Chatsworth, Calif, Masterplan is a national outsourcing organization that offers clinical technology management and medical equipment maintenance management programs.
As technology advances, data collection shows no sign of abating. Imaging alone generates terabytes of data. “A moderate-size cardiology department that we service does somewhere around 10,000 to 12,000 procedures a year between their echo, cardiology, and cardiac catheterization laboratory,” says Mark A. Weber, manager of clinical systems, Vericis/HeartSuite Hemo Systems, for The Christ Hospital. “We may store 4 terabytes or 5 terabytes of image data.”
Much of that data is stored long-term. Regulations at national, state, and local levels require that clinically relevant information be kept for a specific period of time—no shorter than 5 years and often longer. Pediatric records are typically kept until the patient reaches adulthood (age 18 or 21). Some hospitals decide to keep all data for as long as possible since in some instances, such as oncology, older information can still be clinically relevant.
The options mean that hospitals—and clinical/biomedical engineering departments—need to develop clear data storage plans that incorporate growth, maintenance, migration, expiration, and collaboration. More and more, biomeds in particular find themselves facing data storage challenges that include too little knowledge, time, space, and/or budget.
“I think that as you look at data storage, what you need is a strong investment in both the knowledge and tools to address this,” Herr says.
This knowledge includes understanding the data that is stored, the environment in which it is stored, the technology and its capabilities, future projections, expansion, and protection: against disaster, obsolescence, and the invasion of privacy.
So Much Data
“We’re seeing a tremendous increase in storage requirements for every area of the hospital,” Herr says. Data is kept not just for clinical purposes, but also for education or quality assurance. For instance, Herr sees a lot more video saved in the operating room today than in the past, more often for review and quality assurance than the medical record.
“As technology improves in each of the different parts of the hospital, they are capitalizing on that ability. By saving information, you create a knowledge base,” says Greg Scott, biomedical informatics manager for Masterplan Inc at the Health Alliance and The Christ Hospital.
To save space, however, information that is not needed for clinical, education, or quality assurance is often deleted. Raw data may be discarded once interpretive information and key images have been selected for long-term storage, whereas information that has become part of the legal medical record is automatically kept.
“[Clinicians will] pick certain data that really represent the disease state and that is warehoused,” Weber says. For example, if a study captures 140 images, the clinician may pick only 16 or 20 for long-term storage.
Sometimes, however, raw data is not deleted. If the original modality system does not provide an editing opportunity, the entire set of raw data is sent over. And in some instances, the facility errs on the side of caution and keeps everything as policy. “There’s always a fear that if you let people delete things, they are going to delete the wrong thing,” Weber says.
All in One Place
Saving everything means more storage. With so many different types of data gathered from so many different sources, data collection and storage can be a patchwork of policies and technologies. The data may be stored on the instrument (not all instruments are networked), within the department, or on the health information network. It might be shared between hospitals. Physicians often want access from outside. As a result, many hospitals develop a unique combination of requirements, which can get unwieldy.
“There are a lot of systems that don’t fall within the clinical or IT arenas, and we do our own thing to try and pull that data,” Herr says. This may mean local silos of data and physical trips to the device to retrieve information.
When possible, many facilities try to centralize data storage. Greater standardization can improve productivity, ease maintenance, and reduce associated costs. Health Alliance and The Christ Hospital have implemented centralization when possible. The North Chicago Veterans Affairs Medical Center (VAMC), in North Chicago, Ill, is currently undertaking a project intended to centralize data.
“There are two sides: getting patient demographics to the acquisition system and storing the actual images,” says Shann C. Dilosa, imaging systems specialist in biomedical engineering for the North Chicago VAMC. Centralized storage is expected to make these processes faster, but only if the data can be collected in one place.
Browser technology, often available through vendors and their databases, can also help to speed access to files. Weber notes there are often a lot of different icons on hospitals’ clinical workstations that allow physicians to connect to discrete systems through the Internet.
“A physician can go from ICU to cardiology and just walk over to a computer, click on the icon, enter credentials, and pull up the information,” Weber says. Physicians outside the building have similar options.
As a result, current patient data is often easily accessible through an electronic system, where one exists, but one-off systems and legacy data can be more difficult to find since the information may be stored off the network.
“Often, we have to go recover data from optical-based media [CD/DVD]. There’s no remote capability and no central management,” Scott says of off-network storage. Currently, data storage at the Health Alliance and The Christ Hospital provides immediate access to files less than 2 years old, ready access to those less than 5 years old and greater than 2 years old, and manual access to files greater than 5 years old.
At the North Chicago VAMC, a similar process is used. For instance, recent image studies are immediately accessible, but the PACS manager must pull older data from long-term storage and install it on the optical jukebox. This storage device automatically loads and unloads data available from the optical discs on board. “It takes a few minutes to do,” Dilosa says of the pull.
Newer vendor systems address these challenges, but budget or other resources may limit a facility’s particular options. To ensure the development of adequate storage plans, Weber works with vendors to analyze the types and frequency of data requests that are made.
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Weber uses this data internally to develop storage processes that meet the needs of users and take advantage of existing technologies. “Browser technology has definitely changed the workflow—modernized it and simplified it. Legacy data is still a challenge, because the standards and technology change,” he says.
“Everybody is looking at spinning archives, and we’re now moving toward solid-state drives [SSDs],” Weber says. SSDs use semiconductors rather than “spinning disks” to store data, thus eliminating moving parts. The result is the potential for improved performance (such as faster, quieter) and greater reliability, though cost and possible degradation over multiple uses have limited use in the past.
Ultimately, a mix of media is used. “We have to use a combination of online storage, near-online storage, and offline, which is media on a shelf,” Herr says. Eventually, though, room runs out, particularly when adding terabytes of data.
Ideally, the space crunch takes no one by surprise. Smart clinical/biomedical engineering departments develop forecasts for storage expansion needs, working with IT when appropriate. “If IT has a solution that will work for us, we’ll definitely use it,” Herr says.
Technology, particularly life cycles, is germane to the calculation of growth projections. If a new technology is poised to emerge over the next 18 to 24 months, continued investments in current technology, which will likely become obsolete, may be discontinued.
At the North Chicago VAMC, growth projections also take into account the average size of a study and the number of studies expected to be performed over the year. From this, the PACS manager can calculate approximately how much storage will be needed to accommodate new data.
Weber uses similar projections for a 2- to 3-year forecast, taking into account the specific plans of each facility he manages. “We look at where we are today, where we’ve been over the last 2 years, and what the hospital expects from a volume-growth standpoint,” Weber says.
Consulting with the individual facility about development is key. Some hospitals may be planning to shift their inpatient load to community outpatient centers, which would require less storage; others may be building partnerships intended to increase patient volume and, subsequently, storage requirements.
Naturally, budget is always an issue. At Health Alliance and The Christ Hospital, the clinical/biomedical engineering department must make its storage requests through the clinical departments. “So we make sure we know when the hospital is budgeting and make recommendations to the users,” Herr says, noting the biomed team is not always successful. “Then we have to develop alternatives,” Herr adds.
When storage expansion is approved, the ease of implementation depends on the extent of the project. According to Dilosa, an easy expansion would simply make use of empty storage bays by adding additional media.
A more complex expansion may require the system be taken offline for a few days. Weber notes a current expansion project of his has been in planning for 4 weeks.
Lack of physical space or a change in hardware can contribute to complexity. “Most PACS and data centers go through a whole system upgrade every 3 to 5 years,” Dilosa says.
Before embarking on a storage-expansion project, Weber considers the budget, need, cost of the migration, and necessary facility upgrades. “Do you have to add more space, air conditioning, power?” he asks.
Physical limitations are not uncommon and can drive storage location more so than department. Data can sometimes be warehoused throughout a hospital to maximize the use of empty space. Data can also be stored in specific ways to maximize the use of the budget. Weber recalls one upgrade where it was cheaper to keep 5 to 6 years of legacy data available through an online portal until it expired, rather than migrate it to a completely new system. “We put together an extensive plan,” Weber says.
Backing It Up
That plan, like all others involving data storage, incorporated backup. A variety of regulations govern this area too, both for clinical data and quality assurance. “We are now to the point where we’d like to standardize our backup process,” Scott says, noting challenges include regulatory compliance, off-network devices, and dissimilar environments.
Because it is so difficult to standardize, a plan is needed for each device. “We always say there are two types of data users: those who have lost data and those who haven’t,” Weber says.
Backing up is, therefore, a complex process with daily, weekly, and monthly workflow impact. Dilosa estimates that he spends about 25% of his time on data storage issues.
“There’s definitely a lot of oversight that occurs,” Weber says. Examples of daily backup tasks include archive checks, error reports, and matched ordering information; weekly responsibilities include tape rotation and backup duplication. Even interfacing with an outside storage firm takes time.
Protecting against obsolescence can use just as many resources as protecting against disaster. Data migrations are expensive (Weber quotes one project at $15,000) and may not always be successful—technology can disappoint.
“The entire industry found out the dyes [used in 20-year storage media] were starting to degrade faster than was interpreted. Or magnetic tape—that’s supposed to be good for 10 years—we found out that after 4 or 5 years it may not be fully readable,” Weber says.
Even if the technology performs to specifications, for hospitals with very long-term storage plans, a short-term plan should be in place to keep data storage systems compatible with data display systems. “A hospital may have data they need to keep for another 20 years … so they need to look at how technology is going to change and what they need to do to address that,” Scott says.
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The challenges require biomeds to keep one foot in the clinical world and one in the technological—a position they often find themselves balancing in the 21st century. “We’re basically providing services that IT can’t or doesn’t provide and that need specialized knowledge. Data storage is just one of those components,” Herr says.
Although data storage is just one component, it is a common one throughout hospitals, and experts recommend that biomeds acquire what knowledge they can because for a hospital, there can never really be too much data, too much protection, or too much knowledge.
Renee Diiulio is a contributing writer for 24×7. For more information, contact .