John Halamka, M.D. and CIO, CareGroup Health System, Beth Israel Deaconess Medical Center, and Harvard Medical School

The Doctor Is In

Treating the storage pains of healthcare organizations

Faced with tightening budgets and escalating demands on data-storage resources, IT professionals in healthcare organizations worldwide are finding themselves in a pinch.

"Of course, budgets don't go up quite as fast as the demand for services increases," says John Halamka, M.D. and CIO of CareGroup Health System, Beth Israel Deaconess Medical Center, and Harvard Medical School in Boston, Massachusetts.

"Every healthcare CIO in America generally feels like no matter what their budget is, it is too small."

Dealing with budgetary constraints is part of the job, says Halamka. "I'm an emergency physician, so it's all about triage," he says, explaining how he justifies technology spending, including storage-management assets. "For every project and purchase, I use objective criteria of quality and compliance, return on investment, and impact factor to help me triage what we do and what we don't."

It's a similar story for health insurance providers such as ARGE AOK-IS Mitte, one of Germany's largest health insurers with about 4 million subscribers. "Because we are government ruled and politics are involved, we are very much under pressure to reduce costs so that patients' premiums do not rise too much," says Siegfried Baaske, ARGE AOK-IS Mitte's chief information officer.

That pressure for Baaske has led to centralizing the organization's IT operations, in particular the storage infrastructure used to archive emails. This centralization was critical in terms of ensuring that the insurer can meet stringent e-discovery laws that regulate the archiving and retrieval of email messages for litigation purposes, Baaske says.

New solutions, new challenges

If this all seems as familiar as the old doctor-patient saw, "I'm not sure what's worse, Doc, the disease or the treatment," it's because when it comes to treating what ails healthcare IT these days, it seems that every new solution brings with it a new challenge.

Halamka says there is good news, too. "I haven't used film since 1998. Every X-ray, mammography-they're all captured digitally." The less-than-good news: All that digital information costs money to store. With data storage needs growing more than 25 percent annually, managing storage resources has become a hot-button topic for CareGroup. According to Halamka, the Beth Israel Deaconess Medical Center generates five terabytes of medical imaging data annually. New technology inevitably leads to questions for him and his IT colleagues. "How do I back it up?" he asks. "How do I provide disaster recovery? How do I even afford the cost of that much storage? What about information lifecycle management?"

Tiered architecture

To keep pace with data stores currently in the 100-terabyte range, Beth Israel Deaconess Medical Center has implemented an information lifecycle management solution that relies on a three-tier storage architecture.

At the top tier is a Symmetrix DMX Fibre Channel array. "I put all of my most important medical information there," says Halamka. "An X-ray taken today goes to that storage. But what's the value of an X-ray that's a year old?" he asks. "It's a little less, so I take it off the most expensive storage and move it to a CLARiiON, EMC's less-expensive system. The value of a five-year-old X-ray is even less, so I'll move it to EMC Centera storage."

Halamka and Michael Passe, the hospital's storage architect, rely on NetBackup 6.0 to provide data backup and recovery services. They've also deployed Symantec's Storage Foundation on a subset of their Microsoft Windows platforms for volume virtualization. "This aids in volume expansion and migration from storage platform to storage platform without service disruption," explains Passe. "Our enterprise email and file services archival software is Symantec's Enterprise Vault, although we're not in production with the archiving solution yet."

The project's goal, says Halamka, is to deliver "a virtually 'bottomless' mailbox and eliminate the use of archived Outlook .PST files where possible. This will reduce the number of end users calling technical support asking for larger mailboxes and eliminate reliance on Outlook's email file-which is easily corrupted-as a source for email backups.