Healthcare providers have unique data storage challenges. Not only is the data they deal with highly sensitive and highly regulated, but much of it needs to be stored in a live or nearly live state indefinitely. The data must also be kept sacrosanct. For a host of medical reasons (and a few legal ones as well), you cannot alter patients' records once they are archived.
The industry is also experiencing explosive growth in data-from 500 petabytes (PBs) in 2013 to 25,000 PBs by 2020. This is due to a confluence of factors: Digital imaging for diagnosis is improving, 3D ultrasound technology is working its way into clinical settings, and 3-D X-rays and mammograms are becoming industry standards.
These technologies can boost the size of the typical image used today by radiologists and surgeons by a factor of 10. One 60-second scan can generate 10 terabytes (TB) of information, says Greg Hart, vice president of technology for healthcare IT and services firm McKesson. "What that means for storage is a whole shift in how you approach your systems."
Add to that meaningful use, which mandates the implementation, incorporation and use of electronic health record (EHR) systems in clinical settings for everything from entering doctors' orders to creating sharable copies of medical profiles, and you have an industry under siege by data.
And all of this is happening under the overarching mandate from government, insurers, businesses and patients to lower cost and drive waste out of a system that favors redundancy over efficiency, care over cost and privacy over ease of use.
Healthcare Ready to Leap From Legacy Storage Tech to NAS, VNA, Cloud
As an industry, healthcare is behind the times when it comes to using technology. Government mandates mean it must modernize in a hurry. In 2015, the meaningful use incentives being offered to hospitals-millions of dollars, in some cases-turn into penalties.
Moreover, as the program's name suggests, it's about the "meaningful" use of EHR, not just the implementation and adoption of it. "It's not good enough to just have [an EHR system], you have to be using it to a certain level," Hart says, pointing to requirements such as entering 80 percent of all physician orders electronically. "All of this is driving data."
Like Third World counties leapfrogging landlines to build voice and data infrastructures, says IDC Health Insights Research Director Judy Hanover, it's possible for healthcare to replace aging infrastructures with next-generation technology such as scale-out NAS-which is aimed at high-availability, low-latency, high-volume data environments-or cloud-based storage from providers such as Amazon.
"Hospitals are talking about implementing tiered storage architectures and policies that allow them to...determine which images need to be keep in a cache that is available with very low latency and which can be archived to tiers that have more latency but are more economical," she says.
That's what The Ohio State University Wexner Medical Center in Columbus has done with its three-tier storage network from EMC and IBM. (Somewhat surprisingly, email shares priority Tier 1 storage with EHRs.) Most providers aren't here yet, though. In fact, as demand for space outstrips providers' ability to save everything, Hanover is starting to see delete policies for older data that is no longer relevant.
But this is a stop-gap measure. As picture archiving and communication systems (PACS) come online and are installed atop standards-based vendor neutral archives, these systems will let providers manage data much more effectively from a policy perspective. "VNA functionality would allow the implementation of these new clinical policies and these new business-rules based approaches to managing storage," Hanover says.
Cloud vs. On-Premises Storage Debate Has Surprising Winner
Imaging is kicking the demand for more storage into high gear. When PACS and integrated EHR systems are in place, providers are better able to take advantage of data analytics to improve efficiencies and outcomes by examining data across their networks. Most providers are still moving in this direction, though, and the industry has a long way to go before this is the norm.
That was the challenge facing St. Dominic Hospital in Jackson, Miss. Two years ago, the 535-bed hospital that's the hub of a regional network started to evaluate its options for solving its data problems. St. Dominic could continue with its aging SAN architecture, which was ill-suited for managing unstructured data; turn to a cloud provider, which somewhat surprisingly was the most expensive option, or go with scale-out NAS.
After a lengthy evaluation process that looked at major storage vendors such as Dell, IBM, NetApp and AT&T, as well as niche players like Scale Computing, the facility decided on EMC Isilon scale-out NAS. To manage its data, St. Dominic uses EMC data management apps, including InsightIQ performance management, SmartLock data retention, SnapshotIQ data protection and SyncIQ data replication software.
"We've had a massive growth of unstructured data, and it's come from many different areas," says Wendell Pinegar, St. Dominic's applications supervisor. "When we analyzed everything, when we looked at a complete solution, we landed on a scale-out NAS as the center piece of all our unstructured data."
St. Dominic deployed two 100 TB Isilon NL series storage clusters for most of its storage. The facility still maintains a Tier 1 SAN for their XenDesktop virtual desktop (VDI) deployment and transactional databases. It will add 200 TB to this total by the end of this year and again in five years.
While it took only a few hours to stand up the two clusters, moving 500 million records onto the new system took about three months. It will take another year or so to complete the entire migration onto the new clusters. The work is hard, Pinegar says, but the benefits are substantial.
"Think of Isilon as one big C drive. You can store as much as you want up to capacity, and then you can grow a node at a time," he says. In addition, the scale-out NAS makes record retrieval 600 percent faster while improving redundancy levels. Finally, Pinegar estimates that St. Dominic saved 70 percent by opting for Isilon instead of a cloud-based system and will reduce its total cost of ownership by 50 percent over a five-year period.
Isilon came from the life sciences side of the healthcare industry, says Dave Dimond, EMC's chief strategist for healthcare industry solutions, so it's well suited to healthcare provider's demanding environments.
New Facility, New Patients, New Storage Needs
The challenge is similar for Phyllis Teater, CIO at OSU's Wexner Medical Center. As the facility expands (a new billion-dollar hospital is planned to open in July 2014) and more patients enter the OSU network, more storage will be needed. It's not just sheer numbers, too-EHRs and images will continue to drive the storage curve skyward.
"How we store patient records is much more about their virtual record. Anywhere they go, I want to connect those records," Teater says. "As the new tower goes up...you'll see a jump at the rate at which I need to buy new storage absolutely commiserate with the capacity increase of patient care."
OSU leans on 106TB of EMC's VMAX SAN platform for most of its production needs and another 20TB on EMC's VNX5700 for email, printing, clarity and blob. Imaging is handled via the EMC VNX5300 and NS-480 platforms. This adds up to approximately 200TBs. All storage is dual engine and dual connectivity to ensure uptime.
While the data challenge for all industries is great today, so is the opportunity. Insights gleaned from massive amounts of data promise massive efficiency improvements and impressive top-line growth-but only if organizations harness it in a way that is manageable and cost effective. Those are two wildcards storage vendors are working hard to provide.
Allen Bernard is a Columbus, Ohio-based writer who covers IT management and the integration of technology into the enterprise. You can reach him via email or follow him on Twitter @allen_bernard1. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.
Read more about health care in CIO's Health care Drilldown.
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