Image Storage and Sharing as a Service: A DOCHS Case Study

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Six-hospital Daughters of Charity Health System (DOCHS), Los Altos Hills, California, was facing a problem increasingly familiar to providers of imaging services (and particularly to multihospital networks): It was becoming too expensive and difficult to manage its long-term image archive. All archived images were stored in hospital-managed data centers, making them both costly to keep and tough to access. The health system responded by purchasing more tier-one storage, but it was a temporary fix for a growing problem. David SivaDavid Siva, director of medical information systems and technology at DOCHS, says, “Our initial strategy was to grow and manage our storage locally as we leveraged the utilization of our technologies for our variety of PACS, but we found that we were growing at a much greater rate. We found that we had a significant amount of storage that was either unused or not used as well as it could have been—and we needed a better long-term and off-site archive strategy, as well, for disaster recovery.” Cost was also a mounting concern. “Another major driver was managing the operational and capital cost components,” Siva says. “We believed there was a better strategy to be had for the entire picture.” Siva found that strategy in an image-storage solution, called Health Safe, from Symantec™ Health (Mountain View, California). In Symantec’s CIO Digest magazine, Siva describes how he knew that the time was right to try Web-based technology for medical image archiving. “Internet service providers are offering much more bandwidth than they have in the past,”¹ he says, adding that this makes using the Internet (as opposed to a WAN) a viable option for retrieving large datasets quickly. This, in turn, makes smarter management of the image archive possible. Tougher Requirements Numerous factors are contributing to the image-storage problem. HIPAA mandates can complicate business continuity and disaster recovery; to maintain compliance, off-site copies of images have to be stored at secondary sites that are a certain distance from the main data center. Meanwhile, the number of images associated with a standard CT exam is growing exponentially as the available number of detector rows increases, and soon, specialties other than radiology will be contributing their own images to the mix as well. “In addition to the spike in file sizes, there are emerging technologies in pathology and optical imaging that will be making a major dent in our storage,” Siva says. “For health-care technology strategists, that is a major risk area today—it’s no longer just PACS that are driving up image-storage requirements.”¹ Symantec’s Health Safe solution, which DOCHS is pilot testing, works by transmitting images and reports directly from a facility’s PACS to Symantec data centers, from which the information can be retrieved as needed. Health Safe leverages cloud computing, which enables information—and the software necessary to view it—to be accessed, on demand, through the Internet. The more data stored, of course, the more difficulties a health system encounters. Long-term image archiving on-site requires significant capital outlays for powerful servers and for the environments necessary to keep them operating optimally; the energy costs associated with spinning disks and air conditioning can be substantial. “We believe there is significant value in many aspects of this solution, one of those being the capital offset,” Siva explains. “In essence, as we migrate away from a physical on-site storage environment, we leverage the Health Safe solution to offset that operational expense. We’ve validated the value that the solution provides to our organization.” A Robust Solution The speed with which clinicians expect to be able to access archived materials is another factor to take into consideration. “In the old days, in the analog world, a 24-hour turnaround for retrieving an off-site, archived image was perfectly acceptable,” Siva says, “but expectations have changed in the digital world. Now, we need to provide access to archived images in seconds.”1 While Health Safe will aid in ameliorating this issue for DOCHS medical staff, the health system is also pilot testing a second Symantec Health product, Health Image Share, which enables it to grant validated outside users rapid access to images and reports. Siva explains that DOCHS is testing the Health Image Share solution to create a stronger network that’s easier to maintain. “Our efforts there are aimed at providing image access, regardless of the systems we have,” he says. “We are typical of many of our peer organizations—we have a combination of vendors to support a variety of PACS environments. With that in mind, we had leveraged the single storage environment for those, but we didn’t necessarily have the access tools. Image Share will give us the ability to allow ubiquitous access across the different modalities and solutions.” He anticipates being able to provide faster access for outside users. “If someone needs access to a relevant prior study, he or she will be able to get it with a simple request and validation of that request,” he says. “Within minutes, he or she will be able to access any study we have for that patient.” Siva expects both solutions to aid in fulfilling the DOCHS mission of providing the best possible patient care. “We’re no longer bound just to sending or receiving the report,” he says. “We can now provide access to images independent of any browser or PC environment. The value is tremendous because these solutions allow more concurrent care.” Cat Vasko is editor of and associate editor of Radiology Business Journal.