Vertical Focus: Hospitals Scrutinize Digital Storage

The challenge of digitizing and storing decades' worth of paper records is fast emerging as one of the toughest technology projects in healthcare, according to users on both sides of the Atlantic.

"The whole data ceiling is exploding," explains Dr. Zafar Chaudry, IT director at the Liverpool Women's Hospital in Northern England. "As organizations get more 'paper-light,' it is causing exponential growth in electronic data."

It is the same situation on this side of the pond, according to John McKissack, director of facilities services at Baptist St.Anthony's Health System in Amarillo, Texas.

"We have got [paper] records that go back thirty years that we have got to store -- it's a daunting task to look at thousands and thousands of files and think: 'Where do I start?'."

In the case of the Liverpool Women's Hospital, this means tackling some 250,000 paper records that are currently stored at an offsite facility."Our plan is to use a 'scan on demand' service," says Chaudry, explaining that, up until now, the hospital paid up to $80 to get individual paper records couriered over to its site in downtown Liverpool and then sent back to the storage site.

Liverpool Women's Hospital recently struck a deal with U.K.-managed storage specialist Squirrel Storage to set up a service to scan individual records, which Chaudry hopes will boost patient care and streamline his records system.

"They will scan the record and make it available to the doctors within two hours," he says, explaining that the 'scan on demand' service will create PDFs that can be quickly searched for keywords, such as patient names and their specific medical conditions.

"Our records are on average 35 pages long, and it will cost us about $4.60 to digitize every record," he adds.

Although still planning its 'scan on demand' strategy, the hospital has already built out its underlying storage infrastructure to cope with an influx of newly digitized records."Three years ago we only had 500 Gbytes [but now] we have about 30 Tbytes," says Chaudry, explaining that this includes Dell servers, VMware software, two EMC Clariion SANs, and a recently deployed Centera device from EMC.

"We're using about five Tbytes for disk-to-disk backup and five Tbytes for clinical and non-clinical applications," explains the exec. "We built that additional 20 Tbytes because we know that we're about to start digitizing -- that is going to get eaten up."

The hospital, which already has an electronic medical records system from MediTech for its more recent data, is also on the lookout for a state-of-the-art content management system.

"Once we have digitized the paper, the next big challenge is which content management system we use to store that data," says Chaudry, explaining that he is keen to look at EMC's Documentum, albeit with some reservations.

"The high-end content management systems from IBM and EMC are very expensive," adds the exec. "The new company on the block is Alfresco, an open source content management system that is free, so we will be looking at that."Like the Liverpool Women's Hospital, Baptist St. Anthony's Healthcare is also using a third party, Xerox Global Services, to scan its paper files and turn them into electronic records, although McKissack feels that the goal of a paperless hospital is an impossibility.

"The electronic medical record is not the end-all," he says. "With the introduction of electronic medical records, our paper production went up 212 percent -- instead of having one paper chart that everyone looked at, we have an electronic chart that multiple departments will print copies of."

Like his U.K. counterpart, McKissack is also unwilling to digitize all of his paper records. "It requires so many full-time employees and so much equipment to scan them in and then store them that it's really not cost-effective," he explains. "It's more cost-effective to keep them in a traditional warehouse."

The lawsuit-happy culture of the U.S. also plays a big part in McKissack's records management strategy.

"In many cases, once we reach the date that a file can be destroyed, it's destroyed," he says. "In the litigious society in which we live, anything that we have is discoverable -- by not destroying it at the time it can be destroyed, you're opening yourself up to legal action."Clearly, electronic records, although quicker to access than hard copy charts and images, bring a host of organizational challenges that users need to think through.

"It requires an immense amount of throughput and planning," says Derek Danois, president of the National Digital Medical Archive (NDMA), which stores around 100 million images for over 50 U.S. hospitals.

"They have to decide what type of digitization they do," he says, explaining that firms must weigh the pros and cons of creating searchable, but expensive, PDF files versus simple scans of existing paper records.

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