Storage for Electronic Health Care Systems

8/4/2019 Storage for Electronic Health Care Systems

http://slidepdf.com/reader/full/storage-for-electronic-health-care-systems 1/19

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STORAGE FOR

ELECTRONICHEALTH

CARE SYSTEMS

With all of the uncertaintysurrounding electronic healthrecords, one thing is for sure:You’ll be storing more data, withmore protection and for longertimes. Learn how to accomplishthat without breaking the bank.

By Al Gallant

INSIDE :

+ STORAGE FOR

HEALTH CARE

APPLICATIONS

+ RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

+ TIERED STORAGEAND BACKUPS

+ EMERGING BEST

PRACTICES



Storage for Health CareApplications

if you’re a health care CIO trying to understand your organization’s future stor-

age requirements, you have to consider some data points that CIOs in other indus-

tries would never worry about. For example, what is the age of majority in the

states in which your organization operates?

According to legal dictionaries, the age of majority is set by statute as the age a

person first gains the legal rights and responsibilities of an adult. But for health

care CIOs, it also marks the end of the legally required data retention period for

patients born in your facility.

The New Hampshire medical center where

I work services approximately 400 births each

year. Some of these births require extensive

medical imaging diagnostics such as a com-

puted tomography (CT) study. Typical CT

studies are made up of 256 slices, each a 500

KB image. A single study would require 128

MB of data storage. Now, for a single infant

born in New Hampshire in 2009, this 128 MB

study’s images would need to be retained until seven years after the infant reaches

the age of majority. In New Hampshire, that’s 18 years old. The total years of re-

taining this image study in storage as required by HIPPA and New Hampshire

state law is 25 years. How many non-health care CIOs do you know who worry

about their storage requirements out to 2034?

Now, take the same patient and increase the storage requirements based on the

patient’s electronic health record (EHR), which could include multiple diagnostic

images, physician orders, prescription lists, progress notes, X-rays, MRI and lab

results for every clinical visit, and all of a sudden the EHR storage requirements is

in gigabytes. Multiply this by the number of patients born each year, and the num-

ber can quickly move to terabytes.

2 STORAGE FOR ELECTRONIC HEALTH CARE SYSTEMS

STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

How many non-

health care CIOs

do you know who

worry about their

storage requirements

out to 2034?



For many health care institutions, that’s a long-term problem. My hospital, for

example, began with digital storage of radiology images only. Now we have imagestorage requirements for cardiology, neurology, cancer, obstetrics, cosmetic sur-

gery, the spine center, orthopedics, the lab and the trauma center, with more and

more departments requesting image storage.

The largest image storage requirement we manage is for the neurology center.

Our neurology center has a process that synchronizes patient video monitoring

with electroencephalography (EEG) imaging captures, allowing the neurologist to

study a patient’s physical symptoms as the EEG records neurological events. Some

of these studies use continuous monitoring for up to four days. These video im-ages require significant amounts of disk storage. We are managing 8 terabytes

(TB) of video storage for approximately six to eight months of patient visits.

These types of health care video/imaging storage requirements are substantially

different from the data retention and storage requirements for banking, tax return

and credit cards records, and what companies like Amazon.com Inc. keep on file

regarding client purchase records.

So where does a health care CIO keep all this storage? Three places: tiered stor-

age, tiered storage and tiered storage. Image storage is static storage. Once theimage is captured, it will not be modified. Typically, the process is to capture the

image on Tier 1 storage and keep it there temporarily during clinical review. At

some point, usually within a month, the images are moved to Tier 2 storage. After

six months, the images are then moved to Tier 3 or higher because future clinical

review would not require instantaneous access to the medical images. We do this

quarterly with scripts, so that it takes very little staff time to do.

In Figure 1 (page 4), you can see an example of how to use tiered storage in a

hospital information system. Definitions of tiered storage vary greatly from ven-dor to vendor and medical organization to medical organization. This example of

tiered storage is based on raid levels, performance and cost:

I Tier 1 15 KB or greater, 146 GB Fibre Channel (FC) disk with RAID 5 and

shadowing (approximately $15 per gigabyte).


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES



I Tier 2 10 KB, 300 GB FC disk with RAID 5 and shadowing (approximately

$10 per gigabyte).I Tier 3 10 KB, 300 GB FC disk with RAID 5 and no shadowing (approximately

$5 per gigabyte).

I Tier 4 1 TB FATA disk with RAID 5 and no shadowing (approximately $3 per

gigabyte).

The most cost-effective way to manage image storage is with an enterprise stor-

age area network (SAN) solution. Some image vendors, especially those that want

to manage the entire imaging system, will insist on a direct-attached storage array.Most imaging vendors realize the investment a health care institution makes to a


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

Figure 1: Tiered Storage for Health Care Institutions

Dual Fiber Core SANS

VideoCaptureAppliance

EHRSystem

PACSSystem

FiberDiskAppliance

Tier 1 Storage

Tier 2 Storage Tier 3 Storage

Tier 4 Storage

Fiber

DiskAppliance VirtualTapeLibrary

DeDupAppliance

Fiber

DiskAppliance

FiberDiskAppliance

Dual Core Network



SAN solution and will work with its information systems department to use

SAN storage. One of the important things to remember when is that the Food andDrug Administration (FDA) does not require an approval process for disk storage

for medical images. If your vendor tries to tell you the storage has to be FDA-

approved, feel free to show it the actual regulation in Figure 2.

One last consideration is whether to mix clinical and other data on the same

SAN. While some device and medical application vendors will push you away

from that, the increasing integration of health care data demands at least some co-

mingling. The key is to always make sure your storage for clinical data is deliver-

ing the performance you need. I


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

Figure 2: The FDA and Storage Devices

Contrary to what

you may hear from

some vendors,

the FDA does not

approve specific

storage devices for

medical use. The

language of the

regulation merely

describes generic

data storage

technologies.

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=892.2010

http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=892.2010



Healthy Storage Cures PACS,EMR Data Growing Pains

ALAN HOWARD

IT Director

Princeton Radiology

Better Care ThroughBetter Storage

www.compellent.com

Data-intensive image archiving, administration systems and

electronic medical records have exponentially increased

data storage and recovery needs in the healthcare industry.

Compellent is on call for the always-on IT departments at

hospitals and clinics, giving them the easy-to-use, flexible

storage system they need to provide the best patient care.

Is your storage ready for explosiv

data growth?

Read this IDC report to see how

Princeton Radiology prepared.

Analyst Brief: Dramatically Improve

Recovery and Reduce Storage Cos

for Patient Imaging Environment

Learn why easy provisioning, auto-

mated tiering and continuous data

protection give you the power toput patients first.

With the Compellent SAN, we were

able to simply add drives and allocate

that capacity without reprovisioning

servers.

http://www.compellent.com/~/media/com/Files/White_Papers/IDC_Princeton.ashx







Radiology Information System/Picture

Archiving andCommunication System

a radiology information system/picture archiving and communication sys-

tem (RIS/PACS) manages medical images. RIS/PACS pioneers started serious de-

velopment work in the mid-1980s. Researchers at universities across the country

saw digital imaging as the practical solution to storing medical images. They knew

film-based medical imaging had serious limitations: It could be in only one place

at a time, usually not where it was needed. The time it took to get the film to where

it was needed was a lengthy process, and film was easy to lose in transit. Storage

of the film-based images was difficult to manage. It was bulky, heavy and fragile.

Exposure to heat, cold and sun would easily damage films.

Digital imaging eliminates these issues. The biggest benefit of digital images is

the ability to be seen by anyone, wherever they were, as long as the images adhere

to the Digital Imaging and Communications in Medicine (DICOM) standard.

DICOM also came about in the mid-1980s, created as a standard for digital imag-

ing by the American College of Radiology (ACR) and the National Electrical Man-

ufacturers Association. These two associations created a much-needed successful

relationship between the clinicians who needed digital imaging and vendors who

could build it.

DICOM PS3 is the present standard. It covers just about every medical modal-

ity, the type of medical equipment that can acquire images of the human body. A

short list of DICOM image modalities would be ultrasound, magnetic resonance

(MR), positron emission tomography, CT, endoscopy, mammograms, digital radi-

ography and computed radiography.

RIS/PACS systems are specialized computer systems that can capture DICOM

images from a host of modalities and store the images in a hierarchical file struc-

ture/database for clinical review. Even though DICOM has been around since the

1980s, it was not until 2004 that the Food and Drug Administration approved the

first RIS/PACS. Since then, all the major modality manufacturers—GE, Philips


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

http://dicom.nema.org/

http://dicom.nema.org/



and Siemens, for example—have developed FDA-approved RIS/PACS systems.

The components of a RIS/PACS system that acquire FDA approval are the com-puter system that interfaces with the modality equipment and the image review

monitor. The disk or SAN storage does not require FDA approval.

RIS/PACS systems can now be found in all sizes and specialties. The vendor

market has greatly expanded from the large medical devices vendors like GE and

Philips to the niche market vendors. The cost of PACS systems is also diminishing.

At one time, the large vendors pretty much controlled the market because of their

custom interface to their modality equipment, but with the DICOM standards de-

velopment and FDA approval process, moreand more vendors are competitively driving

the market to provide lower-cost solutions.

The most significant changes are newer, Web-

based RIS/PACS systems that greatly expand

the image viewing availability by providing

cloud-based storage with Web/Internet image

viewing.

These cloud-based RIS/PACS systems aredriving down the cost of medical image storage. However, the costs of RIS/PACS

systems are still driven from the process developed in the old film image days.

Most RIS/PACS vendors still charge by the image—so it doesn’t take long for a

RIS/PACS system to become very expensive. This is why most advanced

RIS/PACS systems are limited to large health care institutions that benefit from

the long-term total cost of ownership of the hardware. They also benefit from hav-

ing many different modalities. Smaller health care providers might have only X-

ray and ultrasound modalities, making a RIS/PACS system just too costly.That’s why Web-based service providers of RIS/PACS are getting a lot of atten-

tion. The RIS/PACS provider can service multiple smaller health care service

providers easily over the Internet, sharing the central hardware resources and

spreading out the total cost of ownership.

The fasting-growing imaging development in PACS systems is three-dimen-


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

Most RIS/PACS

vendors still charge

by the image—so it

doesn’t take long to

become expensive.



sional imaging and video. Although 3-D imaging has been around since the early

1990s, it has been making dramatic health care advancement in the last four years.I have recently seen two vendors offering 3-D MRI and CT PACS systems. The

smaller vendor’s system priced out at $400,000, and the other was almost $1 mil-

lion. Keep in mind, 3-D PACS systems are not cheap.

Why 3-D? The biggest benefit and greatest impact of 3-D imaging is in surgery.

Neurological surgeons are seeing the enormous benefits of 3-D imaging when

dealing with difficult and invasive surgical procedures. Having a precise 3-D

model of a patient’s brain allows the surgeon to be more precise and less invasive

during an operation, equating to less trauma and less collateral damage. The bene-fit of a 3-D PACS system doesn’t stop at brain surgery. Three-dimensional volu-

metric images allow plastic and cosmetic surgeons to build more precise facial

models that could not be accomplished with two-dimensional scans of dental and

facial images. Three-dimensional CT modality of the gastrointestinal tract has great

benefits in bowel diagnosis. Clinical applications of 3-D CT allow for early diagno-

sis and evaluation of lymphoma, gastric carcinoma, ulcers and lesions. Three-

dimensional ultrasound is also now becoming popular and beneficial for obstetric

exams. Besides allowing parents to see very clear 3-D images of the fetus, the 3-Dultrasound also allows the clinician to visually see the fetus body development.

New surgical procedures are being developed hand in hand with the 3-D RIS/

PACS systems. Sunnyvale, Calif.-based Intuitive Surgical Inc. developed a 3-D op-

tical robotic assist surgical instrument in 1999. In 2006, the company released the

da Vinci S System model and followed that in 2009 with the da Vinci Si System

model. This robotic surgical instrument provides minimal invasive surgery for

procedures that historically were very invasive. A surgeon sits at a workstation

console using an enhanced, high-definition, 3-D optical vision endoscope and fourrobotic arms perform surgery with incisions of only 1 to 2 centimeters. The da

Vinci HD display allows for 3-D video viewing of the operative target, as well as

additional 3-D video modalities like electrocardiograms and ultrasounds. Accord-

ing to Intuitive, its system is “currently the fastest-growing treatment for prostate

cancer, which is the second-leading cause of cancer-related death in men.” I


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES



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Tiered Storage and Backups

if your initial question was “where does a health care CIO store all this imaging

data?,” then your second question has to be, “How do I protect all this data and

make it available whenever it’s needed?” These are the main components of a data

retention and protection strategy for health care:

Tiered Storage: There are additional benefits, besides performance and cost

when using tiered storage. Tiered storage in a SAN environment allows for storage

management you wouldn’t see in a standalone storage environment. This includes

on-the-fly backup snapshots, performance

monitoring, storage reassignment across dif-

ferent tiers and multilevel SAN redundancy.

Migrating SAN logical units from mirrored

sets to nonmirrored is also easier to manage

in a SAN environment when you want to

economize on capacity for data that no longer

needs mirroring-level redundancy.

Data Snapshots: Snapshots are copies of

data elements at a point in time. The term, now heavily used in describing backup

storage, has been borrowed from photography vernacular. Good snapshot solu-

tions allow a system environment or a protected health information (PHI) data en-

vironment to take a backup at a point in time without pausing the system or

database. Virtual machine platforms such as VMware and Microsoft’s Hyper-V

can snapshot the whole operating system state to a backup file on the fly without

downtime. This backup state allows for fast restoration and full-state recovery.

Image storage solutions do similar snapshots that maintain state from a point in

time, again without taking the RIS/PACS system down. That is the correct solu-

tion for high-availability systems, which is what you should consider most


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

Good snapshot

solutions allow a

system or a PHI data

environment to take

a backup without pausing.




STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

RIS/PACS systems. It provides one of the best high-availability options for safely

backing up PHI data.

Deduplication: Deduplication is a fairly new approach to data management. It is

simply the deletion of duplicate data elements. Backup or near-backup storage can

require a large amount of disk. Deduplication can dramatically reduce the amount

of disk storage required for backing up PHI data in a disk-to-dedupe disk environ-

ment. That’s why data deduplication is especially effective for longer-term archival

storage.

Deduplication is becoming more popular with virtual tape library (VTL) solu-tions. VTL is somewhat of a misnomer, since most VTL solutions use Serial Ad-

vanced Technology Attachment (SATA) or Fibre Attached Technology Adapted

(FATA) disk drives in a tiered storage array. SATA and FATA drives allow for

greater storage for the lowest cost. I am aware of several clinical institutions that

have completely eliminated tapes and tape drives as a backup solution. Instead,

they have installed VTL systems with deduplication as their backup strategy.

The advantages are pretty straightforward:

I Significant reduction in data backup storage;

I Very quick restoration of data from disk compared with tape;

I More secure storage in a VTL than with tapes; and

I Easy management of backup data.

Consider that tapes can be easily lost or stolen, whereas low-cost SATA or

FATA disk storage appliances are not typically lost or stolen.

Deduplication is rapidly maturing, with major vendors providing solid solu-tions. IBM, Hewlett-Packard Co., NEC Corp. and EMC Corp. all have good dedu-

plication offerings. I am biased toward the target appliance method of

deduplication where the data is pulled to an appliance and deduped at that point.

This means large amounts of data are being pushed to the appliance over a Fibre

Channel or IP SAN. Some CIOs prefer the “source” method of deduplication, in



which the dedup software resides on many source computer systems and the

data is deduped before being sent to an appliance to be placed on the SATA andFATA storage systems. I don’t feel the distributed method of managing the dedu-

plication software is wise. A central deduplication appliance is easier to manage

and provides the best secure method of storing data. One important reminder:

Most deduplication software offerings cannot process encrypted data. This can

be a significant problem for CIOs trying to manage EHR systems and PHI data,

but it can be overcome by a topology in which data is first deduped and then en-

crypted.

DICOM Image Compression: DICOM images are PHI. Managing the compres-

sion of this type of PHI is very important for a health care CIO. Some deduplica-

tion vendors say they can dedup DICOM images, but in reality most have limited

ability to do so. There are FDA-approved third-party compression offerings avail-

able for DICOM images. The major RIS/PACS systems vendors can and do pro-

vide these compression tools to manage the backup storage of DICOM images.

This is usually offered as a backup process for DICOM images when moving the

image data from a Tier 1 storage level to an archiving or higher-tiered storage level.When working with your RIS/PACS vendor, make sure to go over this process.

Not compressing the archived medical images can become very costly.

DICOM Encryption: DICOM images can and should be encrypted. Many health

care CIOs focus only on PHI data, not PHI images. I wouldn’t forget to encrypt

any medical image when backing up or archiving the images. Losing medical im-

ages would be considered a breach of PHI data and would require a health care or-

ganization to be subject to the procedures and penalties defined under HIPAAregulations and the HITECH Act of 2009.

I really feel confident in the tape backup and archiving solution that uses hard-

ware encryption. This solution really makes any PHI data stored on tape fully

encrypted. In the event of a tape being stolen or lost, I am fully confident that the

encrypted PHI data on the tape cannot be compromised. I


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES




STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

LEARN MORE ABOUT DATA DEDUPLICATION

Data deduplication1 is a relatively new technology that has two main advan-

tages: shorter backup windows and less storage consumed for backup and/or

archive. Both of those benefits can be very attractive for health care institutions

with around-the-clock medical care, extensive digital imaging requirements

and, of course, more data to come as EHR systems take hold.

Here are several resources that can help you understand this technology

more, or help your team evaluate the best solution for your organization:

I This data deduplication tutorial2 explains the basic approaches that you

have to choose from, such as inline deduplication or post processing. You’ll

also get an understanding of the hardware choices you have, along with a

table of the major vendors and their products and product features.

I If you want to get a little more depth on the same issues and understand

some of the more popular deduplication products better, “Data deduplica-

tion approaches in backup today3” will help you with that.

I For IT managers in large institutions, or with very large data stores that will

require multiple deduplication devices, an emerging approach is global data

deduplication. To understand how this works and what the main product/

technology choices are, read “Global data deduplication can simplify ad-

ministration of multiple deduplication devices4.”

1 “What is data deduplication?” http://searchstorage.techtarget.com/sDefinition/0,,sid5_gci1248105,00.html

2 “Data deduplication tutorial” http://searchdatabackup.techtarget.com/generic/0,295582,sid187_gci

1346356,00.html

3 “Data deduplication approaches in backup today” http://searchdatabackup.techtarget.com/generic/0,295582,

sid187_gci1353079,00.html

4 “Global data deduplication can simplify administration of multiple deduplication devices,” http://searchdata-

backup.techtarget.com/generic/0,295582,sid187_gci1367467,00.html

D

http://searchstorage.techtarget.com/sDefinition/0,,sid5_gci1248105,00.html


http://searchdatabackup.techtarget.com/generic/0,295582,sid187_gci1346356,00.html









http://searchdatabackup.techtarget.com/generic/0,295582,sid187_gci%201346356,00.html
























When it comes to data de-duplication, most companies only offer one kind of solution. But with Quantum, you’re in control.

Our new DXi7500 offers policy-based de-duplication to let you choose the right de-duplication method for each of your backup

jobs. We provide data de-duplication that scales from small sites to the enterprise, all based on a common technology so they

can be linked by replication. And our de-duplication solutions integrate easily with tape and encryption to give you everything

you need for secure backup and retention. It’s this dedication to our customers’ range of needs that makes us the smart choice

for short-term and long-term data protection. After all, it’s your data, and you should get to choose how you protect it.

Find out what Quantum can do for you.For more information please go to www.quantum.com

© 2009 Quantum Corporation. All rights reserved.

De-boxed in



Emerging Best Practices

in 2007, the Radiological Society of North America established at the American

College of Radiology’s (ACR’s) Intersociety Conference a Radiology Reporting

Committee (RRC) to identify and promote best practices in radiology reporting.

Here is an excerpt from the RRC report published after the committee’s June 2008

workshop:

“In order to define the best practices in structured reporting, a

technical framework is needed to store, disseminate and imple-

ment reports in software applications. A knowledge representa-

tion that enables software applications to guide radiologists as

they report cases is essential. One of the simplest and most prac-

tical knowledge representations is the report template: a list of

reporting element placeholders that prompt radiologists as they

create reports. The workshop participants recommended that

such a knowledge representation be part of a broader technical

framework for structured reporting that is based on open, stan-

dardized Web technologies such as the Extensible Markup Lan-

guage (XML). XML documents can be viewed in Web browsers

and can be edited in standard word processors (13). XML also fa-

cilitates interchange among health information systems through

industry standards such as the Health Level Seven (HL7) Clinical

Document Architecture and the Digital Imaging and Communi-

cation in Medicine Structured Reporting (DICOM-SR) protocols.”

My interpretation of this report is the ACR is focusing on establishing image

storage best practice recommendations for EHR systems. I believe using XML will

not only meet the goals for structure reporting, but it will also address authentica-

tion to software applications by integrating Security Assertion Markup Language


STORAGE FOR

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AND BACKUPS

EMERGING BEST

PRACTICES



with structured reporting and establishing a Web-based standard for digital image

storage management and viewing. The ACR report further states:

“The clinical report is an essential part of every imaging procedure. A

radiology report documents the study’s important components and

the interpreting physician’s analysis of the findings; it communicates

information to the referring physicians, records that information for

future use and serves as the legal record of the episode of care. In ad-

dition to its clinical function, the radiologist’s report may be used for

billing, accreditation, quality improvement, research and teaching.”

This information is confirming that images and radiology reports are legal

medical records and need to be defined as PHI and managed as such in all EHR

computer systems.

On Sept. 10, the DICOM Working Group Ten Strategic Advisory board met in

Athens, Greece. The American College of Radiology, represented by Dr. Charles

Khan, presented its latest report on structure reporting initiatives.

“[Dr. Kahn] noted that RSNA is developing a library of some 60-70 re-

porting templates and some XML middleware using [Relax NG]. He

emphasized that these templates were not standards telling one how

it must be done. Rather, they provide a record of best practices.

RSNA believes that this initiative will stimulate greater demand for

DICOM Structured Reporting that can demonstrate the benefits of

intervention and have a strong positive impact on healthcare.

Dr. Kahn also indicated that RSNA has submitted an applicationfor membership in the DICOM Standards Committee and offered to

provide support for a newly constituted Working Group Eight on

Structured Reporting.” 1

1 Minutes from the DICOM NEMA DICOM Working Group Ten Meeting Sept 10 2009 Athens Greece


STORAGE FOR

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RADIOLOGY

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SYSTEM/PICTURE

ARCHIVING AND

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AND BACKUPS

EMERGING BEST

PRACTICES



EMERGING DICOM IMAGING TECHNOLOGIES

Many RIS/PACS vendors are looking at 802.11 technology to wirelessly transmitDICOM images to their PACS systems. Most RIS/PACS vendors confirm that

wireless network LANs are a critical component to manage and view images in

EHR systems.

More EHR vendors are developing procedure workflow integration to include

DICOM storage capture as well as multiple modality capture, allowing clinicians

to expedite clinical orders for labs and medications. Clinicians will be able to man-

age other EHR components such as patient demographic information before, dur-

ing or after multiple modality procedures.Emerging storage best practices are focusing on speed of DICOM image capture.

RIS/PACS systems vendors are seriously looking at solid state storage, where in

the past they relied on high-speed mechanical disk drives for initial storage cap-

ture. Solid-state storage is becoming more cost efficient and has increased dramat-

ically in size offerings. Presently, it is not unheard of to purchase 4 TB of solid-

state storage without breaking the bank. Solid-state storage brings to DICOM

image capture speed in the range of 100,000 I/O operations per second; terabytes

of flash RAID, 2 GB or better in sustained channel bandwidth to the solid-stateflash and double data rate cache measured in gigabytes. All of these improve the

speed of a RIS/PACS system to capture multiple modality DICOM images as well

as dramatically increase the speed of delivering the images for viewing.I


STORAGE FOR

HEALTH CARE

APPLICATIONS

RADIOLOGY

INFORMATION

SYSTEM/PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

TIERED STORAGE

AND BACKUPS

EMERGING BEST

PRACTICES

ABOUT THE AUTHOR:

Al Gallant is the director of technical services at Dartmouth Hitchcock Medical Center in Lebanon, N.H.

Storage for Electronic Health Care Systems is produced by CIO/IT Strategy Media,© 2009 TechTarget.

Mark Schlack, Vice President, Editorial

Al Gallant, Contributing Writer

Jacqueline Biscobing, Managing Editor

Linda Koury, Art Director of Digital Content

FOR SALES INQUIRIES:

Stephanie Corby, Director of Product Management, [email protected],

(781) 657-1589

TechTarget,

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