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TIERED STORAGEFOR HEALTH CAREAs the number of doctors and hospitals using electronic

health records and digital images grows, so will the

demands on storage. These strategies will help healthcare IT professionals meet those storage needs.

Storage

Strategiesfor HospitalsGoing Digital

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NHINSTANDARDSWILL EASESTORAGEBURDEN

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1 TieredStorage forHealthCare A SearchHealthIT.com e-book


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HEN GREG JOHNSON

became chief tech-nology officer fouryears ago at the Vir-

ginia Common-wealth University Health System,VCUHS was, in some ways, a techno-logical pioneer among health careorganizations. The system has usedelectronic medical record (EMR)software since the 1990s and com-puterized physician order entry(CPOE) software for another decadebefore that, Johnson said.

Unfortunately, the organizationsstorage and backup systems wereanything but state of the art.

First, with no way to centrally man-age the mixed bag of storage areanetwork (SAN)-attached, dedicated,server-attached and network-

attached storage devices, the mem-bers of VCHUS small IT staff spentmost of their time fighting fires andtrying to get things to work together

that werent designed to, Johnsonsaid. The setup was wasteful, ineffi-cient and ineffective, he added. Wewere constantly losing data becauseit wasnt being backed up properly,we had drive failures, you name it.It was a disaster.

In addition, backups were done ontwo separate tape systems. Neitherworked very well, Johnson said. Data

archiving was outsourced to IronMountain Inc., and it generally tookthree to four days to locate andrestore requested files from tape.

The final nail in the coffin cameabout two-and-a-half years ago, whenVCUHS was migrating applications

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STORAGE STRATEGIESFOR GOING DIGITALHealth care CIOs who need to upgrade or expandstorage infrastructure have several options to consider.BY ELISABETH HORWITT

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StorageStrategies for

HospitalsGoing Digital

NHIN StandardsWill Ease

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Using TieredStorage, Sans

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from the mainframe to Windowsservers. The Oracle Inc. database and

the Cerner Corp. EMR database hadto be backed up and synchronizedwithin the same two-hour window inorder to be reintegrated after thetransition. The restoration processwas supposed to take 25 hours. Thefirst attempt failed at around 18hours; the second and third at 23hours. Upon discovering that one ofthe tapes had bad media, the IT

group backed up both systems on theremaining drive, then spent an entireday manually synchronizing the twodatabases. Total time: five days.

Health care clinicians have zerotolerance for downtime, said John-son. Imagine if wed been recoveringan emergency production system.The hospital would have been ondowntime procedures for five days.We realized how vulnerable we were,and started making major changes[to the storage infrastructure].

Many hospitals are now at thepoint where VCUHS was four yearsago. The federal government is pres-suring them to adopt electronichealth record (EHR) systems asquickly as possible, offering mone-

tary incentives to those who canprove the meaningful use of EHRtechnology by 2015 and assessingpenalties to those who cannot. (Gen-erally, an EHR system is set up toshare data with other systems, whilean EMR system is not.) However,

budget-strapped hospitals are balk-ing at the cost of such deployments,

according to Joe Flowers, a healthcare analyst and futurist.Like VCUHS Johnson, many IT

executives have realized that theircurrent storage and backup installa-tions will need a serious upgrade, ifnot a total revamp, in order to ade-quately support the interoperability,administrative and capacity demandsof their EMR and EHR systems.

BACK TO BASICS

VCUHS new storage strategy camedown to three basic elementscon-solidation, standardization and cen-tralization. We realized we neededcentralized management in order toensure the integrity of all our sys-tems, Johnson said. To accomplishthat, we needed to simplify and stan-dardize as much as possible on asingle vendor platform.

VCUHS replaced four legacy EMCCorp. Clariion systems with two IBMXIV virtual storage systems, one atthe primary site and one at the back-up site. The XIVs management soft-ware works with IBMs Tivoli Storage

Manager and SAN Volume Controllerto provide automated storage provi-sioning and resource allocation.

Engineers no longer need to do ad-ministrative chores such as format-ting drives, partitioning and creatinglogical unit numbers. The system is

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also extremely difficult to break,Johnson said, because processes are

automatically reallocated across thegrid of drives when one fails.Replacing two Clariion boxes with

a single XIV shrank the data centerfloor footprint by 80%, and droppeddata center temperature by 6 degreesFahrenheit, Johnson noted. UsingSATA instead of high-end networkdrives has cut the cost of a terabyteof data in half, he added.

In addition, IBM Virtual TapeLibrary replaced the old backup tapesystem as well as VCUHS archivingarrangement with Iron Mountain.We can now restore a file in 30seconds, said Johnson.

STORAGE CHALLENGES

AND SOLUTIONS

Unfortunately, many hospitals, par-ticularly smaller ones, lack the inter-nal resources to do a major upgradeto high-end and leading-edge tech-nology. There are ways around thisproblem, however.

Johnson suggested taking advan-tage of advanced computer-basedtechnologies by joining a health infor-

mation exchange, or HIE. Thesegroups bring together health careorganizations, generally in the samegeographic region, to share patientinformation electronically, promotecontinuity of care and sometimessave costs by pooling IT resources.

Some HIEs support configurationsin which one large health care organi-

zation hosts and administers patientrecords on its EHR system, whichsmaller hospitals and clinics accessremotely, usually via the Web. Mean-while, the governments NationwideHealth Information Network (NHIN)promotes the idea of having all U.S.health care organizations sharepatient records.

This brings up the question of

where the information will reside, andwho will be responsible for managingit. Not surprisingly, major medicalorganizations are leery of turningover their patient records to anotherprovider, particularly a competitor.

This, in turn, raises another ques-tionhow to track individual recordsand ensure consistency across differ-ent providers systems. Leading stor-age vendors such as IBM and EMC,and HIE software vendors such asAxolotl Corp., Initiate Systems Inc.and Wellogic provide middleware toaddress these issues. Furthermore,leading EMR and EHR vendors arerallying around open source masterpatient index and patient record loca-tor software.

Hospitals in the process of revamp-ing their storage infrastructures alsoneed to determine when and whereto move patient records that nolonger need to be accessed by clini-cians in near-real time.

Close to 80% of hospitals have a


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transactional clinical data repositoryfor capturing immediate patient

data, said David Garets, executivedirector of The Advisory Board Co.Some hospitals also use the reposito-ry for ad hoc querying, which canlead to serious problems such as dataloss. Garets recommended installinga second tier to which data can beoffloaded for ad hoc querying andreporting.

Another way to bring a major EMR

storage infrastructure revamp underbudget is to turn it over to a Softwareas a Service (SaaS) provider. Forexample, eClinicalWorks LLC andPracticeFusion Inc. take care of stor-ing and accessing records reliablyand securely as part of their SaaS-based EHR offerings.

THE POLITICS OF STORAGE

Industry sources agree that hospitaldepartments can sometimes resem-ble fiefdoms that are accustomed tomanaging and purchasing their ownsystems and do not appreciate inter-ference from central IT departments.This is particularly true of radiologydepartments.

For instance, VCUHS has broughtnearly all departmental storage sys-tems onto its SAN. Radiologyremains the holdout. As long as pic-ture archiving and communicationssystems stay isolated and propri-etary, Johnson said, IT administra-

tors have limited visibility, particular-ly when it comes to locating and

troubleshooting problems.Indeed, Flowers noted, hospital cli-nicians and specialists across theboard tend to be institutionally andorganically opposed to the idea ofsharing their information withsomeone outside their departmentor, worse still, with another, possiblycompeting hospital. They may havevalid security concerns, but quite

often its mainly a control issue.Hospitals cannot afford to drag

their feet for long, experts agree. Itsnot just because noncompliance withthe Health Information Technologyfor Economic and Clinical Health(HITECH) Act will mean financialpenalties down the road. How hospi-tals store data is at the core of all thechanges health care will undergo dur-ing the next few years, in order tomake patient care better, faster andcheaper, Flowers said.

To accomplish this, hospitals arelooking at major changes, not only totheir IT infrastructures but also to themind-set of their IT staffs and clinicalcommunities. Fortunately, the ongo-ing development of NHIN standards

and the growth in SAN technologyadoption offer hospitals a usefulblueprint for starting this work. I

Elisabeth Horwitt is a contributing writer

to SearchHealthIT.com. Write to her at

[email protected].





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mailto:[email protected]:[email protected]:[email protected]


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CCORDING TO A con-gressional confer-ence report released

Feb. 12, 2009, theSocial SecurityAdministration (SSA) has a vitalinterest in exploring how health infor-mation technology can be integratedinto the disability process throughthe widespread adoption of electron-ic medical records. Congress maynot have known it at the time, butNationwide Health Information Net-

work (NHIN) standards are playingan increasingly important role in theway the SSA and other health careproviders share electronic healthrecords (EHRs). That, in turn, isreducing the need to store hardcopies of images and paper records

for long periods of time.AspartoftheHITECHAct,Congress

appropriated $1 billion to the SSA

$500milliontoreplacethe30-year-oldSSA National Computer Center and$500 million for health IT resources tofacilitate the adoption of EHR systemsin disability claims. Fifteen percent ofSocialSecuritytaxesareallocatedtodisabilityclaims,makingtheSSAoneofthelargest disability insurers in the worldas well as the keeper of the worldslargest medical image repository.

In the past, when X-ray film waslost or damaged there was no choicebut to duplicate the procedure; thatwould delay the availability of infor-mation and leave patients frustrated.On the other hand, it is very difficultto lose an image stored in a picture




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NHIN STANDARDS WILLEASE STORAGE BURDENBy letting providers exchange patient records and imageselectronically, Nationwide Health Information Networkdata-sharing standards keep providers from filling filecabinets. BY AL GALLANT

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archiving and communication system(PACS). The image can be copied

and electronically transferred manytimes without degradation. It can bestored for minimal cost and is easilyretrievable. Transferring PACS imagesthrough NHIN standards is, therefore,an important step in lowering thecost of health services.

To that end, for the past year theSSA has ran tests to obtain EHRs andPACS images from sites in Virginia

and Massachusetts to process dis-ability claims through the NHIN. TheSSA has found that disability claimsfiled electronically take less time toprocess than claims filed on paper.

The NHIN enables a common,Web-based platform for health infor-mation exchange by providing theservices, protocols, standards, speci-fications and legal agreements for thesecure transmission of health infor-mation. The NHIN Workgroup, whichis part of the Health IT Policy Com-mittee chaired by the Office of theNational Coordinator for Health IT(ONC), is drafting recommendationsto extend the use of NHIN standardsfor health information exchange.

The SSA announced on Feb. 1 the

extension of claims processing usingEHRs and NHIN standards to 15organizations. These private groups(see Organizations Receiving SSAGrants) received a total of $17.4 mil-lion in HITECH Act funds to set uptheir systems.

Michael J. Astrue, the commission-er of Social Security, estimated that

more than 15 million paper requestpackages are sent to health careproviders annually. Letting providersuse their own computer systems toperform electronic transfers reducesthe amount of time it takes theprovider's staff to manually processpaper records. It also cuts the costand time it takes for the SSA to makea decision about a disability claim.

STANDARDS OFFER KEY BENEFITS

The NHIN Workgroup has identifiedseveral other benefits of using thisinfrastructure for informationexchange:

I Improved care qualityand lower health disparities.

I Lower costs resulting frominefficiency, errors, inappropriateor duplicative care, and incompleteinformation.

I Improved coordination amonghospitals, laboratories, physicianoffices and other entities.

I Faster response to threats andemergencies.

Through $560 million in HITECHAct funding, the ONC worked with19 other federal agencies to developopen source software known as Con-nect to help health care organizationsexchange information at the local and

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national levels using Health LevelSeven International (HL7) and NHIN

standards. Connect was originally setup for federal agencies to support

health-related missions, but its nowavailable to any organization for

health information exchanges thatuse national standards. In fact, the





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Organizations Receiving SSAGrantsThese 15 private groups received a total of $17.4 million in federal fundsto set up claimsprocessing systems using EMRs and NHIN standards.

NAME LOCATION AMOUNT

California RegionalHealth InformationOrganization

CareSpark

Center forHealthyCommunities,Wright State University

Central Virginia Health Network/MedVirginia

CommunityHealth InformationCollaborative

DouglasCounty Individual PracticeAssociation

EHRDoctors Inc.

HealthBridge

Lovelace Clinic Foundation

Marshfield Clinic Research Foundation

Memorial Hospital of Gulfport Foundation Inc.

OregonCommunityHealth InformationNetwork Inc.

Regenstrief Institute Inc.

ScienceApplications International Corp.

SoutheasternMichiganHealth Association

San Francisco

Kingsport, Tenn.

Dayton, Ohio

Richmond, Va.

Duluth,Minn.

Roseburg, Ore.

PompanoBeach, Fla.

Cincinnati

Albuquerque, N.M.

Marshfield,Wis.

Gulfport,Miss.

Portland, Ore.

Indianapolis

McLean,Va.

Detroit

$1.625million

$1.363million

$999,000

$1.139million

$977,000

$502,000

$1million

$1.4million

$1.083million

$998,000

$1.1 million

$284,000

$350,000

$1.587million

$2.988million


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SSA is using Connect to exchangedata with the organizations listed

in Organizations Receiving SSAGrants.Connect uses the following compo-

nents to enable health care informa-tion exchange:

I The Core Services Gateway imple-ments NHIN Interface specificationsand helps providers locate patientsat other organizations, request and

receive documents associated withthe patient, and record the transac-tions for subsequent auditing. Thiscomponent also authenticates net-work participants, authorizes therelease of medical information andtracks consumers' preferences forsharing their information.

I The Enterprise ServiceCompo-nents provide default implementa-tions of enterprise componentsrequired to support electronic healthinformation exchange. These includea master patient index, XDS.b docu-ment registry and repository, authori-zation policy engine, consumer pref-erences manager, and a HIPAA-compliant audit log.

I TheUniversal Client Frameworkcontains applications that can beadapted to create edge systems, ref-erence systems, test systems ordemonstration systems on top of theexisting Connect platform.

Connect is one of the smartestinitiatives to emerge from Wash-

ington. Usually, each governmentagency develops its own gatewayin a nonpublic bubble, and the finalproduct is little more than a bunchof nonfunctioning links. In this case,however, 20 federal offices definedtheir needs, jointly developed a sys-tem through the Federal HealthArchitecture, tested its connectivefeatures and made it available for

any public health care organizationwithin a year's time.

As a result, every health careorganization in the nation now hasaccess to a system through whichmedical information follows an indi-vidual, clinicians can have readilyavailable medical data, and duplicatemedical procedures can be kept to aminimum.

However, switching from paper todigital files wont solve your organi-zations problems overnight. Afterall, those digital files must be storedas welland, just like paper records,digital images can quickly get outof control if they are stored with noclear plan in mind. The utilizationof tiered storage is one strategy that

should keep digital record and imagestorage in check. I

Al Gallant is director of technical services at Dart-

mouth-Hitchcock Medical Center in Lebanon, N.H.,

and a contributing writer to SearchHealthIT.com.

Write to him at [email protected].





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10/182010 BridgeHead Software, Inc. All rights reserved. Other trademarks appearing in this document are the property of their respective owners.

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F YOURE A healthcare CIO trying tounderstand yourorganizations future

storage require-ments, you have to consider somedata points that CIOs in other indus-tries would never worry about. Forexample, what is the age of majorityin the states in which your organiza-tion operates?

According to legal dictionaries, theage of majority is set by statute asthe age a person first gains the legal

rights and responsibilities of an adult.But for health care CIOs, it alsomarks the end of the legally requireddata retention period for patientsborn in your facility.

The New Hampshire medical cen-ter where I work services approxi-

mately 400 births each year. Someof these births require extensivemedical imaging diagnostics such asa computed tomography (CT) study.

Typical CT studies are made up of256 slices, each a 500 KB image. Asingle study would require 128 MB ofdata storage. For a single infant bornin New Hampshire in 2009, this 128MB would need to be retained untilseven years after the infant reachesthe age of majority, which is 18 inNew Hampshire. Therefore, asrequired by the Health Insurance

Portability and Accountability Act(HIPAA) and New Hampshire statelaw, the image study must remain instorage for 25 years. How many non-health care CIOs do you know whoworry about storage requirementsout to 2035?




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USING TIERED STORAGE,SANS FOR IMAGESImage and electronic health record data storage is a long-term problem for health care IT administrators. Tiered storageand SANs can help prioritize management. BY AL GALLANT

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Now, take the same patient andincrease the electronic health record

(EHR) storage requirements for thepatients EHR, which could includemultiple diagnostic images, physicianorders, prescription lists, progressnotes, X-rays and MRI and lab resultsfor every clinical visit. All of a sudden,the EHR storage requirement ismeasured in gigabytes. Multiply thisby the number of patients born eachyear, and the number can quickly

move to terabytes.For many health care institutions,

thats a long-term problem. My hos-pital, for example, began with digitalstorage of radiology images only.Now we have image storage require-ments for cardiology, neurology, can-cer, obstetrics, cosmetic surgery, thespine center, orthopedics, the lab andthe trauma centerwith more andmore departments requesting imagestorage.

The largest image storage require-ment that my institution manages isfor the neurology center. Our neurol-ogy center has a process that syn-chronizes patient video monitoringwith electroencephalography imag-ing captures, allowing the neurologist

to study a patients physical symp-toms as the EEG records neurologicalevents. Some of these studies usecontinuous monitoring for up to fourdays. These video images requiresignificant amounts of disk storage.We are managing 8 terabytes (TB)

of video storage for approximatelysix to eight months of patient visits.

These types of health care videoand image storage requirements aresubstantially different from the dataretention and storage requirementsfor banking, tax returns and creditcards records.

So where does a health care CIOkeep all this storage? Three places:tiered storage, tiered storage andtiered storage. Image storage is staticstorage. Once the image is captured,it will not be modified. Typically, the

process is to capture the image ontier 1 storage and keep it there tem-porarily during clinical review. Atsome point, usually within a month,the images are moved to tier 2 stor-age. After six months, the imagesare then moved to tier 3 or higher

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HEALTH CARE VIDEO

AND IMAGE STORAGEREQUIREMENTS ARESUBSTANTIALLY DIFFER-ENT FROM THE DATARETENTION AND STORAGEREQUIREMENTS FORBANKING, TAX RETURNSAND CREDIT CARDSRECORDS.


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because future clinical review wouldnot require instantaneous access to

the medical images. We do this quar-terly with scripts, so that it takes verylittle staff time to do.

The example of tiered storagebelow is based on RAID levels, per-formance and cost. Definitions oftiered storage vary greatly from ven-dor to vendor and medical organiza-tion to medical organization, soplease do not take this example as

being strictly defined.

I Tier 1: 15 K or greater, 146 GBFibre Channel (FC) disk with RAID5 and shadowing (approximately$15 per gigabyte).

I Tier 2: 10 K, 300 GB FC diskwith RAID 5 and shadowing(approximately $10 per gigabyte).

I Tier 3: 10 K, 300 GB FC diskwith RAID 5 and no shadowing(approximately $5 per gigabyte).

I Tier 4: 1 TB FATA disk with RAID5 and no shadowing (approximately$3 per gigabyte).

The most cost-effective way tomanage image storage is with anenterprise storage area network(SAN). Some image vendors, espe-cially those that want to manage theentire imaging system, will insist on a

direct-attached storage array. Theydo not want other applications to

affect their image systems and feel aclosed imaging system provides themthat level of risk assurance. Mostimaging vendors realize the invest-ment a health care institution makesin SAN technology and will work withits information systems departmentto use SAN storage. One of theimportant things to remember whenworking with image storage vendors

is that the Food and Drug Adminis-tration (FDA) does not require anapproval process for disk storage formedical images. If your vendor triesto tell you the storage has to be FDA-approved, feel free to show it theactual regulation.

One last consideration is whetherto mix clinical and other data on thesame SAN. While some device andmedical application vendors will pushyou away from that, the increasingintegration of health care datademands at least some co-mingling.The key is to always make sure yourstorage for clinical data is deliveringthe performance you need. As manyhospitals have discovered, SAN tech-nology provides that desired per-

formance, even as record stores con-tinue to grow. I

Al Gallant is director of technical services at

Dartmouth-Hitchcock Medical Center in Lebanon,

N.H., and a contributing writer to SearchHealthIT.

com. Write to him at [email protected].

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EALTH RECORD stor-age needs are tax-ing the ingenuity of

health care IT pro-fessionals faced withtheir institutions ballooning quanti-ties of data. Storage makes for a chal-lenging conundrum. Data sets includ-ing huge image files must beavailable rapidly for a time, thenstored securely for years, all accord-ing to HIPAA regulations. If thatwerent enough, hospitals and med-

ical practices face tightening budgetsthat rule out the easy answer, whichis to simply mount more and moredisk drives to handle their rapidlyproliferating data.

John Fagg, manager of storageservices at University of Utah Health

Care in Salt Lake City, said data athis institution is not quite doublingevery year, but [it's] close.

For many hospitals, storage areanetwork (SAN) technology is the bestway to marry fast performance withexpandability. Utah Health Care, forexample, is relying on Fibre ChannelSANs and Brocade SAN switches tohandle its burgeoning data.

SAN technology is virtual storage,which means the logical units of stor-age are separated from the disk drive

arrays that physically store the data.Logical units are allocated to differentapplications but can be expandedquickly across storage arrays, shouldthe need arise.

You can grow a [logical unit] onthe fly and spread it across multiple




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SAN SPEED, FLEXIBILITYRULE THE DAYAs health care data proliferates, providers are turningto storage area network technology, which they find easyto expand without compromising performance or breakingthe bank. BY STAN GIBSON

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RAID groups, explained Jeffrey Had-don, storage administrator at Utah

Health Care. Using the technique ofthin provisioning, its possible toassign an application a 1 TB logicalunit that utilizes only 200 GB of disk.Its easy to grow it in the back-ground as needed, without affectingend-user performance, he added.

Despite the appeal of SAN technol-ogy, some medical software vendorseither do not support it or are reluc-

tant to do so, according to SteveHuffman, vice president and CIO ofMemorial Health System in SouthBend, Ind.

Some applications are still not onour SAN. Some vendors say theyrenot comfortable with the SAN envi-ronment, Huffman said. Nonethe-less, he has implemented SAN-basedhealth record storage wherever pos-sible and has moved a significantportion of Memorial Healths applica-tions, including those from CernerCorp., Oracle Corp. and McKessonCorp., to the SAN.

FIBRE CHANNEL SAN

CUTS DOWNTIME

Fibre Channel SAN technology, whichis ideal for connecting servers toshared storage devices, has provedits worth at Metro Health in Wy-oming, Mich. We have been a FibreChannel site for years, said AivarsApsite, technology manager at Metro

Health. Its very resilient. It doesntreally go down. Its highly redundant

and failovers are seamless.The institution has redundant FibreChannel SANs in its primary datacenter and its secondary data center,located 12 miles away. The centersare connected by redundant fiberlinks, and data is mirrored.

The setup was tested when anaccident severed one of the fiberlinks. On another occasion, a Fibre

Channel switch failed. In both in-stances, our Fibre Channel redundan-cy worked flawlessly, and we neverincurred any downtime, Apsite said.

The hospital recently completed amajor storage upgrade from 120 TBto 254 TB using a Hewlett-PackardCo. StorageWorks XP20000 seriesdisk array, with an HP StorageWorksEnterprise Virtual Array 8400.

FLASH DRIVES

OFFER FAST RETRIEVAL

Although Fibre Channel SAN per-formance suffices at many institu-tions, Wausau, Wis.-based Aspirus,a network of hospitals serving north-ern Wisconsin, has turned to flash

memory to provide extremely fastresponse time in its health recordstorage system.

In Aspirus data center, EMC Corp.enterprise flash drives are housed ina Clariion CX4 Model 960, which isknown as tier 0 in Aspirus tiered

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storage architecture. That architec-ture is fleshed out with iSCSI SANs at

tier 1, Serial Advanced TechnologyAttachment, or SATA, drives at tier 2and EMC Centera archival storage attier 3, which handles long-term stor-age for its picture archiving and com-munications system (PACS) fromSectra AB, cardiology images andvideo. (Remember that the defini-tions for storage tiers are not set instone.)

Aspirus Epic Systems Corp. soft-ware applications also are served bythe EMC enterprise flash drives. Laterthis year, Aspirus will add an Oracledecision-support application that willalso store active data on the flashstorage. It gives physicians near-realtime retrieval, said Tom Whalen,server systems team leader atAspirus. We can serve morepatients through the system. It bothincreases volume and quality of clini-cal care.

Business applications, payroll,enterprise resource planning andhigh-speed reporting applicationsalso are on the tier 0 flash drives. Inall, Aspirus is storing about 4.5 TB ofdata on flash memory, and may move

its Sectra AB PACS data to flash inthe future, according to Whalen.

ISCSI SAN: FLEXIBLE STORAGE

Like Aspirus, Community HealthPartnership Inc. in Eau Claire, Wis.,

has implemented iSCSI SAN storagetechnology. Community Health is

relying on Dell Inc. EqualLogic iSCSISANs for the bulk of its storageneeds, from active data to emailarchiving. The speed, flexibility andlow cost of iSCSI give the health careprovider a one-size-fits-all approachto health record storage.

We can take any SAN and up-grade the firmware easily. The PC600 to the PS 6000all the firm-

ware is the same, said AndrewViolet, systems engineer at Commu-nity Health.

Community Healths storage archi-tecture consists of nine iSCSI SANs inthree groups of three, handling a totalof 90 TB of data. One group of high-performance SANs handles activedata, working in tandem with anotherlocal SAN. The third SAN group han-dles backup at a remote site.

When it embarked on implement-ing Allscripts-Misys Healthcare Solu-tions Inc.s EMR software, Communi-ty Health considered adopting a FibreChannel SAN but found the higherspeed didnt justify the steep addi-tional cost. Throughput is impor-tantbut its not nearly as important

as the actual amount of data we canstore, said Keith Grey, IT technicalservices manager and security officer

Staying with iSCSI allowed Com-munity Health to implement All-scripts EMR software by spendingonly $65,000 for storage upgrades

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