Healthcare providers deal the increasing demands of retaining electronic medical records for patients and institutions.Michael Passe, storage architect for Beth Israel Deaconess Medical Center, has a challenge on his hands - to digitize 85% of patient data for the 556-bed Boston hospital by 2010 and make it available to physicians in easily accessible electronic form.Beth Israel staffers are tackling the laborious task of scanning patient charts and records and integrating them with medical images, along with implementing enough storage each year to accommodate electronic medical records (EMR) for patients.The challenge is one every hospital and doctor's office in the country faces. President George Bush's Health Information Technology Plan mandates that patients have electronic medical records by 2014."More and more visual information is being digitized, accelerating the already-explosive growth of required storage capacity - especially at extreme resolution levels common to clinical environments," says David Freund, senior analyst for Illuminata. "The good news is that digital images are much easier for medical personnel to manipulate and to share among colleagues, whether they are across the hall or across a continent. But that's also the bad news, because it compounds the tracking and retention burden faced by many organizations."EMR implementationAt a glance: HEALTHCAREEnterprise healthcare spent an estimated $27 billion on IT services in 2004, research firm In-Stat estimates.The Bush administration wants all U.S. patients to have an electronic medical record (EMR) by 2014.Currently, 20% to 25% of hospitals and 15% to 20% of physician's offices have adopted EMR systems, according to RAND.RAND forecasts that adoption of EMR could save $77 billion per year and cause a 4% increase in IT productivity.With Beth Israel now in the early stages of EMR deployment, about 35% of its data is in electronic format, with the remainder in paper, Passe says. He's working toward the goal of having 85% of the hospital's records digitized by 2010.At that point, the remaining 15% of data will be scanned as Adobe Acrobat PDF files. Everything else, including X-rays and diagnostic images from the hospital's Picture Archiving and Communications System (PACS) image-management system, admission information and transcribed data, will be incorporated with the EMR system.Such storage demands cause a major headache for Passe. "As you can imagine, over the last two years the various formats and information we need to retain has had a significant impact on storage both in my area and in the cardiology and radiology departments," he says.To meet this burgeoning need for storage, Passe installed an EMC Symmetrix 3930 array, two Clariion CX600 storage systems and an EMC Centera content-addressable storage system. He also adopted an information life-cycle management strategy to store and retain the data, some of which must be kept for as long as 30 years.Passe's top tier of storage, where current EMR data resides, is 22T bytes of EMC Symmetrix DMX storage. "As data becomes accessed less frequently, it is moved to 40 terabytes of midtier EMC Clariion storage," Passe says. "And, as the data further ages it is moved off to 9.6 terabytes of Centera storage for a long-term archive."The effect of EMR and PACS on storage is immense for Passe. One computed tomography (CT) exam can take as much as a 1G byte of storage. Passe currently has a 50T byte storage-area network (SAN )."If you consider that a digital X-ray is about 10M bytes of storage at a minimum, then a large hospital is likely to require several terabytes of storage just for X-rays, not including associated patient files," says Stephanie Balouras, senior analyst for Forrester Research. "Then because this information has to be retained for 20 years or potentially for a patient's entire life, the long-term storage requirements are fairly significant."The amount of data being stored on Beth Israel's SAN has grown by as much as 200% a year because of document storage. With the EMC SAN and its tiered-storage plan in place, Passe estimates that this growth will slow to about 25% to 30% a year.Document demandsElaine O'Bleness, director of health information services for Banner Health Care in Greeley, Colo., has seen the upside of EMR. She deployed an Optio QuickRecord Intelligent Hub (an appliance that indexes and organizes EMR data) to manage her Fuji PACS and EMR data."We have had all laboratory, radiology and all transcribed reports, plus all point of care for nursing in QuickCharts," O'Bleness says. QuickCharts gives clinicians intranet and remote access to QuickRecord health data."We have three EMC Clariion CX600s we use for PACS in radiology and cardiology, but we have to incorporate into QuickRecords storage, as well," says Mike Brachtenbach, senior network analyst for Banner, who manages 18T bytes of storage. QuickRecord data is stored on an IBM disk attached to the company's RS\/6000 host computer. The RS\/6000 communicates with the EMC Clariion SAN. Brachtenbach is looking at adding an EMC Centera to his SAN for deep archiving.One of the healthcare organization's biggest challenges with EMR is scanning paper documents into the QuickRecords system. "Scanning is incredibly labor-intensive, not to mention the fact that it takes up a lot of space and once you are done you only have a piece of paper that is electronic that you can't do anything with," O'Bleness says.According to Optio, scanned reports can take 10 to 20 times more space than an EMR."With QuickRecords, we've eliminated approximately 60% of requests for physical medical records and wiped out health information management backlogs," O'Bleness says.John Young, a senior systems engineer at Presbyterian Health Care Services in Albuquerque, N.M., also is implementing EMR throughout his organization. He is tying together several clinical systems and a McKesson PACS."EMR and PACS has had a 200T byte impact on our storage," Young says. "We are experiencing a 20% growth rate per year. When we have to retain data for up to 20 years, it's a major issue to deal with."Presbyterian Health Care Service stores its medical data on an IBM Enterprise Storage Server and two DS4400 storage arrays with 7T to 8T bytes of storage, which cost his organization about $1.2 million to implement.Three to six months of PACS and EMR data is initially stored on an IBM Enterprise Storage Server at Presbyterian Health Care Services. As the data ages, it is moved to the DS4400s for 12 to 18 months. Finally it is archived on IBM 3590 Limited Tape Open tape library with IBM Tivoli Storage Manager."From a technical perspective, we have seen benefits from implementing this SAN," Young says. "We now have storage on demand, easier maintenance, standardization and time savings."