Health-care market faces struggle to store electronic records
by Shane Schick
The Anna-Laberge Hospital Centre sits on Brisebois Blvd. in Châteauguay, Que., a multi-level structure that straddles the length of approximately seven football fields. This is a place that already had plenty of room to accommodate its staff of physicians, nurses and other health care providers. But in 1992, when 23 out of 25 emergency room doctors resigned following a botched IT upgrade, it had even more.
Recalling the incident almost 10 years later, Monique St.-Jean, the hospital's IT director, describes it like a cautionary tale for colleagues who rush to implement new technology into their organizations.
"They under-evaluated the number of servers, and the power of the servers they needed," says St.-Jean. "Going to electronic record-keeping, they didn't plan enough workstations."
St-Jean says in those early days, performance was spotty, doctors became frustrated and problems could not be solved in time. Those issues have largely been resolved, she says, but with plans to replace approximately 200 PCs over the next two years and an installation of Novell's network management software in progress, St.-Jean has chosen a phased approach to respect the doctors' workflow.
Founded in 1988, Anna-Laberge is probably one of the youngest hospitals in Canada to take on the process of converting 100 per cent of its paper-based patient data into an electronic format. The technical glitches and learning curve might be expected as inevitable bumps on the way to a more streamlined, efficient process. What hospitals might not have anticipated — and what some hospitals have not prepared for — are the storage requirements that will arise as they reach their goal. St.-Jean, who says Anna-Leberge is about 80 per cent of the way there, isn't worried.
"Disc space is so cheap," she says. "We could actually destroy some of these documents — for people who are deceased, for example — but we haven't really started that process because the disc space is there. It's not an issue anymore."
Victor Winney disagrees. As the vice-president of marketing at KOM Networks, Winney says some U.S. states requires hospitals to keep patient records — whether the patient is living or dead — for a minimum of seven years. These aren't just text files but larger image files, including everything from brain and CAT scans to fetal monitor readings. Typically, hospitals store these files in an optical "jukebox" — a series of optical discs in a device that can put them into drives. "That jukebox is great, but over time, they're not going to keep all the files online," he says. "As they move along, the likelihood of a file being pulled becomes less and less, so they want to remove the disc."
In Canada, the duration of patient records is less legislated and varies widely among hospitals, but in some cases, it may even surpass that of their U.S. counterparts.
Sam Marafioti, vice-president of e-health and chief technology officer at Sunnybrook Hospital in Toronto, says his organization keeps paper records for 10 years, but he wants to exceed that guideline. "We've said to our medical advisory committee that we believe a record should be available in perpetuity," he says. "But we need to figure out the data management implications of that over time."
Other hospitals have decided time is on their side, and have put off an electronic patient record initiative altogether until a more workable storage solution is available.
"We were looking at the storage of medical information, but as far as we got was investigating the different ways of storing it," says Winton Cape, the IT director at Grace Hospital in Toronto. "Right now we basically use microfilm."
Even on microfilm, Grace Hospital keeps "dead" records only. Cape says the hospital considered CD-ROM as one alternative, as well as tape, but the costs of the project prohibited the organization from moving forward. "We figured that if we waited a bit, the market will change and allow us an even more efficient way of storing that information," he says.
Marafioti says cost was an issue at Sunnybrook as well, particularly in the face of massive restructuring in the industry as a whole. In the same year that Sunnybrook asked for $23 million in investment for the electronic patient records project from its board, Marafioti says Sunnybrook was busy cutting $22 million of its operating budget.
The cost factor, however, may take second priority to efficiency in some organizations, particularly if some patient records have already been converted. Marafioti says its board not only unanimously supported its mandate but has asked his team to accelerate their plans, partly due to the difficulty of maintaining two separate systems.
Similarly, St.-Jean says the sheer size and layout of Anna-Laberge made the project mission-critical. "When (doctors) are on a call, it's like five miles to go, five miles to come back," she says. "All the time that was lost there, we're going to gain it back."
Grace Hospital's Cape sees similar advantages. "Just having the customers being able to get at that information the instant they need it, that saves a whole lot of money," he says.
While there are a growing number of storage alternatives, KOM Networks' Winney says hospitals with an electronic patient records mandate should start planning now. "It depends on what the hospital wants to do, and how they want to keep and maintain data," he says. "Some people like to make sure it's at the device level, for instance, with fetal monitors, because if the whole monitor goes down, they don't want anything going on. In other cases, it's at the IT level . . . hospitals tend to be a little behind in their infrastructure."
In most cases, however, hospitals are too anxious to make electronic patient records a reality before they tackle storage issues.
"Storage management is probably the next technology headache that all IT professionals are going to have to deal with in the next year," Marafioti says. "We're just beginning to deal with it on a corporate basis."