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CIO Leadership: Mercy's Fred Terry fights digital data explosion

Janesville, Wis. - Healthcare technology managers like Mercy Health System's Fred Terry have an image problem. More precisely, they have an imaging problem that is creating the potential for system-busting data overload.

Fred Terry
Terry, director of information systems for the Janesville-based Mercy, is staring at a growing body of data being generated following the adoption of healthcare IT, particularly the implementation of picture archiving and communications systems. These systems, which can hold hundreds of image "slices" per scan, are creating a massive storage challenge that has one Wisconsin CIO, Aurora Healthcare's Phil Loftus, worried about a failure of computer networks carrying mission-critical data.

Since paper records are being discarded of as they are replaced by electronic medical records, the failure of healthcare computer systems would result in the inability to provide a high level of care, he noted.

Loftus spelled out the challenge during WTN's recent Digital Healthcare Conference. Even though digitized imaging systems generate a large volume of images from individual patients, he said only a handful actually might be read. “For those patients, you now have orders of magnitude more information, in the form of electronic information, than you ever had in a paper world,” he said.

Aurora now has 10 terabytes of EMR data alone stored on its network system - 4.5 megabytes of EMR data per patient, excluding images - and Loftus would like to shave that down to two or three terabytes. His advice to CIOs - start thinking about what data can be stored outside the organization's mission-critical system - is something that already is part of Terry's emerging storage strategy.
PACS dilemma

Epic System EMRs are gradually being rolled out in Mercy's clinical settings, with hospitals to follow, but the heaviest volume so far has come from medical imaging.

PACS, which capture those images and make them available to caregivers throughout the Mercy Health System, was installed beginning in October of 2003, first in its three hospitals and then in its 65 clinics. As it was rolled out over time, more and more data volume was added to the Mercy system, and now the clinical EMR rollout is adding to the data flow.

To illustrate how much data is entering healthcare network systems, Terry said Mercy now has about 6.2 terabytes of data, but expects to add another five terabytes over the next year or so.

“The volume of storage does have to increase, and you definitely have to plan for that,” he said. “That [PACS] is not something you install once and then walk away from.”

As part of a re-engineering of storage levels, Terry has devised a strategy for the short, intermediate, and long-term. The decision that faces Terry and other healthcare CIOs is not whether to archive older images and records, but how much and on what medium?

Terry's immediate goal is to provide more redundancy and storage online, but an intermediate step will involve failover - backing up data on new storage technology at an off-site location. Long term, older data and images would be stored on an older (and slower less expensive) technology or even on tape. They would take longer to retrieve, but older medical data loses value over time, so there are trade-offs.

“We're trying to kill two or three birds with one stone,” Terry said.

Radiologists have been informed of the coming changes, as will other departments as the strategy evolves. Legal counsel, for example, has to think about e-discovery requirements and will want to weigh in when Mercy determines which data to keep in slower back-up archives. (Loftus indicated that several data sets are fair game for archiving, including old images, past vital-sign monitoring, and records of the deceased).

Mercy caregivers have gone back as far as four years to retrieve images, which will influence that archiving decision, Terry said. Ideally, the organization would like to keep five or six years of images on the newest storage technology.

While there are intermediate and long-term pieces to the strategy, there is a pressing immediate need, especially since Terry doesn't know if there is a specific tipping point that triggers system failure.

“We [now] have a single point of failure,” he noted.

Mercy network

Terry has worked in healthcare and information systems for 35 years and has been with Mercy since graduating from the University of Wisconsin-Madison with a bachelor's degree in accounting.

Back then, Mercy Hospital was a stand-alone, acute-care hospital. Now the 240-bed hospital is the flagship component of an integrated delivery network that serves south central Wisconsin and a swath of northern Illinois that extends to the northern suburbs of Chicago. In addition to three hospitals and 65 clinics serving 24 communities - with close to 100 end-point connections in its IT support area - Mercy's delivery network includes several transcriptionists and radiologists that work remotely from home.

Within this network, Mercy provides acute-care services, insurance products, plastic surgery, multi-specialty and multi-practice clinic settings, a retail environment that includes a pharmacy and a home health equipment store, and home-care services like fetal monitoring for expectant mothers.

Mercy deals with three key vendors: McKesson, which has supplied most of its legacy systems that support patient care in hospitals and for PACS throughout the enterprise; Epic Systems clinical electronic medical records, which have been rolled out since last September (2007) and will be completed within two years in all clinics; and SoftMed, now part of 3M Co., for dictation and transcription services.

In recent years, the information systems department has been able to provide more remote monitoring for caregivers, including remote access to lab results and PACS on their home PCs, and an enterprise master patient index that enables them to seamlessly access patient information without having to know a patient's EMPI number. This ease-of-access is one of several reasons Mercy recently received a Malcolm Baldrige National Quality Award, the highest Presidential honor for quality and organizational performance.

Floating their workflow

In dynamic organizations, operational excellence is a never-ending commitment. Mercy's Epic implementation in clinics, its primary technology initiative, was designed with the input of multi-disciplinary teams, including physicians and other system end-users. According to Terry, the Epic project will do more than allow Mercy to shed paper records (and save physical space), develop improved analytics for state reporting purposes (in Wisconsin and Illinois), and eventually enable the integration of genetic information and EMRs. It is being undertaken with an emphasis on workflow standardization.

Every clinic in Mercy's network has "little bit different ways" of charting and ordering, Terry stated. Therefore, one purpose of the ongoing EMR optimization process is to standardize workflows as much as possible. “Some of physicians and nurses float from clinic to clinic, so to the extent that we can maintain as much standard activity from clinic to clinic, it makes it easier for them to float,” he said.

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