The safe keeping yet easy access of, files and documents is critical in the healthcare industry. Well-archived medical records could mean the difference between life and death, with a missing piece of information resulting in the wrong diagnosis or the wrong treatment. The records also form the backbone of any medical investigation, which is why healthcare authorities dedicate huge amounts of resources to keeping them in order. Here, JIM COOK, chief executive of storage specialist, Arkivum, explores the challenges ahead for health trusts
Medical records are so important to the NHS that its Code of Practice states they must be managed by a board member in each authority. The code also requires that a policy statement is in place which should identify who is responsible for records and specify which information needs to be completed.
Every aspect of the system needs constant and thorough monitoring for a full and up-to-date view of who has done what and when, both inside the organisation and out
A patient’s medical history can contain a large amount of information in differing formats, from doctors’ notes and prescriptions to X-rays and MRI scans – and the majority of these documents need to be kept for the lifetime of the patient and up to 10 years after their death. While this applies to all paper records, NHS guidance currently states that electronic records must not be deleted or destroyed for the foreseeable future.
Combined with the drive to digitise all patient records, this is creating a storage challenge for many health authorities. Traditionally, medical facilities would have large rooms devoted to paper records of all the patients they see. This has its advantages, such as being inexpensive, easy for onsite staff to access, and posing no formatting issues, but there are also fundamental drawbacks. The records are susceptible to loss through natural disaster or misfiling, are difficult to search through and there are often issues with allowing outsiders, such as practitioners or even the patient themselves, to view them.
This is further complicated by the Data Protection Act 1998 , which gives patients the legal right to apply for access to health information held about them, including NHS or private health records held by a GP, optician, dentist, or hospital.
Consider the options
Files likely to be used and accessed frequently, such as those of a patient currently undergoing hospital treatment, should be kept on quick access drives either locally or in the cloud. Meanwhile, files that have not been used for some time, such as maternity records or those of a deceased patient, should be kept in an archive, and this requires careful consideration from practitioners.
The top consideration is the integrity and security of data, as any missing data can lead to a wrong diagnosis, or worse. For example, if notes recording a patient who has had a metal plate or pins inserted are not available when scheduling an investigation using an MRI scanner – a machine that uses magnets for imaging – the results could be disastrous. Medical files contain some of the most valuable pieces of information, which no patient would like falling into the wrong hands.
It is not enough to write files onto a hard drive and put it on a shelf, as there is a strong likelihood that eventually data will become lost due to drive failures or become unreadable as technology becomes obsolete
Medical institutions, therefore, need to be using a safe and secure way of archiving that fully guarantees data integrity. The archive, itself, needs to be managed by a dedicated team of specialists, otherwise mistakes are likely to be made.
The IT system is also an important factor. It is not enough to write files onto a hard drive and put it on a shelf, as there is a strong likelihood that eventually data will become lost due to drive failures or become unreadable as technology becomes obsolete. Countering these problems requires an archive infrastructure that pro-actively manages data to ensure it remains intact and accessible. Many organisations are either unaware of these issues, or cannot afford to do this in-house, resulting in an increased risk of data loss.
Head in the clouds
An alternative is to outsource archiving. Cloud storage can be attractive as it replaces large in-house cap-ex costs with much more manageable on going op-ex costs. However, most cloud providers offer no absolute guarantee of long-term data integrity as typically their focus is on storage for back-up or for hosting live systems, the requirements for which are different to archive, as information is continually being accessed and the ability to achieve high availability and rapid recovery from failures is needed. As a result, cloud storage services typically don’t have all the checks and measures in place associated with long-term data retention where integrity needs to be guaranteed for more than a lifetime.
In order to mitigate risk of data loss, institutions should keep several copies of the data in different locations, both online and offline, secured and actively managed. Active management is needed to ensure media is migrated regularly, the condition of multiple data copies is monitored, and all actions are tightly controlled to guarantee proper processes are followed and only by those suitably trained. Security should be applied through user access control, authentication and ISO27001 hosting environments. Above all, every aspect of the system needs constant and thorough monitoring for a full and up-to-date view of who has done what and when, both inside the organisation and out. Additionally, if archive hosting is outsourced, a succession plan must be in place in case the service provider ceases to operate. This could include the requirement that at least one copy of the data is kept in a separate escrow account.
Know your limits
With the apparent limitations of hard drives, the most reliable and cost-effective format best for long-term data storage is Linear Tape-Open (LTO) data tape. Power requirements are low and data densities in modern libraries are very high, while backwards compatibility is good, with a well-defined roadmap going forward that guards against obsolescence. Adoption is also high across almost all industries, so good availability and support is assured. Linear tape file systems make data tape storage open and interoperable, so LTO is ideal for offline escrow copies, in addition to supporting high-speed rapid access possible through automated tape libraries.
Ensuring data integrity is one thing, but archived data is useless if it cannot be found and accessed in a timely way
LTO is also more cost-effective for archiving than running spinning disk drives, with research from The Clipper Group1 finding that the total cost for the long-term storage of data over a 12-year period on a hard disk is about 15 times more expensive than data tape.
Ensuring data integrity is one thing, but archived data is useless if it cannot be found and accessed in a timely way. Here, data tape in libraries supported by an asset management system provide the ideal combination, meaning that files can be easily located and retrieved within minutes at the click of a button.
Reference
David Reine and Mike Kahn (2010) In Search of the Long-Term Archiving Solution - Tape Delivers Significant TCO Advantage over Disk. Dec 23, 2010. Report from the Clipper Group. Click here