By Kelly Baig

In most hospitals, scanning is used to convert many types of paper documents into electronic images. For example, registration staff can scan insurance cards and admissions forms and add them to the electronic record for admitted patients. Emergency staff can scan pictures, documenting procedures with subject matter ranging from wound care to suspected abuse.

Scanning paper documents into an enterprise content management (ECM) application enables those documents to be seen directly from the EMR application. This helps to improve patient care and safety with increased information accuracy as well as availability to the clinical staff. Scanning forms can also assist hospitals in their need to process claims for payment more accurately and with less delay. The reduction in file cabinet space is another benefit of the scanning process.

In MEDITECH hospitals, the ECM application most used is called Scanning and Archiving (SCA).  Another popular ECM application is McKesson’s Horizon Patient Folders (HPF). However, regardless of the ECM version, the resulting millions of small files created by the scanning process are difficult to protect using traditional backup and recovery methods – and protection is critical because the data is part of the patient record.

What makes scanned files so difficult to protect using traditional methods?
When hospitals scan documents and pictures, they create many small files. In a typical small community hospital, for example, it’s common for BridgeHead to see several TB of scanned file data which is stored as millions and millions of small files.

The traditional backup process is to read through a file system and find all of the files which need to be protected. This works well for file systems which have a few big files. However, reading through a file system which contains millions and millions of small files takes a long time. In point of fact, for a typical small hospital, it can take several days. Then, the backup must capture the individual files required, convert them into the backup format, and store them on the backup media.

Waiting several days for backup is impractical in most settings – and, for scanned images, it turns out that the traditional approach is a waste of effort. Keep in mind that these are scanned images: they do not change once created. Therefore, capturing repeated backup copies of the same files does not make much sense. There simply isn’t any new data within the file, to make it worthwhile to protect it again.

As you can see, then, the traditional approach for data protection is not a good fit for the nature of scanned images in the patient record.

What works better for protecting scanned image files?
A better approach for protecting scanned image files is to combine data archive with backup. This is the approach which BridgeHead deploys and which is in use at many MEDITECH hospitals running SCA as well as at hospitals running HPF.

The integrated backup and archive approach created by BridgeHead is depicted in the diagram. This integrated solution is designed to capture scanned image data using archive, and then rely on backup to capture the server system configuration files and that portion of the data which is more subject to change.
In simple language, you can think of this approach as an application of the 80:20 rule. For data like that which is created by SCA or HPF, it’s more optimal to use archive to capture the 80% of data which is unchanging. Then, use backup to protect the remaining 20%.

The integrated approach is optimized to ensure rapid data capture, reducing what would have been many days to just moments for the protection of SCA or HPF images. Just as importantly, recovery is optimized as well. The application recovery process can facilitate rapid restore of the ECM application and its environment along with the smaller set of data held in backup. File or image recovery is directly from the archive and does not require restoration of a backup.

Protecting the majority of the data in an archive is a better design for hospitals. Unlike data which has been backed up and must be converted as part of recovery, data held in the archive, by its nature, is in usable format. This means that it can be used in place from secondary storage as soon as the application is operational.

For all of these reasons, an approach to healthcare data management which integrates archive and backup capabilities is a best fit for managing hospital data.

Protection of Image Data in Horizon Patient Folders
Yale-New Haven Health System in Connecticut uses the BridgeHead approach for managing their HPF image data. Jonathon Valente, a manager of storage and UNIX server systems in their IT services team, offers these remarks on their BridgeHead deployment:

“BridgeHead Software is our ‘go-to’ solution for protecting unique data for any hospital application. For example, we use BridgeHead for our Horizon Patient Folder application because its integrated archive capabilities make it ideal for managing HPF’s millions of small files. BridgeHead protects HPF data quickly, easily, and cost-effectively.”

Protection of Image Data in MEDITECH SCA
Humber River Hospital, one of Canada’s largest regional acute care hospitals, also works with BridgeHead to protect its scanned image files. Othman Khan, a senior technical analyst at Humber, notes:

“We have a variety of storage equipment all working together in our environment with the capability for different brands of storage to provide recovery of MEDITECH data. BridgeHead’s single HDM platform for backup, archive and disaster recovery makes this possible and has reduced our costs while providing flexible recovery. Integrated archive is particularly critical, as it provides us with a true healthcare data archive with quick backup and comprehensive recovery.”