Homerton University Hospital Foundation Trust had a storage problem: with its National Programme for IT (NPfIT) storage deal drawing to a close in 2015, it needed to source and build a new storage architecture, and fast.
Not only that, but hundreds of terabytes of existing images needed to be painstakingly migrated from a BT data centre, checked and stored according to archiving rules worked out with radiologists and other clinicians.
Oh, and it would be nice if the hospital could be less reliant on a quaint tape back-up process, a hierarchical disk-storage system, instead of all tier-one storage, and when hospitals or other organisations outside the Trust need images, perhaps they could access them online rather than having images burned onto a DVD-Rom and biked over?
It was in that environment that Dzinja Kabambe, head of strategic IT projects at the Trust, approached the migration and modernisation of the storage environment at the organisation.
"Our radiology imaging solution was procured under the NPfIT and that contract is coming to an end. We have to replace that by June next year. Part of that contract is also some central storage for all of those images, which holds years of x-rays and various images. We needed to do something quick," says Kabambe.
What is more, all x-rays, angiograms, CT scans, ultrasound scans and other clinical images were stored on ageing and expensive tier-one disk storage devices, as per the NPfIT contract.
A tiered storage system would help cut the cost of storage hardware so that images are kept on devices appropriate to clinical requirements, while an archiving system set up in the Microsoft Azure cloud could be used for longer term archiving.
During June and July, says Kabambe, the Trust's IT staff have been slowly and painstakingly migrating their legacy images from the BT MIA database.
"They need to be catalogued so that we know what's there, and then setting up the retention rules - such as if a patient hasn't been here for a year you can remove the data from primary storage," says Kabambe.
The aim is that even complex, resource-intensive images should be accessible within one or two seconds if it is a current patient, or up to 10 seconds if it needs to be retrieved from the cloud.
At the same time, though, the idea is that the system will be proactive so that, for example, images will be linked to appointments.
"The system should know that if we've booked an appointment for a particular patient coming in next week that it should 'pre-fetch' their images and store them on the tier-one storage system ready for them," adds Kabambe. "The challenge for us now is to set up those rules."
For resiliency, the Trust has two on-site data centres with replication between the two, while everything will be stored in the Azure-based archive and, just in case, saved to a tape back-up system too.
Linking the various elements of Homerton's storage architecture is the Vendor Neutral Archive (VNA) solution from Bridgehead Software, a specialist in medical-imaging storage and archiving.
Although it is initially being used for radiology images, the aim is to expand the use of VNA to manage images from other departments within the hospital, such as cardiology.
Indeed, in the future, the system may also need to play host to 'digital pathology', which will make the computing and storage requirements of radiology seem trivial in comparison.
One of the key features of the VNA software for the hospital, adds Kabambe, is the ability to enable organisations outside the Trust to securely view images online when patients are referred to other hospitals or specialists.
And, overall, the multi-tier architecture, backed up to the cloud, will radically reduce hardware costs.
"Instead of having to spend in the order of £50,000 per year on storage, we can expand our cloud storage or buy some tier-three storage instead. That's an order of magnitude cheaper - we can literally knock a zero off that sum when we need to expand," says Kabambe.
Indeed, with the NHS becoming more open to competition, the successful, best-run Trusts are already expanding to take over services from failed or bankrupt Trusts. And that couldn't be done within the straightjacket of the old, expensive, centrally dictated NPfIT.
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