Editor’s Note: This article by Kayt Sukel appears in Healthcare Informatics Technology Insight Series and is reprinted here with permission.
Digital storage has become — and will remain — one of healthcare’s biggest information technology challenges. According to the Wall Street Journal, nearly 600 million imaging procedures, including CT scans, X-rays, ultrasounds, mammograms, and MRIs, are performed each year in the United States alone. And as imaging technology makes new gains, allowing for higher resolution, three-dimensional, and live-action views, those image files are expanding. So much so, AT&T Inc.’s ForHealth Group estimates that image archives are growing by approximately 40 percent each year.
So what can a healthcare organization do beyond investing in more server space? To start, take a hard look at their corporate data retention policies.
What do I keep? And for how long?
Shelly Susong, a senior application analyst in Radiology Information Systems at Covenant Health in East Tennessee, says the storage costs for the health system were growing exponentially. This hospital system, with nine acute care hospitals, multiple outpatient and specialty facilities, and other affiliated member organizations and physician clinics, serves thousands of patients annually.
“We produce about 650,000 studies each year. And these images keep getting bigger and bigger. As the technology gets better, the same number of images is requiring even more storage,” she says. “The culture, for us, was to keep everything. And it was becoming too much. The administration was getting tired of us coming to them and asking them to buy more and more storage.”
Storage that could cost hundreds of thousands of dollars. Data retention across the enterprise was quickly becoming a difficult balancing act. How could Covenant Health continue to offer state-of-the-art imaging, part and parcel of high quality patient care, and yet rein in expanding storage needs? To answer that question, they needed to revisit the organization’s internal data retention policy—and define what, where, and for how long each study needed to be kept.
The Importance of Buy-In
Of course, solidifying a data retention policy is easier said than done. Susong says that there are a lot of urban myths surrounding image retention in the healthcare space. And those myths have, historically, driven procedure.
“Most technologists will tell you that mammograms have to be kept forever. And so films were kept and shuffled around to support that,” says Susong. “Pediatric images were kept until the patient reached the age of majority at 21. And some sites thought that you needed to keep nuclear management studies for 10 years. But the truth is, we weren’t completely sure what we were really required to do.”
But the team was determined to find out. Susong and colleagues started digging in, looking for documentation to separate the image retention myth from fact. And they found that many of the assumptions they were operating under were not supported by law or hospital regulations.
“We dug and dug. We looked at documentation from the American College of Radiology, at The Joint Commission, at the state of Tennessee, at everything we could get our hands on,” she says. “We soon learned that we were only required to keep images for four years and mammograms for 10. Nuclear management studies did not have to be kept for 10 years, just the radiation dosing records. We soon learned we were keeping a lot more than we had to.”
If Covenant Health changed the existing retention parameters based on that research, they could free up a significant amount of storage space—a move that would not only allow them to store future studies but also permit clinicians to pull up those studies on the organization’s various information technology systems more quickly. With their updated research in hand, Covenant Health’s radiology, legal, risk management, integrity compliance, privacy, health information management (HIM) and administrative departments convened to fine-tune and then finalize their data retention policies based on fact and mandate, not healthcare urban legends.
“We’ve now documented our retention policy for everything. The state of Tennessee says we need to keep images for four years. We decided to err on the side of caution and retain images for five years—including the pediatric images. Because we want to do the right thing for our clinicians and our patients,” she says. “With the backing of the executive leadership, we were able to get past a lot of confusion, work together, get buy-in from all parties, and come up with the right policy for us.”
Putting Policy into Action
With the new policy in place, Covenant Health then had to go through the arduous task of deleting outdated files—more than 15 years worth of studies. The healthcare system procured Conserus™ Image Repository Retention Management application, an add-on for Conserus™ Image Repository, to help them safely remove those files in both accordance with HIPAA regulations and their new retention policy. Susong and colleagues started slowly, first deleting studies stored prior to the year 2000 across the enterprise.
“The application allowed us to set rules by site, by number of years, and other parameters we had set,” she says. “We started with small chunks at a time—making sure that everything was working the right way with those very oldest of images. And we were pleased to see it was doing what it was supposed to be doing.”
Working methodically, the team has moved from those older files to more recent ones. Again, the application allowed the team to delete legacy images from the PACS and other systems, leaving behind a simple message that the image has been deleted due to Covenant Health’s data retention policy. She credits the application for helping the team quickly put their new policies into action. “We wouldn’t have been able to do it without the application, there’s no question,” she says. “It is not a task we could have ever managed without it.”
Susong says that implementing the application was very straightforward — and the team was quickly trained on its use with a training webinar. “It’s a fairly intuitive system,” she says. “And a very easy implementation.”
And not only does it allow for automatic deletion per the system’s retention policy rules, technologies can also put a hold on deletions for legal or other reasons, ensuring the deletions don’t get in the way of physician workflow, patient care, or administrative needs.
Keeping Storage Costs in Check
Since implementing the new data retention policy, Susong says that Covenant Health has saved a significant amount of storage and related fees. “As we are getting near to being caught up, we can think about other possibilities,” she says. “We are now looking to carve out different areas of storage to maximize speed of image retrieval. And we’re planning to add more.”
Susong says the Conserus™ Image Repository Retention Management application has been an excellent tool to help her team follow the Covenant’s image retention policy rules. “In the past, we weren’t following our own rules. We weren’t always sure what the rules were. This tool helps make sure we do what we are supposed to do,” she says. “And with image retention requirements growing by leaps and bounds each year, keeping up with these rules will help us save money on storage and make room for new larger data sets. Ultimately, it’s something that is going to be a great benefit for our clinicians and our patients.”