MetroHealth CIO gets clinician buy-in for content management

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MetroHealth Medical Center in Cleveland needed a better medical data management strategy than just holding on to everything indefinitely. But before it could move to enterprise content management, it needed buy-in from clinicians that some data could be removed from storage after a predefined period.

Sure, storage is relatively inexpensive. But as far as MetroHealth chief information officer (CIO) Don Reichert was concerned, moving to a consolidated storage system with enterprise content management wasn't just about the money. He wanted to ensure that the health system was thoughtful about the length of time it held on to all types of information -- whether it's email, radiology images, cardiology data, or anything else.

The journey started about two years ago and ultimately led the nonprofit, county-operated health system to implement OnBase by Hyland enterprise content management software (Hyland Software). As MetroHealth begins to add clinical information such as radiology images and cardiology data, it's essential to get clinicians on board with a schedule for data storage that will allow MetroHealth to save on archiving costs while preserving clinician access to important data.

Shaping the decision

Shaping MetroHealth's decision were various regulatory requirements regarding the storage of and access to key medical data, such as mammograms. Say, for example, that a woman has a mammogram. According to federal law, the health system has to hold on to her mammography images in an active state for two years.

MetroHealth CIO Don Reichert.MetroHealth CIO Don Reichert.

"MetroHealth has to follow the law," he said. "But after those two years, as an organization, we can get rid of those images."

Reichert was looking for an enterprise content management solution that would allow the woman's physician to receive a notification that the two years were coming to an end and her physician could allow the system to remove her images from storage. With its go-forward plan using the OnBase software, MetroHealth has an audit trail in place to show that a physician chose to eliminate the images after the two years had elapsed.

The audit trail demonstrates that the health system thought through these issues and developed a policy for retaining and eliminating images in way that adheres to federal regulations, he said.

All-in with all data

Reichert's storage management strategy is to start with email and then move to cardiology data. His plan is to retain three years' worth of emails on a rolling basis and dramatically reduce the amount of cardiology data -- which now measures 30 terabytes -- on a vendor-neutral archive (VNA) within six months. Later this year and into 2017, he'll tackle data from radiology, dermatology, orthopedics, and ophthalmology.

Starting with administrative data -- such as email -- doesn't require as much risk as working with clinical information, Reichert said, and it enables MetroHealth to apply the lessons learned to cardiology data. He's chosen to pursue cardiology data before radiology images largely because of the volume of radiology images. MetroHealth generates more than 300,000 to 400,000 radiology images each year, he said in an interview with

Getting all of the data stored on a single VNA will give MetroHealth the freedom to choose any vendor it wants for its radiology PACS or cardiology systems in the future.

"That means I won't have to move the data again," Reichert said. "All I need to worry about is the front-end piece."

This is a money saver for MetroHealth, as it costs $200,000 every time it has to migrate its cardiology data to a new archive, he said.

The VNA approach will also allow better patient care because all images and data -- regardless of specialty -- will be stored within the vendor-neutral archive.

Changing the status quo: Bringing clinicians onboard

The VNA approach -- particularly its protocol that manages image storage by tagging images with a scheduled elimination date -- was a hard sell for cardiologists and radiologists, in particular.

"Since ours is a teaching and research hospital, their first reaction was, 'We can't get rid of all these images. We write articles. If we set up this system [where images are eliminated], we won't have access to these images for research purposes.' "

Here's what Reichert told them: "I'll be able to tell you every time you've reached out to a particular study, and I'm certain that within six months or less, I'll be able to show you how often you've touched an image. So my question was, 'If you haven't touched that image at all in 30 years, what makes you think you're going to use it again?' "

Historically, MetroHealth has spent $1.5 million each year in storage costs. With the health system's VNA approach, Reichert said he'll cut storage costs in half.

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