Managing The Healthcare Data Deluge

Topics: Healthcare IT Management

Premiered: August 26, 2013 | On-Demand Webcast

Our nation's rapid move from paper to a digital native posture for its medical records is being driven by significant regulatory and payment reforms -- from initiatives such as Meaningful Use and the Affordable Care Act (ACA). This once-in-a-generation transformation is creating a healthcare data deluge that is both unstoppable and exponentially growing. Both the amounts and kinds of medical data we need to manage in modern IT environments are unlike anything we've seen before. Given how important data is and the fact that paper-based backups are no longer acceptable, each provider must develop a strategy to manage its healthcare information lifecycle in a manner that guarantees availability, responsiveness, and reliability of data.


Michael Leonard

Michael Leonard
Director of Product Management, Healthcare IT
Michael Leonard is the Director of Product Management for Healthcare IT at Iron Mountain. He is responsible for the growth of our Healthcare IT services business and he helped launch Iron Mountain’s cloud archiving business.

Shahid Shah

Shahid Shah
CEO, Netspective Communications, LLC
Shahid is an internationally recognized enterprise software guru that specializes in healthcare IT with an emphasis on e-health, EHR/EMR, Meaningful Use, data integration, medical device connectivity, health informatics, and legacy modernization.


Speakers: Shahid Shah, Award-winning Government 2.0, health IT, medical device integration software expert, Mike Leonard, Director of Product Management for Healthcare IT, Iron Mountain
Moderator: Mike Perkowski

Male: Hello, and welcome to this presentation, Managing the Healthcare Data Deluge. This presentation is being brought to you by Iron Mountain. Before we begin this presentation, please know that the slides for this presentation we put to your screen automatically no audio streamed to your computer.

If you have any questions, you can answer them by clicking on the questions tab on a lower left-hand side of your screen and click "submit question". You will be answered by one of the speakers and get back to as soon as possible. With that said, it's my pleasure to pass it over to our moderator, Mike Perkowski to introduce the speakers. Mike?

Mike Perkowski: Thank you very much. Welcome to our web-seminar. I'm Mike Perkowski, I'm your moderator. Our program today focuses on the exciting, confusing and always changing issue of managing the healthcare data Deluge. And we call the data deluge for good reason.

Perhaps no industry in the world is experiencing a greater more dynamic and explosive growth of information, and all of its different forms: text, voice, digital, video, social and all other formats in the healthcare industry. Obviously compliance, regulatory, legal issues are really big catalyst for this but always be rapidly nature of healthcare delivery even takes place in the 21st Century.

When you add in, you know, such important trends as mobility, digital imaging, records management, it's really to understand why this is so critical for a healthcare organizations. Now, after all decisions on (EMRs), meaningful use, (tip) or another (facets) of healthcare impact everything from patient's satisfaction and quality of care to practitioner competency and financial controls.

So our program which is sponsor that made possible by Iron Mountain features the insights experience and opinions of two expert speakers. We are going to hear from Shahid Shah, an award winning and widely recognized expert on healthcare IT. Shahid is known as the healthcare IT guy. And he is a technology strategy consultant to a number of federal agencies. He is one actually the Federal Computer Week, Fed 10 Awards (inaudible) excellence in healthcare IT expertise in the federal sector.

And Shahid is also going to be joined in our panel discussion by Michael Leonard, director of product management for healthcare IT at Iron Mountain. Michael received Iron Mountain Healthcare IT services business and he has an extensive background in healthcare IT and records management. He has worked at a number of leading healthcare technology companies such as Merge Healthcare, GE healthcare and EMED Technologies.

Together, Shahid and Mike are going to offer not only strong opinions about the current state of healthcare IT that’s contributing to the Deluge. But they are also going to offer some practical advice on how healthcare organizations not only can survive this Data Deluge but actually (prize) in it.

So first, Mike Leonard, thanks for joining us. Any open (quotes) before we jump in to this?

Michael Leonard: Yes, thanks, Mike. You did a great job setting the stage for today's discussion. You know, one thing I want to add is, you know, when we are talking to customers we hear this all the time that this is a huge challenge, the Data Deluge, everybody say or think so.

You know, when we hear about the tight budgets and the problems that everybody is having in terms of the reform, in terms of payments in healthcare reform, you know, this is a very important topic. So, you know, those are the topics that we want to be addressing today.

Mike Perkowski: Great. Shahid, thank you for joining us. Any open quotes of your own?

Shahid Shah: Yes, thanks, Mike and Mike, both of you. It's great to be here, and I appreciate Iron Mountain for delivering this really important educational session. The main thing to think about during this conversation, and the one key takeaway is that there used to be a time when digital health or data was really a nice to have. But even if something happened to it that you still had a lot of backups and paper was available, and you can do a lot of things even without the digital side. Of course, that’s actually not the case anymore.

In fact, if you've read some of the responses and writings from folks who have dealt with the Boston terrorist incident, and what happened there, and other incidents like this. When data is not available, things go badly very, very quickly. And so when data is no longer optional and the deluge of data is coming in, at the rate that it's coming in, this educational session that Iron Mountain is putting together is really terrific. And I'm happy to be here to talk about.

Like you said (might show an) opinion but hopefully some actionable advice as well.

Mike Perkowski: OK, great. So now that we have established the sense of urgency here, let’s jump right into it. You know, let's start it off at a high level about, talking about the state of the healthcare industry. Mike, what is this for healthcare IT today and in the near future?

Michael Leonard: Well, I think an important point is to really understand what's driving the growth of the healthcare IT infrastructure has been put in place. And it really comes down to the healthcare reform that’s happening across the country. I mean, the amount of merger and acquisition activity is up tremendously. And based on the reform, you know, it's clear that healthcare organizations and the healthcare delivery system must change. I mean I think that’s not even (available).

So as we think about the things are happening through the Healthcare Reform Act in terms of, you know, meaningful use and the new Accountable Care Organizations are being put into place. You know, people have to put infrastructure in place that’s going to be able to support the shift. And so, as the structure changes and the shift happens, you know, healthcare IT is just becoming more strategic than it ever has been in the past.

Shahid Shah: Exactly. And so what I would like to add to that is that what we should probably consider is the fact that the old way of managing data used to be that, you know, the IT folks will take care of it. So we are going to (that) our normal business, and someone back in the back and will handle all of the data, they will make sure that it's available. And whenever we need it, we will just be sure it's there.

That work (look) fine when we are talking about data as a retrospective type of utilization meaning that whenever we needed it for reporting or something, we will go back and dig it up as we need it. But of course, we need to really treat that as asset, it's a corporate asset just like money is. We don’t take money and say, "OK, you know what we will just hand this to some department in the back and they will just handle it." Everybody worries about money, everybody should worry about data.

When you treat data as an asset, you treated as the gold mind that it is because data is not only useful for retrospective use like it was in the past, not just for tactical use like it was in the past but really when we do – when we needed for Accountable Care Organization, when we needed for meaningful use, when we needed for healthcare reform, we are looking at population health, we are looking at analytics. We are trying to do things that are more prospective in nature trying to figure out and predicting what's going to happen next year based on data that we've had from the past.

And data actually like Fine Wine, (Ages) really well. So something that you didn’t know that you need it five years ago. You can actually use to do predictions two or three, or four years from now. So one of the key things is try not to think of data as just some IT problem that is a new sense, and somebody should be dealing with on the back-end. It's a strategic asset, treat it like money, treat it like gold because in the future it will be even more valuable than however valuable it is today.

And one of the things that you should absolutely try to figure out is, what is the accuracy of the data? What is providence of the data? Where do they come out from? And who owns it? All of these things are really, really important for prospective needs.

Mike Perkowski: So the outlook of it is really critical, I mean we are going to cover that a little bit more. We could probably do an entire (inaudible). And Mike, it sound like you were going to add something to that?

Michael Leonard: No, I was. I just wanted to add that not only is the information important for healthcare organizations going forward but from population management perspective. The patients are going to have to start to think about it in the same terms.

Mike Perkowski: Right. Yes, very good point. So, you know, if the understatement of the year (call) this a data explosion. Shahid, what can healthcare organization expect in terms of value of all of this critical data now, you know, coming to the forefront now and in the future?

Shahid Shah: Yes, this is such an important topic because for the last probably 20 or 30 years, and in fact it's not commonly known that one of the first systems that ever created on a mainframe back in the 50 was to manage healthcare administration data. And so we've had the ability to manage admin data or economic style, monetary style data for over 60 years in healthcare so none of that is new.

But what we are seeing is if you imagine that the administrative data was, you know, with a unit of one. And that, you know, we've got all of this admin data, it is where it's at today. If we just add in meaningful use data, we are multiplying that by 50 to 100 times because there is a lot more clinical data that is being managed just with that meaningful use stages one and two.

If meaningful stage three, medical device data comes in, now we are starting to talk about potentially 500 times, 1,000 times that data add in the medical imaging and the, things like X-rays, MRIs, etcetera. And now, we are moving to thousands of times the kinds of data volumes that we have.

If you think about where we are with data today, almost 80 percent of data in healthcare is unstructured which is make –basically means that if (you are) doing image format, it's in text format that maybe presented as physicians notes, etcetera. But what we are moving to is, you know, (Genomics) and (inaudible) beyond that. And then we will move to 10,000 the amount of data that we are managing today.

So it's going to get worse and it's going to get worse really fast which is why it's so important to understand what is that providence, where is the accuracy. You can't treat every kind of data the exact same way. So we will talk a little bit about what the best techniques are to manage that with the huge amount of volumes that are about to come down the pipe.

Michael Leonard: And I will also add that, you know, additionally in terms of the technologies were just mentioned as (tele) health (approach) as well and remote monitoring and remote patient care grow, even remote diagnostics growth, that will also add to this, you know, in such the same manner as the medical imaging does today.

Mike Perkowski: OK. So we painted a picture here of obviously a tremendous explosion, number of causes, lot of it, you know, regulatory and legal, a lot of it just sort of changing in a way that healthcare is delivered. You know, what are some of the key challenges that you see that actually managing, you know, all this data? How does this impact healthcare IT given this incredible data?

Shahid Shah: Yes, so even as little as five or ten years ago we were able to manage stores growth fairly straight forward that was, you know, we just bought additional hard drives in a predictable path. So if we knew that we managed 10,000 patients as of last year, we might manage 11,000 or 15,000 patients the next year, and you can do that incrementally. You can figure out what that stores growth looks like.

But now, we need to (inaudible) these segment in tier to help reduce the cost because it's coming in much, much faster. The velocity and the volume is much faster. So how you do growth planning is a major challenge.

The second thing that’s a major challenge is not all data can be kept active at all times because as we know, when you are storing something on a fast hard drive, it cost a lot more to store that than it does for example to stored on a slower tape drive. So you have to make sure you understand what is the value of the data as it comes in, how long is it going to stay active, when do I make it inactive.

For example, an image that I have gone and done a (read) for, a videologist that already read an image. Now, a note needs to be made available, the note has to be continuously available for a long time but the image should be able to be backed up. So you can't treat all growth the same. You can't treat old data the exact same way. And it's very important to work with both vendors as well as folks within your IT team to understand how do you manage inactive data.

Then, there is a huge challenge recovering from a disaster. So you can't just say that all the data is going to be backed up the exact same way. It's going to be archive the exact same way. So how you recover from a disaster member? I mentioned at the beginning that there is no scenario that you can just go to paper backups anymore.

Paperback ups are just not going to be possible going forward. So recovering from disaster, bringing data back into inactive mindset from a passive set that has been backed up is very, very important. How you are going to manage these data centers? Just like facilities, facility management is obviously the most important thing, you know, how many hospital based you have in a hospital, how you manage facilities, how many floors you have.

And just like a few years back, we started to think about how we are going to integrate data centers, where do they go. You now have to double and triple that kind of thinking because you have to manage the data centers inside your facility then managing outside facilities, and your outside outsourcers and vendors, etcetera.

Now, add to all of that, you know, not – that wasn’t just hard enough is you have to protect all that data from a security perspective. So what is your chain of custody, who are you trusting with the data that goes in from your – as the time it comes in to your most active state, to your inactive state, to your archive state. So avoiding a breach is really not (preview). I'm just saying that we are HIPAA compliance, you know, lots of vendors.

And we like to think that, OK this is a HIPAA compliance solution, that really doesn’t mean a whole lot unless there is an entire process behind it. So if you think about it avoiding a breach, managing your data centers, recovering some disasters and accessing data in a tiered manner to help reduce cost are all major challenges that you are going to need help with.

Michael Leonard: And there is another challenge that comes before all of these, and I think that is creating organizational alignment. Without senior clinical and IT leadership being on the same page, you are not really going to be able to solve any of those challenges so that is clearly an important aspect to think through that to get through any of these solutions that he just talked about, that Shahid just talked about. That alignment at the senior level in the organization is just imperative.

Mike Perkowski: OK, good. So, you know, there are lot of challenges but in a lot of ways, we are still are kind of at the early stage of all of the development of all of the data in the healthcare IT space. And people are putting in place no approaches but, you know, clearly they are not ready yet to handle the deluge, at least where it's going.

You know, Mike, what are some of the deficiencies that you see healthcare organizations wrestling with as it relate to information life cycle management?

Michael Leonard: Well, you know, when we go and talk to customers, what I hear time and again is that there aren’t really enterprise policies in place, not only for life cycle management but for some of the IT side but even on the record management side, the retention policies that needs to be put in place.

So because it's been such a siloed approach, you know, by department over the, you know, past 10 or 20 years that mindset hasn’t really change in (enough) organizations I would say to really make that difference where these enterprise policies are in place.

Shahid Shah: Yes, I couldn’t say that better. What we want to make sure is that information life cycle management was often referred to as ILM be treated in the same way as patient care procedures are managed today. So they we are well documented in general, they are well organized and well understood approaches as to who is responsible for this part of care.

For example, when a patient comes in, who is responsible? When the patient is in the ICU, who is responsible? When the patient is being discharged, who is responsible? We don’t really have that kind of thinking around the information life cycle in the same way that we manage the patient's life cycle.

So in each one of those cases, we have to start realizing that data is a strategic asset. And in those patient care processes, we need to start inserting them and saying, "entry of patient". Here is what happened, (one there) in ICU. Here is what happened with data, when they are being discharged? Here is what happened with data.

So as we start to think about data in the same way that we think about money. So wherever we think about money and the administrative side and the cost side, we think about data the same way then we are starting to make progress. If not, if information life cycle management is not a real discipline, if information life cycle management does not have a (head) within your hospital, within your facility then you are really not taking that seriously because data again is an asset like money, it has to be treated like gold, and be inserted and permeated through the various processes, through a valid information life cycle management approach.

Mike Perkowski: I think one of the key thing that you talked about there in information life cycle management is that, you know, it's easy probably for people look at it the technology issue when clearly is not – it's much more about business process that is about anything else, the technology.

But speaking of technology and process, one of the other areas that we hear a lot about, and there is probably a lot of confusion about is this notion of back up in archiving. And one of the things that is – that’s important is to really understand that there are differences between the two.

So, Shahid, what can healthcare IT professionals do to make sure that their data is both properly backed up and archived?

Shahid Shah: Yes, great question. So from a back up perspective, what we are really trying to deal with is ensuring that we have what is called continuity of operation. So when you are dealing with the two areas: back up and archive. The first thing you want to say is what are all my business process is? And this is why ILM, the information life cycle is important, what are all my business life cycle?

Then we take the very simple ones like, you know, patient registration, patient discharge, patient moving from room to room, these are all business processes. And what you say is, what happens if my system goes down during a business process step? And once you have properly identified your business process steps and you have identified what the requirement is for continuity of operation of each one of those steps, then you started properly thinking about backups.

Because backups are very different in archiving because backups are about ensuring you have access in the event of a system going down, and is a real technology solution. There are lots of solutions available and how you integrate that.

Archives are quite different. Archives are really focused around generally compliance and ensuring that you have multiple tier so that they doesn’t cost you so much. If you keep everything archived by (Mary Lee) to keep everything active instead of going to archive. Then it means that you have a lot more a cost associated with each one.

So with backups, the most important things is insert them into your appropriate steps and know how do I continue my operations if any particular piece of technology goes down. And how do I have my data and make sure that if a hard drive is lost versus entire data center is lost, etcetera, but with archiving which you want to know is, what are my compliance requirements in my state? And this becomes even tougher when you have a large hospital or a large facility that goes across multiple states.

Each state has their own archiving of data requirements, some say, you must keep it forever. Some say, you must keep it for seven years, and you have to build those rules into your solutions to ensure that you don’t mix up archiving and backup because they are two different things.

Michael Leonard: Yes. And we hear all the time from customers that, you know, they think about archiving and they immediately just think of storage. And we tend to think of archiving as a discipline that many organizations don’t treat as its (own) separate discipline. They kind of get these backup concept but the archiving concept, we feel from the conversations we have with customers hasn’t quite become seen as its own discipline.

And by approaching at that way, we think, you know, healthcare organizations will be able to take a more long-term approach to creating an archive policy so that they handle all those compliance issues that are archiving is really about.

Mike Perkowski: OK, so good points there between the important things between the two of them. Let's talk a little bit about managing data and addressing the challenges. What are some of the best practices, Shahid, that are now emerging about, you know, the best ways to do that, the most efficient ways to do that?

Shahid Shah: Yes, the first thing what I would say is establish ILM, the information life cycle figure out who is going to be responsible for the things that I'm just about to talk about. And then walk through, and much of this is documented fairly well in some of the materials you can get from this educational session and (including) white papers.

Starting number one though is assessing and understanding the sources of all of your data. So some data comes in, you know, for example if you go back to that example I gave around, the patient's registration versus patient discharge, different kinds of data comes from different places on the first step versus the last step (or) 100 steps that’s in the middle.

So as you understand each of the sources of your data, it could be an e-HR, it could be in many cases you might be learning about a patient coming in because they have reported something on Facebook, etcetera. There is going to be lots of different sources, so understanding that is number one.

Estimating your data growth for each kind of data. So for example, one source of data is imaging. MRI is a different size than an X-ray. So you have to estimate your data growth for each kind of data. And there aren’t thousands of data types, meaning source of the data. But they are likely in the dozen if not a hundred in a fairly sophisticated environment.

So once you know the sources and you have understood the data growth for each size, you start to segregate structured and unstructured data by figuring out whether or not you have high volume, how much time did it takes to enter the system, what is the speed of data delivery required between the systems. And then based on all this, you start to develop the data management strategy and then institutionalize.

And this is the most important thing, you know Mike mentioned a minute ago is if it's not a discipline, you will have data loss and you will have business failures because of it. The world of paper backups is going and gone in many places. So if it's not discipline, if it's not institutionalize, if you don’t have documented as to knowing where your sources are, how your – how big your data is, and how you are going to segregate structured and unstructured data by particular roles so you know how you are going to use it.

You will not have a good data (management) strategy and end up having a lot of broken processes when something fails. And the problem is a lot of facility don’t realized they have a problem until a hard drive is lost or until if something gets that happens.

Mike Perkowski: So Mike, you talked to a lot of customers, where are they in terms of establishing their own best practices for this? Are they still trying to figure this out or they started to learn, you know, things and started to, you know, propagate this best practice throughout their organization?

Michael Leonard: Well, I think most organizations have, you know, they are on the path to putting these practices in place. But, you know, going back to the archiving discipline, you know, that to me seems to be the area where most organizations are far behind where they are in the maturity of their backup processes.

I do want to just add a couple of comments about the, you know, sources of data. You know, we recently were talking to organization that went through review of just the imaging sources of data, not even modalities but imaging systems that might be receiving data from modalities. And they came up with over a hundred imaging applications in their organization and (get for them) because it was across so many different apartments. So just give you a sense of how pervasive just the imaging aspect of the data deluge is.

And then the other point I would make too is if folks are looking to, you know, estimate their data growth, they really should be thinking about it over, you know, three to five, to seven-year period. Because if you just look at it over the next six months to next year, not really painting a broad enough picture because, you know, some of these infrastructure decisions you don’t live with them for a decade. So you really need to make sure you think about the data growth over longer periods of time.

Mike Perkowski: OK, good idea. So one of the next things we want to think about is this whole notion about what sources or activities are being out or is suppose, you know, continuing to do things, you know, (in-house), on premise.

Mike, can you tell us a little bit about, you know, how you see outsourcing storage management functions and how it could impact total cost of ownership?

Michael Leonard: Well, I think if you are actually even considering outsourcing, go back to something I said earlier, it goes back to alignment at senior management. It's not a decision that is made by any single part of the organization. It's usually going to be input both from the business leadership, the IT leadership and the clinical leadership to make that sort of a decision. So that’s really the starting point for any sort of – (ensured) thought of outsourcing.

Shahid Shah: And what I would add is that when we said that data is an asset, it's like money. You typically don’t outsource all your handling of money somewhere else without being prepared to do that internally. So in general, you try to do as much as you can internal. But really what's happening these days is that (would) so much being requested of your hospital IT department, it turns out that even in a really, really good IT department, many people who are dealing with data management, backups, archiving, these very important jobs are doing so part-time.

So if you look into your environment then you say, is there an ILM head? Can they manage this without help from the outside? Is the IT team properly staffed and budgeted to ensure that all of the stuff that we just talked about of the last few minutes is being done by the internal IT team. Then you say, "Hey, why would we worry about outsourcing? We've got it all. We understand it. We know all of our sources of data. We know exactly how they are being handled, etcetera. We don’t need any help."

But that’s – there are probably a handful of organizations like that in the world. Most of their organizations are so busy just keeping up with regulations, keeping up with the requirements for e-HR, the meaningful use, and IT (detain), etcetera that these other jobs because data isn’t something you see every day, you see applications every day. People complain about applications, why does (if) something show up.

These underlying things about where data stored, how it was managed, etcetera are not (thought) about until something goes wrong. And that’s the trick here is you want to think about this before something goes wrong. So even if you are going to do anything other than bringing an outsider to help come in and say, "Hey, help us do some alignment. Help us do some management here. Help us understand what our problems are."

And then use internal processes whenever possible or if you are sure that your IT team cannot do it because they are not resourced or budgeted properly, it's best to just immediately start thinking about outscoring.

Mike Perkowski: You know, it's very interesting, you know, this discussion about outsourcing. For decades, people have talked about this whole balance between core versus context (the idea) if it was a core function or applications stayed (in-house), it was context, you know, it got outsourced.

Then a lot of people I think wrongly interpreted that context were to be important or (tactical). And I think, you know, what we are learning now is that a lot of the things that are very strategic for you, you want to consider outsourcing because it might require specialized knowledge and expertise that you don’t have enough (specialist), it's more IT departments.

Shahid Shah: Right. The only thing to keep in mind from an outsourcer perspective is sometimes you want to be careful to make sure that your internal people don’t just assume that the outsourcer will just do everything, and they don’t need to watch out for it. And that’s the real key here is that there are lot of outsourcers out there that will come in. some of the work behind the scenes that make you feel better about it, but they don’t know enough of the entire information life cycle management to make sure that you literally have one throat to choke if something goes wrong.

So what I have seen a number of times in customer setting is they do go outsource. But it turns out that the outsourcer was so small or couldn’t handle the entire job that a finger pointing blame game going on when something bad happens is they say, "Hey, we were just supposed to manage the backups and making sure the (tapes) go from one data center to another." We were never supposed to low the take-ups and make sure that the back – that data was actually on the (tapes).

I mean if the silly stuff like this, you want to make sure that when you are outsourcing you are careful to pick a vendor that understands the entire process and knows that a backup for example is not useful unless you actually test the backup and make sure that it actually comes up at archiving. And these compliance matters in state A versus, you know, like if you are in Texas versus Massachusetts, they have completely different laws. Just make sure that manage those.

So the care in outsourcing comes with vendor selection, and not everybody can do this job.

Michael Leonard: Yes, and it's important – just to add, I mean, you know, you have to set those expectations upfront between the healthcare organization and the outsourcer. If everybody is on the same page right from the beginning and everything is, you know, explained and everybody agrees to it, you know, that’s what's going to keep that divergence from happening. But I have seen that in many cases myself, so I would totally agree with you, Shahid.

Mike Perkowski: So one of the other benefits that people have always look for outsourcing to help them with is financial of course. And you know, we want to talk a little bit about the impact of capital cost on an outsource storage management model. Shahid, what are some of the issues relating to those?

Shahid Shah: Yes, so the first place of outsourcing is very helpful is that it removes…and we know in healthcare industries for example that in hospitals they are often on a two-year budget cycle. So if you didn’t get something budgeted a year ago or two years ago, you are kind of out of luck.

So what helps in this model and the outsourcing model especially when you are moving to a service driven model is that you can reduce your capital expenditure. And say instead of saying, "I'm going to go buy, you know, huge rocks and lots and lots of disk drive, etcetera." You move to an operational or Opex model so you don’t have to buy the same equipment over and over again. And not worry so much about buying things for putting your data center.

But even though if that’s quite helpful, you know, Capex and Opex is very, very useful. Most people forget the fact that where the money really is, is not in hard drive or storage or whatever. It's in buying the people that you need to properly manage continuative operations, backups, data storage, understanding data (storage), etcetera.

So what's nice and even if you outsource just your storage but you don’t outsource your HR where the expertise is needed, it still puts you in a bad place. So you want to reduce your Capex to Opex to make sure that equipment is managed. But you also want to think about how do you reduce the HR cost and move that to an Opex scenario so you have a stable price every month and every year with the percentage growth, of course.

So you will say, "OK, I'm going to be at Opex of x dollars a year with x amount of growth." And leave it that that will give you the best predictability and ease of budgeting.

Michael Leonard: And there is another aspect of outsourcing I think is also important, it's kind of related in terms of if you are going to be working with outsource, you also need to make sure that you are working with a partner who is, you know, going to be signing a (VA) agreement, I mean that is imperative now. You really can't work with an outsourcer if they are not going to be able to meet those requirements, you know, that the covered entity is responsible for as well.

So that just becomes an important, you know, the decision point to make sure that you are working with outsources who to meet those requirements that you have for them.

Mike Perkowski: So earlier in our discussion, Mike actually mentioned the sort of the danger (of apparel) of data silos, right, and the importance of eliminating them and avoiding them whenever we can. One of the goals obviously is to try to be able to share patient, you know, more than we have done in the past and certainly for the future.

For instance, you know, health information exchanges,HIEs are all about, you know, sharing data. You know, then we've got of course the move to accountable care organization. So you know, Mike, what should healthcare providers consider as they move to HIEs and HCOs particularly as it, you know, relates to eliminating and breaking down data silos?

Michael Leonard: Actually it's interesting, I think Shahid touched on this right at the beginning. It's really thinking about the future because you are creating a foundation today to start to be able to collect and properly put data in the right context so that you can then start to use it into the future.

So, today I think is really about trying to design the appropriate infrastructure that will create a foundation that you can then grow from. And we see that those – whether we are talking to (peers) or providers to kind of figure out what is the right infrastructure to put in place today. And how do we make sure that it's going to meet the needs, you know, many of them are unknown needs that they will have in the future.

So, we see a lot of our organizations struggling with that today but it's really about creating that foundation to help you prepare to use some of the data that’s coming in today in the future.

Shahid Shah: Yes, and that foundation, one of the trickiest part about that foundation is that most of us in healthcare today and our facilities are quite inward looking. So we have a facility, and we might have multiple facilities but we deal with our data, it's ours. And we know even if we don’t know all of it, we know in general where the data is, etcetera.

But really HIEs, accountable care organizations, patients that are on medical homes, the next generation bringing in as Mike said earlier, patients into this picture means that we must be outward looking, outward focus instead of inward focus. What this means is that data that used to be managed by a single legal entity now needs to be promoted through multiple legal entity that might be part of a larger organization.

So all of the stuff that we talked about: understanding your data sources, managing growth, etcetera now have to be expanded with the idea, and we talked about providence and data ownership, and comprehending the path that data goes through. This becomes even important, even more important is as you – if you decided do it yourself that, you know, you can obviously make sure you understand what are the sources of data that I create versus what are the sources of data that my partners and the outsiders create.

But if you are dealing with an outsourcer, just make sure you make the proper selection and somebody that’s sizeable enough whose got – who understand the idea that outsize and data management is very different, how you do the HIPAA regs around it, how do you track the data and the security around it is very different.

So everybody knows they are going to be moving to more and more integrated system. What they are not sure about is, what are the legal ramifications of data that I create that becomes property of someone else and vice-versa. So you need a really comprehensive integrated, unified approach to managing that data. And otherwise, it will – you might get into trouble not because you lost data but because you shared it with someone that you weren’t supposed to.

So there are some dangers here that you can't do anything about except better planning and tracking measurement, management, etcetera, in your full information life cycle approach. So just remember, this means instead of inward looking or outward looking, just make sure you take into account the outward looking phase into your ILM strategy.

Mike Perkowski: Let's shift gears just for a little bit something that’s, you know, really kind of a groundbreaking thing and a tremendous implications in the healthcare industry. And that’s to move from what we might call volume care to value care. Obviously, you know, we are quickly moving away from the legacy transition, you know, from fee for service to pay per performance or pay for, of course, better patient outcomes.

You know, Mike, what are some of the impacts that you see in the shift from the fee for service model to the new pay per performance model?

Michael Leonard: I thought you said Shahid.

Shahid Shah: Yes, so I would say the biggest issue from the shift from volume to value is coming in the fact that data becomes your core asset as we have discussed. And that asset itself is what's going to drive the business processes. So typically, you know, in the last, as I mentioned, you know, data has been around in healthcare for a long time. You have actually started to – we have used data before as a way of recording what we accomplished. And that has been the idea of volume care.

So I did something, I saved it and I move on. But in the case of value driven care, we can't understand that value until we know what is everyone else done and what are the steps that we need to take in order to ensure that there is better care, better outcomes, etcetera.

So knowing where all your data is, understanding what that data means, using it for predictions and for population health, and for understanding where care is moving forward in the future rather than just looking at it retrospectively becomes very important. So this impact, the biggest impact on the shift from fee per service to pay per performance is this idea that I am recording something for auditing or for payment purposes to the idea that I'm tracking older data, I'm recording something so that I can use it in the future to get better care out of it or better outcomes out of it. That seems like a simple distinction but it's huge. It changes dramatically the way that we manage the data comes in and how it's used.

So the shift is going to be giant and you got to make sure that you got the right ILM to help you achieve it.

Michael Leonard: And I think it's important to point out, you know, that at the macro level when you think about the population management, having this measurement taking place at the patient level will be helpful and imperative in helping with the overall population management as we move forward with this model.

OK. So now let's take a minute to talk a little bit about information government, the governance and having, you know, the right framework for that. Mike, what does a provider really need to do in order establish the proper information governance framework?

Michael Leonard: I wish our consulting team is on the phone today because they did give an earful about what organizations can do. But it goes back to senior management, (by-end) or senior management agreeing that a process has to be put in place.

You know, somebody in the IT organization or even mid-level in the clinical organization, they are not going to implement an information governance solution on their own. It really has to be driven down into the organization so it really has to come from senior management.

From there, you know, there is a number of ways it can be implemented. And generally, you would review, you know, all the different systems in your institutions, get an understanding of, you know, other, any departmental policies that might already be in place.

Then you have start looking at the states where you are providing care. There are many organizations now that provide care across state lines or even internationally. So to put something like that in place, you know, it's generally a large project. And without senior management buying, you really not going to get anywhere.

Shahid Shah: I think probably the most important part of that was, in the old vernacular, who is the decider? One of the biggest problems that we have seen in ILM based approach is that aren’t fully mature. There is not a single decision-maker or a group of decision makers who know here is what happens to data. This is the role that we are going to follow, etcetera.

If you like going to a hospital and wondering what the patient's clinical care pathways look like that there is nobody who decides that everybody willing (and only) decides, you know, how patient care is delivered and what pathways they use, and what procedures they are going to use. So understanding who is going to decide keeps your implementations fulfilling because most implementations of proper data fails because of governance…governance problem, you don’t know who is making the decision.

So the first thing to do is make sure you have an ILM role. That ILM is well defined a committee in which the decision makers are present, if set up that that committee and the associated work is budgeted properly, that proper vendors are selected. And then goals are set up to say what does proper governance mean, how do you know that you have a proper ILM. You can certainly bring an outsiders to help you understand that but your folks internally as Mike said have to agree with that.

So you figure who is going to decide things, make sure you have proper governance, and that committee of decision makers have to be present. Because I have seen a lot of committees in which people just don’t make any decisions because they get to talk about it but nobody decides what to do. So it is a big detail to make sure that information governance is in place.

Mike Perkowski: And Shahid, you mentioned budget which is obviously a key issue, a nice transition to our next point is the importance of really treating this as an investment obviously we are talking about the strategic nature of data. We are talking about data as an asset. We are talking about information life cycle management and critical decisions are being made. You know, you have to, you know, convince people that these are really strategic investments that are, you know, important we make.

Shahid, how do you make information life cycle, you know, an investment priority (unless) make it more accessible to the organization?

Shahid Shah: Yes, I would say, the simplest way to think about it is to think – and whenever you say something about data, replace the word data with money. So, how is money governs in your hospital? How is money life cycle managed in your hospital or facility?

So, if you think about data as a true asset just as important as money, just as you said Mike an investment, you will start to react and change your organization around an information life cycle manager becomes immediately accessible. Because just like in most hospitals where cost containment is important, data management must be that same level is important.

So we are about to run into a new HIPAA on the bus time frame, you know, in October we are going to start the new Omnibus rules. How do you know what impact the Omnibus is going to have if you have not done the basic ILM prep work? What's going to happen as the audits and compliance increased over the next couple of years? How are you going to ensure that data integration in your health information exchange or accountable care organization is working properly if you don’t know what's your information life cycle management looks like?

So the best way to get this very high impact discussion started in your organization is to say, data is an asset, it is an investment. We will treat it the same way as we treat money. If you can get – if you can get beyond the snickering and if you can get beyond management saying, what do you mean by that and get it really established then everything else can go downhill from there because you will get the right kind of attention.

If people do not see data as an asset, if people do not see that as an investment, if they don’t see that as a gold mind, they think that paper backups are still ready. The only way you are going to find out is through a failure of some backup or something like that. And then it will come the hard way, but everybody is going to have to move to this very, very shortly.

Michael Leonard: And there is a further financial aspect to this too because, you know, absolutely agree with it as an investment. But if you can also show that implementing ILM policies across the organization can actually help you save money based on where you are storing certain types of assets. You don’t need to store all, you know, all imaging data on (fast) disk if it's not going to be viewed again after six months. You want to keep it in the appropriate type of technology so you can actually show a cost benefit by implementing an ILM policies well so it goes right to the investment governance.

Mike Perkowski: OK. Well, that has been great. We've covered a lot of ground here today. So that concludes our program. First, I want to thank Shahid Shah and Michael Leonard for sharing their insights and suggestions on our webinar. And I also want to note that you can download a (relevant) white paper on this particular topic. All you need to do is go to and you will be able to access a very important white paper to give you additional insight on this particular program.

Again, we would also like to acknowledge and thank Iron Mountain for sponsoring our program. And if you would like to revisit this webinar in the future or if you would like to refer this program to colleague, be sure to visit and click on the link for webinars to access this, and other webinars.

Thanks again to our speakers. And thanks to all of you for attending this program. We hope you will join us for our future web seminar. For Tech Target and, I'm Mike Perkowski. Have a great day, everyone.