EMC AND Healthcare.

Lots of companies bandy about "24x7" and what a mission-critical set of numbers they are. But if any industry can lay claim to being the world's first true 24x7 industry, it's healthcare. Anyone who has ever worked in a hospital--or raised a child--knows that's true: people's bodies do not observe neat daytime strategies and polite doctor's appointments. So healthcare--including emergency rooms and trauma centers, medical groups and outpatient clinics, insurance carriers and medical billing--should be operating at a 24x7 high availability, sophisticated networking level.

But they're not. In fact, healthcare is notorious for insisting on a dizzying number of conflicting transmission and networking standards--when they're online at all. It is this fact--400+ different healthcare insurance reporting standards--that helped spur the federal government to pass the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This act required the Secretary of Health and Human Services to adopt new standards for electronic health care transactions. Most everyone agrees that long-term benefits will be considerable, with positive impacts on administrative burdens. And administrative costs in healthcare are astronomical: only 10% of the 30 billion healthcare transactions in 1999 were electronic, resulting in upwards of $280 billion in avoidable administrative costs.

But wait--the plot thickens. According to Bill Knight, EMC's Director of Healthcare Solutions, the real reason behind HIPAA isn't the official one, which is "patient security and privacy." This is all well and good, but does it really require such a tremendous investment in new equipment and procedures? We patients may think it does, but the real driver is fraud. If healthcare grosses $1.2 trillion in 1999, and fraud represents 10% of that total, that means a tidy sum of $100 billion a year lost to fraudulent claims. The year 2000 should come in around $1.4 trillion, and healthcare and government analysts put the 2008 figures at $2.18 trillion. If fraud continues unchecked--well, you do the math. Thus HIPAA was passed, to allow fraud investigators to view and identify nonrecurring trends.

Analysts have seen this coming. Gartner and Forrester, among others, have stated that HIPAA compliance will force healthcare storage and networking into the 21st century, as healthcare is 10 years behind in technology development. This is where enterprise solution developers such as EMC and its partners take center stage, especially Oracle and Cisco from EMC's ECOStructure triumvirate, and GE Medical Systems.

The challenges are not limited to act compliance, which won't be fully in effect until 2002. Other drivers towards managed electronic systems include Medicare cuts, the demand to consolidate patient data on secure and highly available enterprise health networks, the rise of HMOs, increasing online transactions, imaging applications, and the breakneck pace of technological change in IT environments.

Compare the ideal healthcare environment and the reality. For example, when radiology acquires a chest x-ray the image might be 15-30MB in size. Ideally the network is available to store the image for immediate retrieval and viewing. That's done securely and is then backed up, with full disaster recovery procedures in place. That's the ideal. The real? Knight says, "Currently in that same world, you're lucky if the server gets backed up every three months. Any hospital, you walk into one, you'll find 30 disparate computers with different access codes or none at all, different ways of bringing things back and sending them over the Internet, and certainly no backup or recovery, and no disaster recovery beyond optical disks stacked up in a corner." Anyone up for seeing ER's networking setup?

Healthcare might be 10 years behind the times in terms of technological adoption (let alone innovation), but HIPAA and other challenges are hurtling them forwards into the 21st technological century. The question then arises: Where do they turn? And how do they afford it?

They are increasingly turning to EMC and healthcare-focused GE Medical Systems, Siemens Medical, HBOC, Meditech, Philips Medical Systems, and Per Se Technologies. Not all of these concentrate on providing high availability, a key selling point for EMC and GE. To that end EMC has partnered with GE Medical Systems to create an archiving solution for GE's new ASP business. The ASP offers medical image archiving and Web-based distribution from mission-critical data centers using advanced information technologies. GE uses EMC as the information infrastructure provider for the centers as GE provides the applications on a cost-per-use basis, via secured Internet networks.

In addition to EMC's support of the ASP business, the two companies intend to co-develop tightly integrated products as well as integrate GE into EMC's ECOStructure (EMC/Cisco/Oracle Infrastructure) initiative. The HIPAA-compliant ECOStructure alliance focuses on integrated advanced technologies and tools to simplify, accelerate, and improve the implementation of highly available e-business infrastructures.

And the next question--how do they afford it? The short answer is, they can't. The long answer is, they have to. Knight said, "Hospitals don't have 10 cents to rub together. But the mission-critical requirements of the system to manage this information is necessary. HIPPA is not an IT decision, HIPPA is an economic decision."

There are healthcare organizations that have made the leap, and are reporting good results. An example is Partners HealthCare System, which includes Massachusetts General Hospital, Brigham and Women's Hospital, and several other hospitals in the Boston area. Partners points out that a primary care physician will typically see one patient every 15 minutes, and spend less than nine minutes to talk to the patient. (I can personally testify to those statistics.) If a doctor spends just 1.5 minutes bringing up an electronic patient record, which is not unusual in hospital environments, that's too long.

By putting remote and networking solutions in place with its Telemedicine department, patient records and images can move freely and securely over the Internet to the primary care providers. In addition, Partners executives estimate that the company is saving around $20 million a year by submitting insurance claims electronically through a regional electronic data interchange (EDI) Web-based network.

Incidentally, this type of streamlined procedure can cut down on serious medication errors. When a healthcare organization moves to a computer, clinical order-entry system, for example, they can reduce serious errors by up to 55%. This isn't small potatoes: a recent survey holds medical errors as the eighth-leading cause of death in the U.S., which means that doctors' terrible handwriting is no laughing matter.

Given a departmental approach in many healthcare organizations, the present trend at EMC is to move to mid-range Clariion platforms, using Symmetrix machines on the back-end for increased security and availability. EMC also uses Symmetrix for Fibre Channel-based imaging server backup. The imaging servers, which are big business in healthcare, are not known for high availability.

As usual, the Clariion and Symmetrix units run over EMC switches and directors, with ControlCenter software providing a centralized management framework. In addition, TimeFinder allows the customer to run multiple operations in parallel by making online mirror copies of active data volumes, while Remote Data Facility (SRDF) enables efficient backup.

While EMC itself does no medical imaging (its subsidiary Data General does), its specialized HealthCare Solutions Group focuses on standards-based archival solutions, providing several HIPAA-compliant solutions across varying medical imaging and informatics platforms. EMC approaches imaging as part of an integrated data mining solution, whose next logical step is developing outcomes. In healthcare, outcomes are the holy grail--and whoever has the best information can present the most likely outcomes.

Some 3,000 hospitals have already installed EMC components, and the company sees enterprise healthcare as having tremendous growth potential, largely untapped in the enterprise storage industry. Knight concluded, "Healthcare is an important positioning tool in the industry going forward. Even in the worst economies, healthcare is always the bastion. It doesn't go down because there's always a need for it."

We all wish it were otherwise, but Knight is right and the opportunity is there.