Increasing storage costs means increasing prices.
We continue to work with clients to make the transition to MicroMD Cloud for a number of reasons. Some seek to reduce their hardware and IT costs. Others want to minimize the work associated with upgrades and security patching and to ensure they are always on the current version with the latest features and fixes.. Others are proactively moving to the Cloud to mitigate potential risk. Others move when faced with high costs of upgrading server hardware or after being hit with ransomware. Regardless of the reason, the Cloud is a more flexible and secure solution to house a store of ever-growing, at-risk data than an aging server sitting under the administrators desk. Not to mention the Cloud enables staff and providers to access their PM & EMR software anytime, anywhere.
While the Cloud offers multiple benefits, healthcare organizations that are managing growing repositories of ePHI must determine what to budget for the service. Regardless of whether your PM and/or EMR software may be hosted in the MicroMD Cloud or through AWS, Azure, or another 3rd party hosting company, the cost will increase over time as the amount of data continues to grow. Whatever Cloud solution you select should offer data storage at two geographically different locations in case of a locational natural disaster. Additionally – and most importantly – you should ensure your service provider also stores a version of your data in a manner that allows for real-time disaster recovery. Each of those services typically requires a separate copy of the database that is stored on Cloud servers. The more data, the more storage space is needed across all three storage areas. As the data set grows, so will your cost to store the data. While budgeting costs for Cloud services may be similar to budgeting for in-house server hardware, processing, and storage resources, it makes sense to review what you realistically need to store in the Cloud to save on storage costs over time.
What’s driving the increase in data storage?
Your databases are expanding
Whether you host your software on your own in-house servers or in the Cloud, if you have EMR, you’ve likely noticed a significant increase in your data storage needs. Practice Management data doesn’t take up a significant storage footprint, even as it grows over time. EMR data is another story. Without even considering other kinds of files and documents that an organization may save in their EMR to streamline workflow efficiency and reduce risk, the database(s) that drive your EMR are LARGE and complex with possibly tens of thousands of data fields – or more! The volume of discrete data fields in an EMR database that allow for complex clinical decision support, interoperability, and quality reporting is large and will continue to grow. Everyone wants discrete data to slice and dice to drive industry change and make business decisions. Your ePrescribing platform and your integrated services need discrete data to work. CMS and commercial payers are making payment decisions based on quality and other measures that can only be calculated by discrete data. Auditors can run reporting and verify compliance with programs. The CDC can make better population-based health decisions. Providers need to share increasing masses of patient data to ensure interoperability. All of these things are based on discrete data. And, now that the data sharing walls between providers are starting to come down, more data, documents, and files are being shared between the hospital and primary care and specialty providers. This requires storage of data and supporting “things” that may have never been received/stored before.
Let’s face it, your EMR data breeds like Tribbles
Anyone remember the Star Trek episode “The Trouble with Tribbles”? Those cute little purring balls of fluff multiplied inexplicably and exponentially. Sure, Practice Management and EMR software were originally intended to simply digitize paper charts and automate some manual clinical workflows. But, the reality was that EMR was envisioned to be a great conduit to start capturing more and more individual, discrete pieces of information to automate more than just manual practice workflows. Over time we’ve seen the evolution. EMR data is captured and rolled up into larger data stores which are now being aggregated and sliced and diced (think AI) to help improve clinical decision making, fill in medical information and care gaps across providers, improve payer operations, ensure profitable payments based on proof of meeting contracted requirements, offer analytics on massive patient populations, and monitor access, transactions, and documentation for fraud and potential medical malpractice. The volume of EMR data even has the power to drive the U.S. healthcare industry from fee-for-service to value-based care!
Audit logs are growing like Midwest grass during spring rains
Another area driving increased data are audit requirements for multiple areas of PM and EMR software. While not every keystroke is being monitored, electronic trails in the EMR that can help prevent fraud, ensure appropriate security and access, and prove transactions are. That monitoring occurs through a growing, behind the scenes library of audit logs that quietly add more data that needs to be stored for reporting. And, most of those logs are required to participate in the CMS Quality Payment Program.
Best practices to help minimize Cloud costs
With all this new data, practices must budget for annual growth in data storage – for their own servers or for Cloud services. The good news is that there are some simple tactics that can help minimize Cloud storage costs.
Document scanning / file types / print to .pdf
As we monitor the storage space needed for our MicroMD Cloud clients, we see more significant growth in some EMR databases versus others. When we look closer at clients with significant spikes in storage or consistently larger month-to-month storage increases, we tend to find a few consistent causes. Often a practice completed a scanning project to add items from paper charts to be accessible from the EMR. Or we learn a practice scans EVERY piece of paper or attaches every data file to be accessible from the EMR. Keep in mind that videos, and multi-image files (i.e. MRI) tend to be GIANT sizes. Or a practice scans all their files using Full Color 12,000 dpi scan settings resulting in massive file sizes.
Tips for printing or scanning to .pdf
- You don’t need to scan documents at graphic designer resolution. Unless you’re going to attempt to restore the Mona Lisa one brushstroke at a time, 300 dpi resolution is a good standard for printing or scanning to .pdf. Resolution essentially determines how crisp and clear your scanned image will be. 300 dpi should ensure you capture enough detail in the scan, especially for documents and images with text, fine annotations, or other details. Anything above is typically overkill. Scanning at the higher dpi really only doubles the size of the file.
- If you can, print electronic documents to .pdf rather than printing then scanning them. The resolution will be better with a smaller file size.
- Choose grayscale scanning over full color when you are scanning something that’s only black and white or when you don’t need the color. Grayscale offers better detail than Black and White and works to identify areas that have shading or have been highlighted (versus blacking out the text in a B&W scan). It’s a larger file size than Black and White, but serves as a happy medium.
- If you are scanning a low resolution or bad looking document to begin with, scanning it at a higher dpi isn’t going to make the document any more clear. Just scan it and move on.
Check out the SCAN TEST below for differences. I recommend pooling together some of your most common print and electronic documents and conducting your own test to see what combination of scan settings work best for your range.
Do you REALLY need to save that in your EMR? REALLY?
Be selective about what you save. Identify what must be saved and for how long. Then create a standard operating procedure (SOP) to document what things should get scanned into the EMR. Train your staff and hold them accountable for using the new standard. At some point you may want to consider identifying a host of files and data to compress and archive in another location – maybe on your own internal server. Also, while it may be mental comfort to know you have real-time access to an entire pool of patient information, you may not really need it. Some practices opt to compress and archive off old former patient data or data they’re less likely to ever need during a patient visit, but that may be housed elsewhere and consulted in the future or kept on hand for auditing or legal reasons. Consider storing your archive on a secure in-house server you use for other things in your practice. While you won’t have real-time access, the data will be there and can be accessed with minimal effort.
It’s not easy to change, although it’s not often when you have the control to save a few bucks over time. Let us know if there is anything we can help with.
Scan Type / dpi
Good for images where you need color reflected in the scan
Minimal resolution difference vs. 300 dpi, but double the file size
Good resolution and picks up shading and fine details in black and white
Doubling the dpi really only doubles the file size. But, experiment with your common documents to see what works best.
Grainy and bigger file size than grayscale; does not pick up shading well
Higher resolution, but takes up almost 6x the file space than Grayscale at 300 dpi
About the author,
Kristen is the general manager of Henry Schein MicroMD. She leads the operational teams that conceive, develop, launch, sell, implement, train and support the simple yet powerful MicroMD solutions.
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