The Digital Healthcare Information Management System (DHIMS) includes PACS as well as other clinical and administrative applications. The components of DHIMS consist of:
• Infrastructure such as the LAN
• Devices that generate or provide a means to input information such as modalities and keyboards
• Storage management
• Information management which in the PACS application is known as the archive manager
• Visualization management which provides the end-user the ability to interact and view the information
The common component for all DHIMS applications including the RIS and PACS is the infrastructure and storage management. The storage management component consists of:
• Secure, high available and accessible datacenter
• Storage infrastructure
• On-line storage
• Long-term storage
• Disaster recovery
• Storage management software such as backup, replication, storage virtualization, security, auditing, administrative, etc.
• Personnel
The storage management component must guarantee that the information stored is secure, highly available and will not be corrupted while stored or in-transit from one component to another. The information stored consists of information that once acquired must not be changed or altered in any way. These are known as fixed content files (FCF). Examples of FCF would be images acquired from various modalities that comply with the DICOM standard. The other type of information would be files that once created may change such as those in a RIS associated with a database that are known as variable content files (VCF). These two file types are managed differently by the storage management component.
The most cost-effective and productive way of controlling the ever-expanding storage requirements of DHIMS and complying with Health Information Portability and Accountability Act (HIPAA) is to eliminate silos of storage and consolidate the storage management system into a single enterprise storage system. To further reduce cost and reduce the risk of data loss or corruption is to out-source the long-term storage and disaster recovery (DR) components of the storage management system to a vendor that has a history of providing these services and has two or more secure, high available and accessible datacenters separated by at least 100 plus miles (1). These are known as Tier 3 or Tier 4 datacenters (2). The tangible and intangible advantages of out-sourcing at least DR and in most cases the long-term storage far out-weighs the potential disadvantages of bankruptcy of the vendor and usability of the information when returned to the client (1).
The comparison of SSP vendors was first published in March 2004 (3) and is now being updated to demonstrate the expanded options and viability of this approach to managing the terabytes of data generated by healthcare institutions.
The tabulation is divided into sections. The first provides the experience of the vendor in the SSP business. The second section discusses the company’s datacenters. Ideally the company should have at least two Tier 4 or Tier 3 datacenters (2) located 100 plus miles apart.
The third section provides information on the storage and storage management hardware, software and services included in their offerings. The fourth section specifies the integrity and security of Protected Health Information (PHI). Reference 1 provides a list of questions that companies should answer to determine their worthiness as an SSP.
References
1. Smith, EM: Fee-per-study storage – The Outsourcing Option, ADVANCE for Imaging and Oncology Administrators, Nov. 2006, pg 45-50.
2. Turner, WP Seader, JH, & Brill, KG, 2006, Tier classifications define site infrastructure performance. Available at: www.upsite.com. (Click The Uptime Institute Inc., click white papers, then click paper title)
3. Smith, EM: Storage Service Provider (SSP), Imaging Technology News, March 2004, pg 43-46.
Edward M. Smith, ScD, FACNP is a Professor of Imaging Sciences in the Department of Imaging Sciences at the University of Rochester School of Medicine and Dentistry. Dr. Smith provides consulting service for both healthcare and industrial organizations (Bycast, Inc., InsiteOne, Inc., Iron Mountain, and MTS Delft) in the areas of PACS and RIS and serves on the editorial boards of several healthcare publications. Dr. Smith is the conference director for Women’s Health and Imaging 2007 presented by the Department of Imaging Sciences that was held January 22-24, 2007 in San Antonio, TX at The Westin Riverwalk Hotel. For more information visit www.urmc.rochester.edu/wh2007. He is also conference director for PACS 2007 presented by the Department of Imaging Sciences that will be held March 20-23, 2007 in San Antonio, TX at The Westin Riverwalk Hotel. For more information visit www.urmc.rochester.edu/pacs2007.
Edward M. Smith, ScD, FACNP, University of Rochester School of Medicine, Department of Imaging Sciences, 601 Elmwood Avenue, Box 648, Rochester, NY 14642-8648. Phone 585-275-1050, Fax 585-276-0461 or email ed_smith@urmc.rochester.edu.
September 23, 2025 
