WorldCare

International healthcare company WorldCare Ltd. runs a second-opinion e-consultation service for people looking for U.S. healthcare advice outside of the country. It's a storage-intensive operation, as the firm sends large medical images across the globe for doctors in the U.S to study.

The Cambridge, Mass.-based company has performed about 12,000 cases since it was founded in 1994, letting patients and their doctors abroad benefit from the expertise of 8,000 specialists at WorldCare's four consortium hospital groups without having to leave their countries.

Hospitals participating in WorldCare's consortium include: Partners HealthCare (Massachusetts General Hospital, Brigham and Women's Hospital and Dana Farber Cancer Institute), the Cleveland Clinic Foundation, Johns Hopkins Medicine, and Duke University HealthCare System.

WorldCare's operation depends on its ability to adhere to strict U.S. federal regulations such as the Health Insurance Portability and Accountability Act (HIPAA), which requires that healthcare providers store clinical data longer and provide ultra-secure retrieval of it.

"We have to aware at all times of who is looking at an image and if any changes are made to it," says Ivo Minkov, senior systems engineer at WorldCare. "We also needed a way to manage our image data to allow us to access it in real time and lock it sufficiently for HIPAA."The company turned to FalconStor Software Inc. (Nasdaq: FALC) to develop a special script to allow WorldCare to audit file movement on the storage system (see WorldCare Takes Dose of FalconStor).

A feature of FalconStor's IPStor software changes the permissions of every file that is written to WorldCare's NAS servers from read/write to read only. It also journals the changes and produces an audit trail that can be used in reporting on HIPAA to show compliance with the federal law. This way, WorldCare can track exactly who has what file and what images have been changed.

In addition, WorldCare uses IPStor software to provision its storage to Microsoft Corp. (Nasdaq: MSFT) Windows, Linux, and Unix clients so that WorldCare users can share folders and files regardless of the operating system they are using.

WorldCare operates in 22 countries, mainly in Asia and the Middle East, collecting radiology images from doctors. It digitizes these images and then transmits them to its hub in Cambridge. From there it sends the images to the WorldCare consortium, where doctors review the material, provide consultation, and then send back the data electronically over WorldCare's virtual private network (VPN). The company has about 50 employees in Cambridge.

"For most hospitals, e-consultation is a cottage industry and so access and retrieval of data is not mission critical," says Joel Khan, CTO of WorldCare. "For us, it's imperative our infrastructure works well... It is core to our business."WorldCare manages about 2 Tbytes of storage today, but this is growing massively, according to Khan. He is in the process of adding another 1.5 Tbytes this month. The company uses a Hitachi Data Systems (HDS) 9200 array as a large network-attached image server from which its staff can grab and view images in near real time. It archives the images on Storage Technology Corp. (StorageTek) (NYSE: STK) DLT libraries.

Alongside the consultation business, WorldCare operates a clinical trials imaging division. This stores and manages the reading of tens of thousands of medical images in any given trial going on at one of WorldCare's consortium hospitals.

The company looked at technology from EMC Corp. (NYSE: EMC), IBM Corp. (NYSE: IBM), Veritas Software Corp. (Nasdaq: VRTS), and Procom Technology Inc. (Nasdaq: PRCM) but said that these were all too slow to push the images. "What sold us on FalconStor was they also support iSCSI," says Minkov. "It is cheaper than buying expensive fiber optic switches to use a real SAN Those Brocade Communications Systems Inc. [Nasdaq: BRCD] switches are not very cheap." WorldCare has no plans for a SAN right now, but since FalconStor can provision storage from SAN and NAS devices, once its network-attached storage infrastructure gets big enough it anticipates building an iSCSI-based SAN.

It seems like HIPAA regulations, coupled with such online applications as picture archiving communications systems (PACS) and electronic patient records (EPR), are driving an explosion of digital content -- and it's all good stuff for the storage industry (see TeraMedica, Maimonides Medical Center, and Neurome Inc.