Imaging Reaches for the Cloud

Timely article on Cloud Computing for healthcare from, especially since I spent half a day (just today) with a solution provider trying to understand their technology and figuring how to ‘Cloudify’ some solutions in the medical imaging space.

Imaging Reaches for the Cloud
The surge in imaging study volume and pursuit of quality has yielded both tremendous benefits and contentious repercussions for patients, providers and payors. But behind the scenes, IT leadership is working on a cardinal issue—where to store the ballooning number of studies and allow quick recall when needed. Some healthcare enterprises are beginning to turn to the cloud, where patient images and information are archived on outside servers, yielding expanded access and reduced costs.

IT gurus agree that the use of cloud storage in healthcare lags behind many other fields. Concerns about patient privacy, lost information and choked access during downtime top the lists of those who say cloud computing is premature for the healthcare sector. Notwithstanding, health IT’s ascendance to the cloud is on the up, with some hospitals migrating years of image archives to external clouds, while others are making the move more slowly, transferring individual applications like image transport and billing according to their practice’s specific needs.

Simplicity pays
In a state where “there’s no such thing as overnight mail,” several Montana clinics teamed up to develop a more efficient solution to transporting images between providers, says Bill O’Leary, PACS administrator for Kalispell Regional Medical Center in Kalispell, Mont. Along with Great Falls Clinic and other Montana hospitals, staff at Kalispell created Image Movement of Montana, with the intent of creating a network for electronic image transport—to improve healthcare in the state and cut shipping costs, while also easing the hassle of transferring studies through several virtual private networks. The project was scrapped, however, when providers discovered that they could get what they were looking for, and more, from an established cloud vendor.

“Whereas our 30 to 40 monthly studies normally took three days to deliver, we can now upload the images, reports and any other data in 15 minutes,” O’Leary explains. The referring hospital receives a call or email from another provider requesting a patient’s images. That referrer then uploads the requested study to the vendor’s site, after which the requesting physician receives an automated email alerting he or she that the report is waiting in the cloud. “This program has cut our [overnight mail] costs by 90 percent, from around $28,000 to $3,000 per year,” O’Leary continues.

Kalispell is currently looking at using the same cloud platform to upload its EMRs, while O’Leary intimates that if the radiology department had not recently invested in a new image storage solution, they might consider moving completely to the cloud. “It costs about $1 or $2 per study, and all you need is access to the internet and email,” says Eric Maki, manager of IT for Great Falls Clinic in Great Falls, Mont. “It may sound like I’m oversimplifying things, but I’m not.” Kalispell Regional Medical Center and Great Falls Clinic have achieved high satisfaction by keeping their work in the cloud remarkably simple. “We had a specific issue we wanted to resolve and we were able to cut our costs by 90 percent. That’s why we were successful, because we didn’t complicate the solution with too much technology,” Maki states.

The homegrown cloud
In search of a better storage solution at a lower cost, San Francisco-based (CHW) has piloted a number of programs and applications that put a majority of the network’s studies in two separate clouds. All of the organization’s 41 facilities (located in Arizona, California and Nevada) still work off of a local PACS, with the additional capacity to access studies completed within the last year through a cache located at each facility.
As the volume and size of studies grew, each hospital faced “a storage monster that you had to keep feeding and feeding,” says Scott Whyte, senior director for physician and ambulatory IT strategy for CHW. The organization responded with two cloud-based solutions.

First, a long-term archive of nearly all CHW images is stored at the organization’s data enterprise center in Phoenix. Through the CHW network, physicians at most of the group’s hospitals can now access images taken recently or years ago, as well as studies performed locally or at other CHW hospitals. This 600-terabyte data network provides clinicians with access to more patients’ prior studies, improving workflow and reducing the number of redundant studies. This internal cloud also eases the IT burden on individual CHW hospitals, which can purge their storage archives after just one year.

In the event that a hospital’s PACS is down or if the CHW network is somehow compromised, the system is guaranteed business continuity with its long-term archive backed up on an external vendor’s cloud. “We’ve only had one instance where a local PACS was down, but we were able to continue functioning, recover the studies and most importantly, maintain clinical workflow,” explains Whyte.

CHW has seen a return on investment in equipping remote clinics with access to CHW’s long-term archive through the external cloud, rather than connecting them to the network. Moreover, this vendor cloud provides CHW with image transport, connecting CHW clinicians with images taken at out-of-network hospitals.

What to look for
Many IT administrators are cautious about migrating entire archives to external clouds—indeed, CHW has done so primarily as a redundancy. “We just do not feel that the vendor market is mature enough to trust our entire study load to yet,” comments James Philbin, director of the Center for Biomedical and Imaging Informatics at Johns Hopkins Medicine in Baltimore.

According to Philbin, practices that are shopping for cloud vendors “have to be sure that the vendor understands medicine relatively deeply, that they understand privacy and that they’re going to be able to keep your information for the long haul.”

“Look for a vendor that has done it before,” echoes Bob Mirabito, CIO of Baton Rouge Radiology Group (BRRG) in Louisiana. BRRG moved its billing to the cloud last year after a five-month testing and migration phase. “There’s a lot to be gained from turning services over to the cloud. … But you’ve got to be cautious,” Mirabito offers. BRRG faced some of the implementation issues that have kept other practices grounded, including a contract that limits the practice’s ability to extract data to build reports and an implementation deadline that was too quick for some of BRRG’s partnering hospitals.

“We’ve had our share of bumps in the road. … [But] our collections have gone up, and our [claims] denials have gone down, and that was our intent,” Mirabito declares. He advises flexibility and support in vendors, which captures another reason why the Montana groups’ satisfaction is through the roof: the clinics conducted extensive testing with their vendor, who repeatedly amended its platform in response to their feedback.

The hesitancy of IT administrators to migrate to the cloud in spite of tantalizing cost and quality benefits indicates a simple point: patient images and information may be the most precious data that hospitals own. The reality is, cloud platforms are already capable of delivering broad, secure and inexpensive access to images. But these platforms are imperfect, and as more vendors enter the market, experience, reliability and affordability will improve. Cloud computing is poised to capture the health IT stage, but it will most likely be an evolution rather than a revolution.

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