With radiology departments generating so much imaging data on a daily basis, and as medical imaging technology continues to advance, many existing picture archiving and communication systems (PACS) and other storage solutions simply do not have the capacity to handle multiple terabytes of data on-site. As a result, hospitals and other healthcare organizations are turning to cloud solutions. It is a buzzword that many are familiar with, but one that many still do not fully understand.
For many, the cloud is synonymous with the Internet. While this is not wrong, it is not totally accurate, either. The simplest way to describe cloud technology is the delivery of information technology (IT) resources via the Internet, as described by Steve Fanning, vice president of healthcare strategy at Infor, during a presentation at the 2015 Healthcare Information and Management Systems Society (HIMSS) annual meeting. Data are stored remotely and accessed electronically via Web browsers or other Web-enabled applications; nothing actually inhabits the individual workstations used by physicians, radiologists or anyone else that accesses the data.
"The traditional PACS is decomposing into elements that comprise a total solution," said Mitchell Goldburgh, cloud imaging solutions manager at Dell, "and IT departments are looking at storage footprints that are quickly becoming unmanageable." When viewed in this deconstructed-PACS context, the cloud largely acts as a vendor neutral archive (VNA), collecting all of the data in one place and in one format.
Compared to the typical VNA, however, a cloud storage archive offers three primary benefits:
- Greater flexibility with data;
- Reduced operating costs; and
- Enhanced data security, including backup and disaster recovery.
The technological needs and capabilities of a hospital change on an almost-daily basis, and so facilities need a responsive storage system. Moving data to the cloud greatly improves flexibility, as there is no hardware or software that needs to be updated; administrators can simply add more storage space as it is needed.
Legacy Health, a large community-owned health system based out of Portland, Ore., moved to the cloud for this exact reason, as described by Melanie Rivero, director of enterprise systems and services and information systems and services, who joined Fanning at HIMSS. Legacy's cloud deployment did not include radiology - focusing instead on overall enterprise resource planning - but the benefits are still the same. "I think the thing that resonates with me the most a year and a half later is that we're agile - we're agile in ways that we didn't even imagine we could be," she said.
Cloud Cuts Costs
Data flexibility is a major benefit of bringing radiology and healthcare into the cloud, but in many cases, it can afford a hospital greater financial flexibility as well. The monetary benefits are usually on par with efficiency improvements as the greatest reasons that organizations are making the switch. While it is always nice to save money, the drive to pare down has gotten an added boost in recent years via the Affordable Care Act and other regulatory changes pushing healthcare from a volume-based to a value-based reimbursement system.
As Henri "Rik" Primo, director of strategic relationships, Siemens Healthcare, notes, the costs associated with moving to the cloud are operational rather than capital-based "where you are responsible for upgrading everything," he said. By making the leap, an organization should largely eliminate costs associated with hardware, upgrades and a majority of infrastructure costs (databases, operating systems, cooling systems, etc.). The exact breakdowns and totals will obviously be different for each organization, but in general there are savings to be found.
What makes financial sense for one organization, however, may not make sense for another. When considering a move to the cloud, organizational leaders need to take a close look at their potential savings margin to determine if it is worth it. As Primo notes, "A small hospital in the Upper Peninsula of Michigan with a terabyte of imaging data a year probably wouldn't benefit from cloud use. In their case, a RIS (radiology information system) might be a better option."
Playing it Safe
While cloud data storage can provide all of these benefits and more, the technology has by no means achieved universal adoption. A survey conducted by HIMSS at its 2014 annual meeting found that 80 percent of respondents (out of 150 total) were currently using cloud services in their organizations; the 2014 Dell Global Technology Adoption Index reported 96 percent of respondents were either using cloud storage or were considering using it.
And the adoption growth is happening at both ends of the healthcare spectrum, according to Bill Stoval, general manager of enterprise imaging for GE Healthcare - both large, multi-facility networks and smaller hospitals "that might not have an IT staff."
The main concern for organizations that have not made the switch, corroborated through multiple industry surveys, is data security. Several high-profile cases of corporate data breaches have made headlines in recent years, bringing the issue to the forefront. The healthcare industry adds another layer to the discussion, with protected health information (PHI) being governed by HIPAA and other privacy regulations.
The idea of ceding sole possession of healthcare data and accessing it via the Internet may raise security concerns for some organizations - but it is also one of the main reasons that hospitals and clinics end up moving to the cloud. Storing data off-site means that it cannot be harmed by technical problems at the hospital. If anything is lost locally, the cloud vendor partner can help restore everything as needed.
Cloud providers can offer multiple layers of security, including:
- A team of individuals dedicated to data security;
- Network security;
- Application security;
- Operations security;
- Physical security, including armed guards, building security, etc.; and
- Continuous monitoring.
This kind of assurance would be difficult, if not impossible, for a hospital IT department to provide on its own. "If you go with a private cloud provider, they're typically more experienced with cybersecurity than a hospital trying to do its own security," said Primo. By utilizing a third-party vendor, a hospital removes these responsibilities from its shoulders, placing them on experts who can ensure greater levels of protection for their data.
To Cloud or Not to Cloud
While moving to a cloud-based archive storage system can have numerous benefits for a hospital and/or radiology department, that does not mean it is the right solution for every organization.
If a hospital or clinic is deciding whether to make the switch, they must consider exactly how they intend to utilize it. In general, most organizations that do move to the cloud deal with vast amounts of imaging data - as in terabytes. For smaller hospitals that do not need the greater capacity, an on-site solution might be sufficient.
If your organization decides a cloud solution is worth the investment, keep in mind that there is no one-size-fits-all template. In some cases, a completely private, customized solution might be the answer. This allows the most direct collaboration between the hospital and the technology vendor, creating a system unique to the individual needs of the users. Companies like Amazon Web Services offer a second option with hosted cloud storage; in these cases, the data is still protected, but resides on Amazon's servers along with all of its other clients. Alternatively, clients could choose to operate some sort of hybrid solution.
Regardless of the final decisions that are made, the most important step, according to Primo, is to maintain clear, constant communication between all individuals, departments and/or facilities involved. In fact, many organizations go so far as to hire a third-party consultant to act as a facilitator between all parties.
That communication extends outside the hospital as well, as Fanning and Rivero both stressed the importance of maintaining a friendly working relationship with your cloud solution provider during their presentation at HIMSS. Legacy partnered with Infor beginning in 2013 to move its enterprise resource planning processes to the cloud, and Rivero pointed to the ongoing, friendly relationship between Legacy Health and Infor as one of three keys to a successful transition to the cloud. "It's critical having a very rigorous process in place where we're talking with the hosting team to understand who does what and when, and the overall production process," said Rivero. The other two keys included:
1. Treating the transition like an implementation project and not just a migration - in other words, managing expectations and realizing that it is an ongoing process, rather than an objective that can be "completed"; and
2. Frequent stress testing of the cloud applications to see how they'll operate and if they can handle the load they are being given.
Once the decision has been made to move to the cloud, it can be difficult to know where to begin. GE's Stoval said it starts and ends with workflows to have the necessary processes in place - whether they're related to collaboration, clinical assessment, VNA management or any of countless others. "There's going to be pieces, and you want to break off where it makes sense, and where the cloud can make you more efficient and effective," he said. Once those are in place, you can begin moving over the RIS, VNA or other systems. "But that's definitely going to be a second step for most people," he said.
While there are many factors to consider, and though it may not end up being the ideal solution for everyone, moving healthcare to the cloud can help hospitals and departments address their ever-shifting data needs. "I think there's an opportunity to increase the pace of innovation in healthcare," Fanning concluded.