In the age of collaborative, distributed business operations and on-demand resources, cloud computing is the model for the digital workforce and anyone who interacts with it. Finance, media, commerce, travel; essentially, any business with a digital component has either moved or is moving much of its operations to a cloud hosting, distribution, or service platform.
‘Cloud’ is such a popular term in every other industry, but in our industry, there’s almost nobody doing it well,” said Steve Deaton, Vice President of Konica Minolta Healthcare IT. “People say, ‘Yeah, we do cloud, but you have to have a crazy Internet connection for it to be fast.’ Or, ‘It only works in a limited environment.’ You don’t just jump on the bandwagon because the word cloud is sexy in every other industry.”
But just as in many aspects of the transition to digital business, Deaton says the health care sector in general, and medical imaging in particular, has lagged behind other industries in adopting cloud computing technologies – first, out of a fear of security vulnerability, and later, out of a fear that the various access points across which the data must travel aren’t robust enough to handle the traffic. Within the past year, however, coding technologies have evolved to be able to offer “amazing functionality in a cloud scenario,” Deaton said, which has in turn increased its affordability for second- and third-tier customers.
“The coding technology is putting us on the cusp of making it affordable for the imaging center chain,” he said. “Until recently, you couldn’t have the tool sets needed in software that was written for the cloud. It needed to be this big server application, and going to the cloud was really only a supplemental thing for the outside users. Now you’re getting to the point where you see people in the last year-and-a-half transitioning from PACS to an advanced viewer for PET-CT, a zero-footprint viewer for the outside physicians; and they kind of pick and choose, and put them all together.”
Nonetheless, Deaton said, cloud-based imaging is a “market-dependent” business opportunity. Enterprise-class institutions, which typically employ their own IT teams, often build their own cloud infrastructures. Small- and medium-sized facilities, which are searching for ways to control costs in the migration of their networks to cloud storage, may offload the work to a third-party partner, a decision which comes with its own set of particulars. But at the hospital level, making the switch to the cloud becomes an expensive endeavor just in the course of digitizing existing patient records. For many budget-strapped institutions, paying to transfer already-completed (and billed-for) medical images into the cloud often feels like “reaching into the same pocket and taking more profitability out of that same study we’ve already paid for,” Deaton said.
“If you’re going to go all cloud, you’ve got to move all the data to the archive,” Deaton said. “If you’re big, you’ve got a lot of data, and it’s expensive.”
Small and medium-sized imaging practices are “business-oriented, cost-conservation people,” he said, often simply because they lack the financial strength “to go buy best-of-breed everything.” For them, Deaton argued, a cloud hosting solution “can reap the best bang for the buck,” and yet, “their IT staffs are often the ones lagging behind the industry.”
Such is the crux of the matter. When firms consider outsourcing their cloud storage to a third-party provider, they’re making a choice based on their options for cost and stability. Security design has trended toward web-oriented client interfaces in the past six or seven years, Deaton said, which has allowed cloud developers to take advantage of the same security measures incorporated in bank or government websites. Even with those advances, he said, the transfers of data still involve moving it via that web front end from the server to the workstation, which is a potential security lapse; a newer security concept called server-side rendering could resolve such issues.
“Just about every viewer out there does temporarily cache a study on its local hard drive,” Deaton said. “Then the computer stores a local copy, and now you have unencrypted data on your computer. If you had a virus, it could copy that data and you’d never know.”
Medical Dealer Magazine | Cover Story | Head in the Cloud – Cloud-Based Solutions in the Medical Device IndustryCreating a network architecture that doesn’t require moving the data to the user terminal in order to access it “is the way that every other industry” leverages the cloud, Deaton said, but the design hasn’t been applied to medical imaging because the high-resolution patient studies stored and transmitted are far larger. Providing access to such images in a secure, HIPAA-compliant environment without bringing the file to the local device “has been the number one show-stopper” in terms of cloud security, he said. When that functionality is present in a system, the next-level implications of cloud access may be realized, including increased productivity, physician multi-tasking, and greater flexibility in patient management and the delivery of care.
“The real goal is what happens in health care when doctors can access all this data in an organized fashion,” Deaton said; “when they see something and it reminds them of something else, and they want to pull up another patient’s chart.”
“What happens when everything in the market is accessible?”
Scott Whyte, Advisor and Former Chief Strategy Officer for Tempe, Arizona-based cloud provider ClearDATA, believes creating that seamless user experience from task to task requires understanding users’ needs. Those workflow considerations must be taken into account at the design phase of any storage architecture.
“It’s important to choose a vendor with deep health care knowledge who can come in and help you sort out user expectations, especially physician expectations, before you invest in a new technology solution,” Whyte said. “What you don’t want to do is build a solution for today that misses the mark for tomorrow.”
For example, operating an on-premises data storage network means a consistent, cyclical reinvestment in server and storage hardware that is not only expensive but which must keep the network in compliance with federal regulations for data storage and security. If a health organization is not using a third-party provider for those services, then it is paying to provide them itself.
“In research settings, if you have to go to and buy on-premises servers and storage, you’re buying a million dollars of computing and storage for predicted peak workloads three years out,” Whyte said. “You might have hundreds of terabytes of data. You might be doing research studies for a week or two, so you have occasionall spikes in the usage of that computing and storage, but since you bought it, capital-wise, you’re paying for it whether you use it or not.”
Alternatively, the computing power and storage of a secure, robust, and functional third-party cloud solution can be activated only when needed, and for fractions of pennies per gigabyte per hour, with security and management function overlays that other hardware may not offer, Whyte said. Unlike on-premises digital storage investments, cloud computing can be made available on demand as opposed to purchasing physical equipment that requires a far larger, corresponding investment of personnel and upkeep.
“Since it’s cloud and you pay for what you use, you can try the cloud inexpensively,” Whyte said. “What is a lot harder to do is to bring in capital equipment. You still have to have a lot of human resources to plug things in and hook them up and get it all to work. You have a lot of elasticity when you move to the cloud.”
Whyte also argued that part of maintaining a HIPAA-compliant standard of care involves keeping confidential patient information secure and private and, even in a cloud computing environment, that task can be made easier or more difficult depending upon the vendor.
“You can get yourself in trouble using the cloud with someone who doesn’t have the highest standards of certification, knowledge, staff training, focus, technology, and standard operating procedures completely focused on safeguarding that patient data,” he said. “Does the cloud service platform really ‘get’ security, and do they really ‘get’ security, privacy compliance, specifically, as it relates to health care? Are they able to back that up contractually? How do they handle breaches? Defense in depth with multiple layers is what a cloud consumer is going to look for.”
For many health care facilities, determining when to migrate to the cloud is a decision contingent on a number of factors, from equipment life cycle to executive strategy. When hospitals develop experience working with secure healthcare cloud organizations – which, increasingly, is a descriptor applied to more of their partners – they establish a familiarity with a solution that allows them to coordinate their services with other caregiving organizations.
“Sometimes you have to partner with another health organization in a market that you might yesterday have competed with,” Whyte said. “That applies to population health, care coordination, etcetera.”
Those partnerships turn on cooperative inter-organizational relationships; but just as important to the future of radiology as migrating to cloud solutions for computing and storage services is migrating to the cloud for the sake of competitive advantage.
Robb Vaules is the CEO and Founder of YellowCross, a startup that connects attorneys with physicians in a HIPAA-compliant cloud solution for consultations and expert witness testimony. Vaules, who’s seen the imaging community wrestle with teleradiology and nighthawking services in particular, believes the cloud is the next iteration of a similar hurdle for many providers, raising questions of competition and service provision as much as of opportunity.
“Storage is cheap; that’s a big part of the cloud,” Vaules said. “The reality comes down to who’s file sharing.”
For practices that don’t have access to certain radiology subspecialists, the cloud is an opportunity to drive new business while also expanding the reach and breadth of their operations. He acknowledges that it’s mostly a world in which mid-sized to larger practice networks are entering, although Vaules, like Deaton, believes the value is exponentially greater for smaller practices. Yet he sees such physician groups being far more willing to invest in buildings than in building their IT systems – and with good cause. For the time it takes to design, install, operate, and support a cloud-based storage system a physician could much more easily close on a real estate transaction, and sometimes, have a more tangible, reliable, resellable asset at the end of the process.
“Between training and installation, you could be looking at $2 to $5 million” to roll out a cloud-based architecture “depending on the volume you have in your practice,” Vaules said. “Past that, you have to sign a service contract, and you’re still going to be paying $10,000-15,000 a month. It’ll take you a year from the time that you decide you want to purchase something to the time you sign a contract, and then it’s another six months to a year before you roll it out completely.”
Host it onsite, “and you’re not only paying for the software, but those IT people,” he said.
“Even a five-person practice is going to have a few more salaried employees” on staff to maintain, manage, and support the cloud.
Just as critical as the capital investment structure, another key consideration in deciding when to migrate to a cloud-based solution involves knowing the competition in the local marketplace, Vaules said. Providing reliable access to imaging data on a secure, multifunctional platform is a service that not only has value unto itself, but which helps drive future business – and “if you’re not doing it, someone else will do it,” he said.
“[Physicians are] needing to have the data faster and faster and faster, not just moving patients through the hospital, but because someone has another appointment,” Vaules said.
“Providing data is a long-term investment in getting more patients and more referrals from those particular people; anyone who recognizes that goal or need is going to pay for it long-term,” he said. “Those who adopt the technology quickly and get in with those referring physicians are going to be able to win the battle long-term.”