On the Horizon: Cloud-based Image Management

How fast are healthcare imaging data volumes growing? In August, at the annual meeting of AHRA: the Association for Medical Imaging Management, Chris Tomlinson, MBA, administrative director of radiology at Children’s Hospital of Philadelphia, described the growth as a tsunami of data driven by varied factors.

Aside from the organic growth that comes from advanced imaging technology, the U.S. population is growing at more than 5 percent per year, which will result in more patients. The U.S. population also is aging as Baby Boomers are entering retirement age—the proportion of Americans older than 65 is expected to grow to 18.2 percent by 2025, up from 12.4 percent in 2005. Tomlinson pointed out that individual studies are taking up more space as well, with advances like multidetector CT scanners requiring hundreds of megabytes of storage per study.

This tremendous growth isn’t helped any by the fact that image management strategies increasingly need to integrate images from other departments such as cardiology and pathology.

The cloud, unveiled

In a cloud-based system, image volume may no longer be as much of a concern. Data are stored on external servers and accessed via the internet through a computer or mobile device. Images often are accessed through a “zero client” web-based PACS, which leverages a provider’s browser and requires no additional download to view an image.

A new model of image storage also requires a new cost model. Rather than a large, upfront capital investment of local server hardware and software, the most popular model for cloud-based storage is software-as-a-service (SaaS), in which providers pay per click or based on a subscription fee.

Aside from not having to stress about storage, cloud-based technology has other advantages, according to Michael A. Trambert, MD, lead radiologist for PACS reengineering for Cottage Health System in Santa Barbara, Calif. Within minutes of the completion of an imaging study, it can be loaded into the cloud and made available for viewing globally. The cloud also offers vendor neutrality, with DICOM wrappers used to ensure interoperability, says Trambert. It also can help providers avoid costly downtime and delays related to faulty CDs.

One early adopter of cloud technology was Virginia Commonwealth University (VCU) Medical Center in Richmond, Va. In early 2010, VCU radiology made the decision to switch to the cloud, and Trambert, along with some colleagues, studied the results.
They analyzed VCU’s conversion to the cloud, looking mainly at workflow and the number of studies uploaded to the cloud vs. conventional physical media. They found a rapid adoption of the new technology, and within months, more than half of all imaging studies were handled through the cloud.

“VCU is a big trauma center and trauma surgeons were actually able to look at these studies before the patient arrived which allowed them to devise a treatment plan, prospectively save time and, presumably, positively impact clinical care,” says Trambert.
Primarily used in the emergency department and for patient transfers, Trambert says the cloud-based image management system has become an essential part of VCU’s workflow process that continues to replace CDs as the image transfer medium.

Gathering clouds

VCU is an early adopter of cloud technology, but they are certainly not alone. A January survey by Harris Interactive found that almost 60 percent of healthcare CIOs from an organization that has both an EHR and a health information exchange said they plan on investing in cloud-based systems. Industry analysts at GlobalData have reported that the U.S. cloud computing market for medical imaging, pegged at $56.5 million in 2010, will grow at a compounded annual growth rate of 27 percent through 2018.

While the technology holds much promise, a move to the cloud comes with its own challenges, and providers need to be aware of certain special considerations. Providers need to be diligent in making sure potential cloud vendors can provide adequate security for HIPAA-covered data, says James Philbin, PhD, co-director of the Center for Biomedical and Imaging Informatics at Johns Hopkins University in Baltimore. He pointed to Amazon’s cloud system, which experienced a security breach last year leading to outages and downtime, as an example of what can go wrong. The good news here is that, while handing over imaging data might initially make providers nervous, Philbin says cloud vendors will have the scale in the long term to provide better security than a typical hospital can provide for itself.
Providers also need to understand the terms of their agreement with a cloud vendor with regard to how long data will be managed. Various state and federal laws govern how long imaging data must be retained, and often vendors are aware of these laws, but Philbin says the onus is on the provider to ensure data will be managed according to its requirements, not the vendor’s.
“Negotiating and looking very closely at those contracts is important,” says Philbin.

Trambert advises providers to fully understand reliability and ease-of-use of a potential cloud platform, which includes learning whether a client application needs to be installed to access images or if the vendor is truly offering a zero-client, browser-based product.

The cloud’s future

Cloud-based technology represents a new way of thinking about healthcare image data storage, but at the current rate of adoption, this could soon become standard.

“Going to the cloud is going to facilitate the commoditization of storage of studies for us all,” says Trambert. “It’s going to bring the price down so there will be rapid adoption.”

CDs as a main source of image transfer are on their way out, though Trambert says they’ll remain the “lowest common denominator” for a while and a good fallback option when transferring data to facilities late to jump on the cloud bandwagon.
Meanwhile, “the cloud represents an opportunity to unify the patient record and also give the patient control over who accesses his or her records,” says Philbin, who anticipates 50 percent adoption of cloud technology over the next five years, with 90 percent adoption within the next decade. Some research data may be stored locally, but most clinical data will end up on the cloud. “It makes the most sense.”