Cloud Storage - More than Just Hot Air

Ms. PACS: It's like, everyone catches on to a concept and it's the most incredible thing since the PACSman shaved his beard.

Seriously - cloud storage is the new BIG Idea...at least in Radiology...while the rest of the IT world has been raving about it...and we as consumers have been using it on Google and Amazon...but - with the exception of tech-savvy you - didn't realize how good we had it up there on cloud 9. In fact, the cloud computing craze has become as ubiquitous as its architecture. Did you know that there is a cloud computing magazine and trade show? Soon we'll see an action figure: Cloud Man, Cloud Ranger, or the Stormy Cloud Guy (the moodier younger brother). But first, before we cash in on the next Disney movie, let's take a step back.

When Amazon introduced its virtual computing environment, Amazon Elastic Compute Cloud or EC2, it created awareness about brought cloud computing in the consumer environment. What Amazon’s customers liked was they paid only for what they used.

The popularity of cloud computing has also reached new heights in medical imaging for its capacity to cost-effectively archive large volumes of imaging data.

How it works: Organizations pull up the image on their PACS, send it to a patient or another facility and send it to a cloud client that sits on their desktop. The image goes to an offsite server, is temporarily stored, until the receiving physician or radiologist accesses it. That provider, who is sent an e-mail notification, can choose to simply view the image on his or her desktop, burn it to a CD, or push it out to the facility’s own PACS.

As evidenced at RSNA 2009, several vendors staked their claim to cloud computing (these were off of the top of my head - i'm sure there are many more - maybe we could start a NEW Radiology in the Clouds trade show:)
- Candelis is an early adopter, leveraging cloud-based computing and storage to make its suite of medical software solutions available via cloud-hosted services.
- InSite One Inc. was also one of the first to offer, pre-RSNA, medical data storage in a cloud environment.
- DR Systems’ Electronic Medical Information Exchange called eMix is a cloud computing-based, vendor-neutral technology that eliminates the need for the provider facility to burn CDs, print films, or fax reports. It also facilitates universal access to medical imaging for a complete EMR.
- Accelerad’s software-as-a-service solution (SaaS), SeeMyRadiology.com, utilizes cloud computing architecture to store all client images on a centralized cluster of servers, providing access to medical images across the entire healthcare continuum.
- Merge Healthcare provides RIS, PACS and disaster recovery solutions in a cloud computing platform. The cloud-hosted solutions also enable rapid implementation of a RIS or PACS.
- **lifeIMAGE is a platform connecting patients and providers to medical imaging studies and reports through two core components. First, for hospitals and imaging centers, its a Local Appliance (LILA) to manage imaging exams introduced by patients on portable media such as a CD. Next lifeIMAGE.com is a cloud-based environment for image sharing and storing between patients and referring physicians.

**I have to say The Dalai of PACS tipped me off to this one. Patient power is a good thing - it should make them more responsible and better advocates for their own health care. No more baby sitting. And they have more data when insurance companies try to re-neg on reimbursing patients for just breathing in a hospital. Do you ever notice how the insurance company bills you....even when they are supposed to cover the bill? Don't get me started:)

Now, you get 10 Bonus Points if you can unravel this mystery lyric:
How do you catch a cloud and pin it down?

Is the future of PACS up in the air? You bet it is. Why? According to Mitch Goldburgh, InSite One, it's because:

1) The distinction of data storage and archiving have been blurred;
2) There are no DICOM or HL7 messages for deleting data;
3) Retention rules for digital information is about to become even more complex with the adoption of health information exchanges where retention requirements extend beyond any single institution.

That's why at HIMSS 2010 expect to see a resurgence of hosted solutions for primary applications and storage service providers. Revolving around the term ‘cloud’ are virtual services offering a lot of benefits for access to new applications, data storage, and imaging exams across the hospital.

So, do you think you got it nailed down?

PACSman: Every time someone mentions cloud computing I think of the Rolling Stones “I said hey! (hey) you! (you) get off of my cloud….” or Judy Collins from her song Both Sides Now (“I’ve looked at clouds from both sides now, from up and down and still somehow, It’s clouds illusions I recall, I really don’t know clouds…at all.”), not the Sound of Music like Ms P is fond of hyper-linking too. She is a true Maria in every sense of the word, waiting for some Austrian goober to sweep her off her feet so they can go hand in hand into the mountains singing Edelweiss together…Now I admit that the relationship that Christopher Plummer and Julia Andrews had was idyllic in every sense of the word but…it’s the movies…let’s get real….
Big idea? Since when? Like clouds, the CONCEPT of cloud computing in healthcare has been around for quite some time and got a lot of fluff at RSNA but it’s still a few years from being accepted by healthcare providers, insurance companies and others, with other areas like cloud-based archiving even further away.
Yes I know there is a cloud computing magazine Ms P- I subscribe to it actually- and if you are out in San Jose March 15-18 and have $2,000 that isn’t earmarked for anything else you can attend Cloud Connect (http://www.cloudconnectevent.com/) one of several Cloud trade shows that are popping up like…well…...clouds…
Craze? Not hardly. Most of what was shown at RSNA was either in the concept stage (RSNA= Real System Not Available) or just getting installed and at the alpha testing stage. I’d hesitate to say few vendors had that have even made it into beta testing yet….but they still were neat to look at.
There are still way more questions than there are answers about cloud computing. The first is insuring that everything you get from one PACS easily translates to another via the common viewer. This takes much more than performing a simple DICOM query/retrieve. When you convert data from one PACS to another (or to a common standard like vendor neutral archives (VNA) have) you may lose things like grey scale presentation states (GSPS) or some database information. This hasn’t quite been figured out yet completely. Then there are the patient confidentiality issues, the HIPAA conformance issues, and a host of others. Some of the papers I’ve seen from clouds supporters are claiming cost savings against sending CD’s out to primary care physicians (PCP’s) at a cost of $30 or more, but is this claim real? For them obviously yes, but for the rest of the market its more a resounding no. Very few hospitals I know send out CD’s to PCP’s. Most use image distribution via the web that is inherent to most PACS allowing PCP’s to select the studies they want to see. Most outpatient imaging centers hand the CD’s to patients to BRING to their doctors as well at a cost of maybe $0.50, with most of this for the CD case and label.
Clouds biggest claim to fame is that a PCP can do a single log and using a single viewer look at all images from multiple disparate PACS from different facilities without having to log onto several different systems saving time (and in the process, money).
So how many showed cloud computing ar RSNA? Too many and not enough.
Does cloud have potential? Cointenly…
Is it ready for prime time today? Cointenly not. I give it a couple of years to work out the bugs then we can talk about clouds like it’s Jack Johnson (aka the Great White Hope) instead of just some overweight pugilistic punching bag full of hot air who wants to overthrow the existing incumbent PACS.Cloud computing has potential but it needs to spend some time in the gym yet working on establishing it’s knockout punch before it steps into the ring against established PACS that are working already. HIMSS should be interesting for sure but the end users have to feel comfortable turning everything over to an unknown and unseen enterprise and that may take a little getting used to…So time will tell….Stay tuned…