Cloud-based technologies have been relatively slow to penetrate the health-care IT market, but several advances in technology—as well as federal programs that encourage the adoption of interoperable solutions—are changing that, according to Vijay Ramanathan, CEO and cofounder of RamSoft Inc. “The biggest trend that is driving cloud computing, in our industry, is what is happening overall in the consumer world, where individuals are using more and more cloud-based services,” he notes. “Every iPhone or iPad is backed up in the cloud. That is going to reduce the perceived risks involved with cloud computing.”
As software has become more sophisticated in the consumer industry, it has also progressed in other industries, Ramanathan says. “The software design is a significant factor, and today, it’s becoming more intelligent,” he says. “Images are not the same as text information, so the architecture has evolved: A PACS solution doesn’t have the same design as an online-banking website.”
Bandwidth and Network Capabilities
For instance, Ramanathan says, downloading diagnostic-quality images from a cloud server can easily consume an organization’s bandwidth, particularly if it is located in a rural or underserved area that lacks the high-speed networks available in more populous areas. Once a barrier to adoption of cloud-based image-management solutions, today, this problem is solved by caching, he explains. “If there’s caching involved—if, say the past year’s worth of data are available through local caching at the health-care facility—then your bandwidth requirement is cut significantly,” he says. “Every time a physician within the organization wants to view the images, he or she doesn’t have to download them all over again.”
The reliability of a facility’s Internet connection is a separate issue. Ramanathan notes that this is still evolving, in many areas. “It’s much less likely that a facility will lose Internet connectivity (in the absence of something like a widespread power outage) than it was just a few years ago,” he says.
While power outages do happen, Ramanathan adds that they can be more crippling when a facility is using a solution that is hosted on-site than when the solution is cloud based. “A typical smaller-sized health-care facility is not likely to have a secure data center with adequate power backups,” he says. “With that kind of environment, cloud computing provides a much higher level of reliability.”
Storage and Scalability
Ramanathan says that storage and scalability are growing problems for health-care organizations—and it is in these two areas that cloud-based image archiving/management truly excels. “Image file sizes are exploding,” he notes. “With a conventional solution, there are hardware upgrades that have to be made on a regular basis so you don’t run out of space. In a cloud environment, that’s all taken care of by the software provider.”
Linked to this concept is that of scalability. Image storage needs to scale according to an organization’s needs, and while file sizes continue to grow each year, organizations undergoing mergers, acquisitions, or divestitures will find themselves with a sudden spike or dip in their storage needs that is even more challenging to accommodate.
“The advantage of cloud-based solutions that is often overlooked is the ability to expand or upgrade the solution on demand,” Ramanathan says. “If your business is expected to grow, it really provides a huge advantage; you can start out with a very small solution and expand as needed.”
Likewise, he says, if a business is shrinking in size, a cloud-based solution can continue to accommodate its needs at a lower price, without a difficult migration to a new solution. “It allows a startup to have the same level of infrastructure as a fully established business,” he says. “It allows consolidation to take place easily and effectively. If you’re planning on doing mergers and acquisitions, a cloud-based solution is the only way to go—and it works out well if you are divesting part of your business.”
Future Practice
The most important factor, Ramanathan says, is that cloud-based RIS and PACS solutions position imaging well for future practice. Of the newly released requirements for stage 2 of the meaningful-use incentive program, he observes, “They cement the need for connectivity between radiology and referring practices. They are going to be a game changer, as far as connectivity is concerned.”
That connectivity is simplified with a cloud-based solution, he says. “I can’t imagine that a large percentage of radiology facilities have the internal IT expertise to connect their systems to each of the referring practices,” he says. “A cloud provider can make that connectivity happen for you.”
One of the aims of meaningful use is to simplify communication between physicians by enabling it to happen electronically. Ramanathan zeroes in on one of the most important communications between the radiologist and the referrer to illustrate the usefulness of cloud-based RIS/PACS. “When there is improved connectivity with the referring physician’s electronic health record or electronic medical record, the ability to notify the referrer properly of critical results is going to be greatly improved,” he says. “If you have an ability to flag something electronically as a critical result, that’s leaps and bounds more effective and efficient than putting in a phone call to the referrer’s office.”
The result will be a welcome shift in radiologists’ practice patterns that will result in better care, he concludes. “This will be a tool that allows a much higher level of interaction between radiologists and their referrers,” he says. “Allowing small facilities to benefit from the same capabilities as large health systems has a democratizing effect. Decentralizing the practice of medicine is beneficial to all: It will provide more options to patients by allowing small practices to thrive with the same level of integration as large health systems.”
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.