Remember when X-ray abandoned cumbersome film once sleek digital suitors showed up? It happened little by little, not all at once. In much the same way, radiology datasets are leaving cramped hardware spaces for the inexhaustible, ever-flexible expanse of the cloud.
It’s not hard to connect these dots and see the pattern. As recalled by researchers at the University of Maryland’s Medical Intelligent Imaging (UM2ii) Center presenting data at RSNA this past December, the transition from film to digital imaging “enabled new, efficient and innovative workflows that have since become inherently obvious.”
In like manner, Florence Doo, MD, and co-authors add in the same study published in the JACR in December that radiologists adopting cloud technologies are “making a conscious choice to steer the course toward a more innovative, cost-effective and sustainable future for [their] field.”1
Importantly, close observers agree, radiology’s relocation to the cloud will, slowly but surely, prompt all other image-intensive clinical departments to join the journey. Chalk it up to, largely, the explosive growth in volumes of medical images from every corner of healthcare over the past few years. That includes not just DICOM-dependent departments like cardiology and pathology but also the visible-light and video-based practices like dermatology and gastroenterology. Not to mention the throngs embracing highly affordable point-of-care ultrasound, with its meaty cine-loops.
All of this spells boom times for enterprise imaging, or EI.
The primary guiding aim of EI adopters is to archive every retrievable medical image from across the imaging ecosystem inside a secure, stable data universe fortified with built-in redundancies, disaster backups and privacy protections.
The images will be retrievable by every permissioned clinician regardless of where they’re stationed or what time of day they need access.
How will the cloud host and optimize enterprise imaging at such sheer scale and so advanced a service level? Health Imaging pursued the question with experts in the field: Radiologist Jared Saul, MD, Chief Medical Officer for Commercial Healthcare and Life Sciences at Amazon Web Services, and Charles Morris, MBA, Director of Enterprise Imaging at AGFA HealthCare. The two are occasional collaborators through AGFA HealthCare’s partnership with AWS on supplying hospitals with cloud-based enterprise imaging services.
Here are some key takeaways from the conversations.
1. Contrary to popular perception, software as a service, aka SaaS, is uncomplicated. Simple, even.
Why does this top the list? Because end-users of imaging data stored in the cloud don’t interface with the cloud; they interface with cloud-enabled software. In fact, as Morris points out, many if not most end-users either don’t know or don’t care where the data resides. They care that the images they need for diagnosing and treating patients reach their screens quickly, securely and at full diagnostic quality.
“I wish more clinicians looking for enterprise imaging would understand how simple SaaS could make their lives,” Morris says. “A lot of times they seem to be overthinking the concept.”
Historically, he adds, providers and their IT support staff were quite justified fretting about storage, services, uplinks, networks, protocols, firewalls and “a thousand other” concerns.
They also had to train staff on how all those different steps and services interact with the enterprise imaging platform, which in many cases seemed almost as intricate as the EMR itself, Morris notes.
More:
As we move our Enterprise Imaging customers to the cloud via SaaS, the thought process of the end-user gets a lot easier. We provide a single bandwidth minimum, a single latency minimum and a straightforward service level agreement. With these basic elements in place, you can plan out your future with upgrades, training, and everything else. You go from a thousand problems to a dozen. It really is that easy.
2. When is the cloud not a good option for hosting enterprise imaging? Some say never.
Admitting his opinion is biased given his place in the cloud world, AWS’ Saul predicts that eventually all storage of medical imaging data will be cloud-based. The main driver, he believes, will be hospitals’ realization that the care and upkeep of IT infrastructure—which includes endless cycles of shopping, purchasing, refreshing, maintaining, and supporting—is a business they can easily get out of. And why wouldn’t they?
“The image data that needs to be readily available versus stored in an archive can be managed more directly. Significant cost savings can be obtained by managing those lifecycles and moving your data up and down between storage and archive.”
Jared Saul, MD, Radiologist and Chief Medical Officer, Commercial Healthcare and Life Sciences, Amazon Web Services
Saul notes that with the cloud, enterprise imaging end-users decide “how many nines” they want for durability and redundancy—whether it’s 11 nines (99.999999999%) or some other nearly perfect percentage—and data is accordingly replicated and securely stored across multiple sites.
What’s more, he adds, if you’re archiving less commonly accessed files, you can reduce the rates to store that data forever
“The image data that needs to be readily available versus stored in an archive can be managed more directly,” Saul explains. “Significant cost savings can be obtained by managing those lifecycles and moving your data up and down between storage and archive.”
He also defines it this way:
This is a strategic decision since storage is static while archiving moves data around as patients age, causing demand for their older medical images to fall off over time. This approach to archiving offers long-term yet cost-effective retention in the cloud. By comparison, if you’re buying space in a data center or standing up your own hardware, you don’t have so much flexibility.
3. Remember all the talk about “cloud-enabled” technologies? Well, with today’s enterprise imaging, it’s the other way around: The technology is enabling the cloud.
Startling? Perhaps, but Morris backs up his claim by describing a changing of the roles among collaborating vendors:
If you were to just lift and shift an old school PACS application into the cloud, the user experience would be very poor. That’s because those kinds of applications are designed to run on LANs, local area networks. But with newer enterprise imaging technologies, leading EI vendors like AGFA HealthCare are opening new avenues for leading cloud vendors like AWS.
“We now have both storage and display technologies that are really, really optimized for distant data centers, equipping providers to expand their patient catchment areas. We are truly unlocking the power of the cloud.”
Charles Morris, Director of Enterprise Imaging, AGFA HealthCare
The avenues consist of access points good for reaching hospital purchasing teams. With a foot in the door, cloud vendors can name-drop their enterprise imaging partners and tell hospital decision makers: “Their application running on our cloud will outperform any software-hardware combination you’ve run on your LAN.”
What’s more, the boost in performance includes more than just high speeds and low latencies. For example, having fully embraced the cloud, AGFA HealthCare has moved beyond downloading images to clients in lieu of streaming images in real time. Morris points out this resembles the way the Netflix streaming service works.
At the same time, Morris says, “we now have both storage and display technologies that are really, really optimized for distant data centers, equipping providers to expand their patient catchment areas. We are truly unlocking the power of the cloud.”
4. Enterprise imaging via the cloud can complement emerging technologies in which all healthcare providers are interested—from AI and machine learning to virtual reality and augmented reality, and from clinical robotics to 3D printing and rendering.
Dr. Saul of AWS maintains that the EI-cloud combo will drive down costs as it relieves providers of the major spend they would have had to make in IT infrastructure, support and staffing. And these savings can be redirected to other technologies that are changing the ways healthcare is practiced in this 21st century, he suggests.
“Once you’ve moved to the cloud, you open up your ability to iterate, experiment and develop new ways of doing things,” Saul says.
Those new ways are likely to fold in fixes to physician burnout. Saul, looking back at his radiology roots, believes the next few years will bring new or improved digital tools that will integrate into, for starters, radiology workflows. He thinks most will involve AI and machine learning. Others will take the form of workflow tweaks aimed at doing more with less.
“Either way, enterprise imaging in the cloud will really start to alleviate some of the burden radiologists have been carrying,” he says.” And that’s going to directly translate to better delivery of patient care.”
Equipping radiologists to focus their attention—eyes on images and working in the flow—means saving them from having to deal with anything and everything else, Saul continues. Traditionally manual tasks become fully automated, easing duties related to quality control, case prioritization, retrieval of prior images and patient histories and so on.
Systems like AGFA HealthCare’s Enterprise Imaging Platform already do a lot of these things, Saul acknowledges. However, thanks to the joint efforts of AGFA HealthCare and AWS, radiologists on the receiving end will enjoy “a more integrated, less platform-dependent approach.”
And as Saul sees it, integration drives much-needed efficiency:
The more image data organizations can get into the cloud, the better able they are to find operational synergies and efficiencies of scale with the EMR, the virtual reality and 3D printing toolkits—and all the other promising technologies that are either maturing or coming down the pike. And those advances really are going to improve the care process.
5. Adopters of cloud-based enterprise imaging receive technology upgrades across the board without even having to think about them.
Morris cuts to the chase:
When you purchase our Enterprise Imaging Cloud solution, you’re getting a better data center, you’re getting better security, you’re getting better power, you’re getting a better network than what you have today. You also have better people because this is all they do. You get better people than you have right now running the network, running the servers, running everything. The people running these cloud data centers are the peak of our industry globally.
But is Enterprise Imaging Cloud SaaS really a major money-saver?
Yes, Morris says.
“The cheapest way to go would be to keep your servers in a closet,” he adds with a chuckle. “Stick your servers in a closet and let the custodian take care of them.”
On the other hand, if the subject is value, he says he can’t think of a technology that gives more bang for the buck than Enterprise Imaging Cloud SaaS.
“Most CIOs I talk to can’t tell me the cost of running an application,” he says. “They have a lot of shared services and there’s a thousand people touching everything. Too hard to calculate what you get for what you spend. With cloud, you get a single bill. You pay that single bill. Your clinicians go about their work taking care of patients. It really is as easy as that.”
It just makes sense, Morris notes.
“I’ve been in healthcare technology for 20 years,” he offers. “In my opinion, the cloud has really become just a matter of common sense. When you combine it with enterprise imaging, it’s nothing less than a no-brainer.”
Saul concurs:
In the past, with traditional practice models, you could predict the capacity that you needed to provision. Radiologist headcount was based on hospital admissions, radiology volumes, patient throughput rates. And now you’ve got practices operating in new ways and on a whole different scale. The technology has to change to provide the right infrastructure for how medical imaging gets done now—and how we’ll be practicing in the near- and long-term future.
To learn more about AGFA HealthCare’s customizable cloud services for enterprise imaging, click here.
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Reference:
- Florence X. Doo, MD, et al., “Economic and Environmental Costs of Cloud Technologies for Medical Imaging and Radiology Artificial Intelligence.” Journal of the American College of Radiology, Dec. 8, 2023.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.