Taking it to the Clouds

Meanwhile, eMix (a subsidiary of the San Diego-based DR Systems), an electronic information exchange company, was about to begin beta testing and needed testers. eMix uses cloud-based technology to house images after they are encrypted and pass through eight layers of security that include a physically secure data center and member and user authentication. The uploaded images are then accessible to the intended recipient through a simple download following an e-mail notification.

Beginning in November 2009, three Montana health providers-Great Falls Clinic, St. Luke Community Hospital in Ronan, and Kalispell Regional Medical Center in Kalispell, all with different PACS, started beta testing the eMix service. No significant problems were encountered, and three additional facilities-Benefis Health System in Great Falls, St. Vincent Healthcare in Billings, and Glendive Medical Center in Glendive, were added as beta sites. In March 2010 beta testing concluded and the facilities signed up with eMix to continue sharing images.

LOWER COST, LESS TIME

On average, users of the cloud save at least $8 per image or study they send, based on a $12 FedEx fee. Knudson adds that sending a CD from her organization can range from $20 to $25, including manpower and overnight shipping charges. She cites a recent savings of close to $20 when Great Falls Clinic sent a radiology image for about $4 via the cloud to a facility they had never been in contact with before.

Besides cost savings, cloud-based computing technology saves a lot of time. Because of the rural nature of Montana, some facilities may not receive a FedEx delivery every day; as a result, shipping an image could take up to three days. Maki recounts one Great Falls patient who made an appointment three hours away in Billings, but forgot to bring the images with him to the visit. Instead of having to cancel and make the six-hour roundtrip again, IMOM saved the day. “We found out 30 minutes before the appointment, grabbed the images and uploaded them to the cloud,” Maki says. “The other organization across town downloaded them and zipped it across their private network in the city and got it there with seven minutes to spare.”

With cloud technology, the facilities also don't have to worry about setting up virtual private network (VPN) connections with the other organizations and undergoing the tedious process of updating the VPNs after organizations upgrade their firewalls. O'Leary says that he plans to send images via the cloud every time a VPN connection to an organization becomes outdated to save time and manpower troubleshooting a new connection.

Cloud-based solutions have been becoming more popular in the healthcare industry lately. According to a report released earlier this year by consulting firm Accenture, 32 percent of healthcare respondents use cloud computing applications, while 73 percent plan to transfer some applications to a cloud-based model. Healthcare was on par with other industries as far as rate of adoption, but unsurprisingly lagged behind the technology and financial services industries.

As far as next steps for IMOM, Kalispell's Bill O'Leary doesn't see many. The lion's share of the work has been done already in figuring out a solution to Montana's imaging problem. The next hurdle will be to encourage adoption among smaller community radiology clinics and facilities. Currently, O'Leary still gets requests from facilities to send out images for them, but that will have to end soon. “I feel we are getting into some HIPAA regulations we probably want to avoid,” O'Leary says. “We don't have ownership of those images. But for continuum of patient care we do it.” Great Falls Clinic's Gayle Knudson plans to reach out to the IMOM community in September to assess where IMOM is and what should be done next. In Knudson's words her team did a “bang-up job” solving their interoperability issue with image transfer. “I honestly believe it was because we had the worker bees, the managers, and the PACS administrators in on it. No one had a personal agenda, and we were all there trying to make the right thing happen.”

Healthcare Informatics 2010 September;27(9):30-55