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A Revelation in the Cloud

March 29, 2010
by Joe Marion
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Last Friday was sort of a revelation for me with respect to image accessibility and cloud storage. A lot of companies are beginning to speak to cloud storage, and remote access to medical images. The list of companies is growing – LifeImage, eMix, SeeMyRadiology, OneMedNet, Symantec, Iron Mountain, InsiteOne, EMC, Acuo Technologies, TeraMedica, IBM, HP, Harris, Google, Microsoft, etc. (sorry if I missed anyone!).

The simplistic view is to look at this phenomenon from the perspective of an alternative means of storing and accessing images to the typical PACS that encompasses a local archive device. Key factors in consideration include the economics of capital cost reduction, and the advantage of a remote disaster recovery facility. Accessibility is also a factor for business continuity, by enabling image access even when the PACS is down.

A conversation with LifeImage last Friday was a revelation for me in terms of considering how facilities look at the technology. I was struck with the fact that there are multiple applications of the technology that are not all mutually inclusive! LifeImage has introduced a product known as LILA, or LifeImage Local Appliance. The intent of this and similar devises is to provide an alternate to CD use for image access and communication. CD’s are entered into the local appliance, and studies can be conveniently accessed via a web-based viewer, both local and remotely. For large referral centers that can handle 50,000+ CD’s per year, this can be a substantial savings in material and the labor associated with handling CD’s. LifeImage can also support the import from external locations directly into the appliance, thereby eliminating the CD altogether. The intent is not necessarily to replace other image storage devices, but to augment them for the specific purpose of improving study accessibility during the diagnostic process.

By focusing strictly on this application, LifeImage (and others) are addressing an entirely different application than remote (cloud) storage for disaster recovery and accessibility. More importantly is the way these applications are marketed. In any large enterprise healthcare facility, information systems is probably the key audience for remote storage applications. In the case of CD replacement, the likely audience is radiology administration. It is conceivable then that a facility could be looking at remote storage alternatives in IT, as well as looking at CD replacement in radiology.

Others such as Symantec Corporation and InsiteOne are focused on a larger perspective, and are attempting to address enterprise-scale remote image storage, as well as provide image access independent of local PACS for business continuity and EMR integration. Still others like Google and Microsoft are looking beyond to the Patient Health Record (PHR) accessible by all including the patient.

The likelihood is that as these products evolve, there will be a convergence – depending on how images are stored in the cloud, they should be accessible to anyone authorized to access them, and the applications will blur. But for right now, I think it is helpful for IT management to be aware of the potential for departmental efforts that may or may not be repetitive to their larger efforts.

I cannot stress the importance of having a firm understanding of requirements before committing to a solution. In a scenario where radiology may have an immediate need to reduce CD’s and improve access, IT may also be examining remote storage for disaster recovery/business continuity. It may be perfectly acceptable to implement a short-term radiology solution without impacting a longer-term strategic IT initiative. However, should radiology pursue a remote storage/disaster recovery solution, that may be counter to IT’s objectives.

The bottom line? Define needs. Document requirements. And make sure solutions are compatible with the bigger picture.

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