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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.



Joe, as always, a perceptive look at some of the more troubling issues for radiology and IT executives. Where I would differ with you is the assertion that incoming CDs are the domain of radiology only. The radiology department is being inundated with outside CDs (with and without reports, presenting its own set of medico-legal concerns about what to import into the PACS, when to perform a secondary read etc.). It's amazing, but most CIOs and CMIOs want to be involved in these decisions, particularly where a decentralized workflow of uploading and viewing CDs is being proposed. For trauma transfers, they want to optimize the study transmission and the workflow to get those images into PACS. And in most cases, it's the CIO who signs off.

For lifeIMAGE, we see a tremendous opportunity to alleviate the problem of outside CDs, as well as the opportunity to empower patients by letting them aggregate their own images and reports in their own Inbox in the cloud.

It's going to be interesting watching this all unfold - it's the wild west out there at the moment!

There are several excellent points in this post. An additional point that was made by a study, published in the September 2009 issue of the Journal of the American College of Radiology, was the incidence of repeat scans that were necessary due to inoperable CD's. In discussions that we have had with customers, it is quite common that CD's are unusable resulting in the need to rescan the patient. This results not only in additional costs to the patient for the rescan, but is also becoming a patient care concern related to the number of scans a patient receives over their lifetime.

Yes, it is the wild west out there, making security an important consideration. Symantec has many years experience with security and the Internet. Our goal is to allow healthcare providers to securely archive and share medical images with other healthcare providers in a way that alleviates the problems associated with CD's.