Cloud and Clear

From capabilities to costs, health care CIOs want clarity on cloud computing. Two vendors speak up on the subject.

When health care CIOs think about cloud computing, the primary driver is business continuance,” said Cristine Kao, global marketing manager for healthcare IT at Carestream (Rochester, NY). That’s because one of the doomsday scenarios CIOs have to be prepared for is a disaster such as a flood or a fire that could impact their health care facility’s data center.

Because of massive networking and telecommunications pipelines, CIOs are now able to seriously consider working with a vendor that can host the primary application—whether that’s for the vast majority of their storage needs or a PACS or a RIS or even a billing solution—in the cloud, says Kao.

She says that the advantages of a cloud-based solution for a health care facility are very tangible: The vendor is responsible for the software and hardware upgrades, while the health care facility only needs to provide access to workstations on-site to obtain information and the modalities that can send images to the cloud.

The benefit is clear, according to Kao. “It’s ‘pure archiving,’ which means that images are stored once to the cloud, then immediately available to radiologists or referring physicians—or, indeed, patients—for consultations and sharing.

“Of course, CIOs aren’t making these sorts of IT investment in a vacuum,” Kao said. “Given the cost pressures of health care reform, providers are being asked to provide health care in a new way.”

Then there’s the issue of risk, she says. “Providers are looking for ways to shift risk onto their vendor partner. If the vendor can manage the applications in a secure environment, while guaranteeing physician satisfaction, CIOs are quite interested in hearing more. Key, of course, is the ability to share information at a critical time of treatment.”

Delivering on the Promise of Patient-centric Care

Kao notes that, given accountable care initiatives around the country, hospitals and groups of health care providers are increasingly centered on the patient. In this networked care environment, the exchange of information in information systems becomes critical, Kao says.

She explains that, while a given regional hospital might have a RIS or PACS from one vendor, outpatient imaging centers that are also part of the same accountable care organization (ACO) might have a RIS or PACS system from another vendor. In order to respond to this need, Carestream provides the Vue Cloud Community, which allows providers to share information via the cloud.

There is a surge of people looking at a single archive of images, says Kao, who notes that many vendors adhere to the DICOM standard within imaging in order to provide access to images within a single repository. The current challenge for health care facilities is to ensure that they are able to consolidate images and information across “ologies” such as pathology, cardiology, oncology, and radiology.

Today, archives can manage all of that data in a standards-based format, so that radiologists and referring physicians can gain secure access to those images and information whether they are physically located at the hospital, at their physician practice, or at home, Kao says.

New Technology or New Buzz Words?

Henri “Rik” Primo, director of strategic partnerships at Siemens Healthcare (Malvern, Pa), strives to debunk the notion that cloud technology is a new technology in health care. “[The cloud] is nothing new,” he said. “It’s been there for a long time [in health care], though with different acronyms.”

To illustrate this point, he points to Siemens Healthcare’s experience running billing applications for health care customers for more than 40 years. “Siemens was one of the first companies to provide billing and scheduling solutions that [were housed] in our data center,” Primo said. “These solutions were connected to different hospitals via mainframe computers. These billing solutions would run in our data center in Pennsylvania, and customers experienced minimal interruption with this model.”

Describing this historical example as a type of hybrid cloud, he notes that there are two other types of clouds commonly discussed in technology circles: one is the public cloud and the other is a private cloud. In a public-cloud model, the company providing the service makes cloud features such as applications and storage available to the general public. In a private-cloud model, the functionality is the same but the infrastructure is designed for a sole organization. Many CIOs would be concerned about providing patient information on public clouds—and with good reason, Primo says.

“If you’re in the business of providing health care today, private and hybrid clouds are accepted. No CIO would consider a public cloud. They’re not secure and can be hacked. Public clouds are great to store information on YouTube or LinkedIn, but if something goes wrong, you lose all of your data,” Primo said.

What Else Keeps a CIO Up at Night?

Today’s health care CIOs want to provide a common infrastructure across all of their hospital’s departments—they don’t want to have individual departments with their own storage depositories with dedicated Windows servers and workstations, Primo says.

Whether health care CIOs opt for a private or hybrid cloud environment, image archiving is a huge concern, says Primo, who notes that Siemens Healthcare partners with Dell to provide a truly vendor-neutral archive for its customers.

According to the company, Siemens Healthcare’s Image Sharing and Archiving service (ISA) is a hybrid cloud-based service for archiving and managing clinical imaging and associated reports from any PACS system. Because ISA is standards-based, any authorized PACS user can use the ISA service to store and access this data, regardless of the vendor that provides their PACS solution. Providing flexible solutions for hospitals and radiology groups, this solution allows clinicians to quickly access patient imaging data at the point of care.

Described by the company as “always available,” ISA’s cloud hosting is provided by the Siemens Healthcare Cloud Computing Center, which provides high business continuity and HIPAA-enabling security, and averages more than 200 million secure health care transactions each day. According to the company, ISA is an IHE XDS- and XDS-I-compliant repository that supports the image-sharing requirements of health information exchanges.

The Bottom Line Is Top of Mind

Not to be overlooked are the cost savings associated with cloud computing, which can be substantial and more predictable when health care organizations use applications that are stored in the cloud, agree Kao and Primo.

Hospitals can implement a private or hybrid cloud to consolidate their data in a single repository. “The goal is that different departments shouldn’t need to have isolated islands of storage—in large part because the cost to manage different systems can be astronomical,” Primo said. “By consolidating on a private or hybrid cloud, hospitals can handle all of their data in a centralized architecture.”

Carestream’s Kao echoes Primo’s sentiments. “Cloud computing is designed to be scalable. CFOs and CTOs are looking for a 5-year return on investment on their capital purchase and service contracts. Two years [after the initial purchase], they have to add licenses and storage capacity. Three years out, [the software is] getting obsolete and [they] need to migrate to the new storage. At the 5-year mark, they’re faced with the decision of keeping the platform and upgrading the software and hardware. A lot of those are unpredictable costs,” she said.

When a vendor manages data storage, health care organizations mostly experience a flat cost, Kao says. “[Health care organizations using the cloud for storage] will have a cost per exam, regardless of the investments the vendor makes to the platform. Over time, the vendor is upgrading and making sure the archive is fully scaled for growth,” Kao said. “[This means that] the customer doesn’t see a spike in operational costs—they’re paying a monthly cost based on usage. Every hospital can predict the number of exams per month and per year. They don’t have to worry about technology obsolescence and some of the soft costs associated with staff capable of handling those systems.”

According to Carestream, customers can save up to 30% in terms of total cost of ownership with the company’s cloud computing offering. Kao says that is because the company will be removing additional costs from health care organizations, such as data migrations, technology obsolescence, and the need to build data centers.

“As IT spending continues to be lower at health care organizations, cloud computing becomes a viable option,” Kao said.

Future Prospects for Cloud Computing

Providing patients with access to their medical data is where health care is moving, Kao says. With access to patient portals, patients want to be able to update their information and schedule appointments, and gain access to exam results. According to Kao, the key will be building a patient imaging portal embedded into the patient portal, which will notify patients when their images are available for viewing and sharing via secure e-mail.

Primo of Siemens Healthcare says that the cloud itself has little to do with workflow improvements—but it can be the perfect platform to promote interaction among physicians and between patients and their physicians. “At HIMSS ’12, everything was about connectivity: connectivity to patients, connecting patients to their own data, and using cloud infrastructure to encourage interaction,” Primo said.

---

Aine Cryts is a contributing writer for Axis Imaging News.