Two industry experts explain the benefits of cloud archiving.

Cristine Kao, Global Marketing Manager for Carestream Health
Solution: Cloud-based e-Health PACS and e-Health Portal

Social networking site Facebook uses it to store photos. Amazon has recently used it to store music. And according to a recent article on CNN (“Why cloud storage is the future of music” by John D. Sutter), other big name IT companies want to expand their services with this in-demand, on-demand technology.

It’s all made possible through the “cloud.”

But just what is the cloud and how does it apply to health care? To learn more, Axis Imaging News spoke with experts from two companies offering cloud-storage solutions.

IE: So what exactly is the cloud?

Kao: I think if you look at the cloud beyond health care, sort of all over the image IT industry, there’s a demand for better utilization of resources. The challenge with traditional IT is that you have one single site within your brick and mortar. You have dedicated resources to manage electricity, space, and so forth. And that’s just the hardware side. You also have challenges to leveraging your software. For example, if you have one server farm or one storage farm, it’s dedicated to one system, and let’s say, it’s at 20% utilization. And then you have another system that is at high demand, like e-mail. So you’re taking up 80% of the storage and you’re running out. There’s no real cross-sharing of resources and management at all when you look at traditional implementation. Why worry about things on-site when you can have somebody else managing things for you? And that’s really where the cloud services started.

IE: How then do we apply that to health care?

Kao: In the traditional health care environment, each hospital manages their own systems. Even now with the need to push for regionalized health care and hospitals trying to provide better patient care, resources are getting scarcer. Everybody is challenged to do more with less. I think if you look at cloud-based services, you’re starting to look at “Can we take that best practice with IT and apply that to health care?” The answer, I think, is yes. The easiest thing to do with the cloud-based is the archive. Carestream Health has been doing this for quite some time, managing archive storage for disparate systems, whether it’s cardiology, radiology, or anything else that’s imaging intensive. We can take it off-site and do it forever. When you talk to [chief information officers] at the hospital, it’s the easiest thing they can let go. When it comes to images, as soon as they’re acquired, the radiologist wants on-demand access, and they want to be able to report right away. Plus you have the turnaround, or the benchmark, that each hospital is striving to provide best results for their referring physician. That’s the first level.

Then you get others starting to think, “If I have the infrastructure in place, could a company potentially manage everything for me, from the PACS to the archive?” This way, they’re not worrying about anything on-site at all because if they can outsource it, and all the service level agreements and performance are the same, why not look at something that is off-site. The trend for that started at the end of 2009 to 2010, this whole idea of offering cloud-based storage, not just for archiving but actually your first image, which is the actual PACS application itself.

IE: What are some of the ways that your customers have been using your solution?

Kao: We have a customer in the Netherlands where they have three different sites, merged together. They had Siemens, Fuji, and Agfa PACS, and they were merging into one organization. Carestream Health came in and said, “We can help you merge that so you can have a single patient record as a single organization.” They said, “It’s very capital intensive when you have three different sites to manage. Is there a way to merge that into one?” They actually ended up purchasing our e-Health PACS solution, which means both PACS and the archive are managed completely by Carestream Health. The benefit for them is that there is no infrastructure on-site, they pay as they go, so it’s basically fee for service, and it’s completely operationalized without a capital cost.

IE: What does this latest release offer that noncloud versions didn’t?

Kao: Before this, it was just the archive, so we were only managing that second copy of information. The performance was never up to the point where you can actually physically let go of that first copy. Now that we’ve built this cloud-based infrastructure, everything is completely virtualized. Information, regardless of where you are, is accessed as though the image is on-site. So for a radiologist reporting that first image, the first copy is readily available. We’re managing for you, but we’re also helping you optimize that performance by sharing all the different resources we have. So rather than the hospital spending money buying servers and hardware and storage, they don’t have to worry about that. Carestream Health manages the growth, and the entire headache that comes with the growth.

IE: Is there a customer this technology is ideally suited for?

Kao: We do see three major customer scenarios. One is basically a customer that wants that second copy of the archive: the storage off-site for pure disaster recovery. The second scenario is due to the competitive environment in the United States. Hospitals are merging; they can’t just afford to merge all the systems and buy a new one. Having a cloud-based service as pay as you go makes it very affordable to be able to merge systems and collaborate with a new portfolio. The third scenario is teleradiology. If I’m a teleradiology group providing reading services for other sites, I don’t necessarily want to own the technology and infrastructure because I can’t afford that. What I do want is access to images.

IE: What would you say to potential customers?

Kao: I think everybody’s scenario would be a little different. Because there is no capital purchase requirement up front, I think if a customer is looking at how much they are spending over time with capital purchase, plus upgrade of the system in 3 or 4 years, plus adding additional storage because they are growing—if you look at those total costs and you operationalize that, you’ll see that e-Health cloud-based services are actually much more affordable as an operational expense over time.

Ken Rubin, Senior Vice President and General Manager, Healthcare at Iron Mountain
Solution: Digital record center for medical images

IE: What has been your company’s experience with the cloud?

Rubin: Iron Mountain has been in the cloud storage business since before it was in style, probably around the year 2000, and we have had a variety of cloud storage businesses mainly around backup and archiving, everything from e-mail to medical images. We have a very mature operation that is run out of 200 data centers that we call data bunkers in Pennsylvania and in Kansas City. And a few years ago, we applied our capabilities in the area of health care because we thought it would be adopting the cloud.

The way we define cloud is that it is a storage-delivered service, available through the Internet with no hardware or software, no capital investment whatsoever, on a utility or usage basis. The service is integrated with the customer’s environment. It has to have all the support services associated with it, so the customer is really not performing any maintenance or support or buying anything. Instead, they are just paying a unified charge and having the service delivered to them on a service-level agreement basis.

IE: So what are the benefits of cloud for your health care clientele?

Rubin: We offer cloud storage not just for medical images but also for any structured and unstructured data in the health care organization. We offer both medical image archiving and vendor neutral archiving. Most customers that you probably know have their information buried in silos. So for each application or data type, they have to worry about separately the storage, the backup, the archiving, the capacity managing, the provisioning of more storage, the migration of data—all that they have to manage on a silo basis. The proposition that the cloud offers is to be silo-busting in that it creates a platform, which reduces the total cost of ownership of storage and storage management. It also improves disaster recoverability because the data is stored remotely from the hospital and is insulated from a catastrophe at a hospital location. Third, it reduces the complexity of managing this heterogeneous environment. In the case of our vendor neutral archive, there are additional benefits in that it provides shareability of data across different PACS systems and so it eliminates the perpetual need to migrate data from one PACS system to another.

IE: Can you tell me what the installation period is like for customers who purchase your solutions?

Rubin: The deployment of the system itself is fairly short term. It probably takes a month or two. If it’s a vendor neutral archiving deployment, you then also have to migrate the data, which varies in time depending on the volume of data. It’s inherently a process that takes time to run. In the case of our straight medical image archiving, the migration is more of a data move than a migration, and it takes less time. Generally, most hospitals are fully moved in within 60 to 90 days of deployment.

IE: Looking at your customers’ needs and demands, what are some of the trends you are seeing in this particular field?

Rubin: We find that many customers today are interested in vendor neutral archiving because they are all putting in EMR systems. Through all the mergers and acquisitions in the health care world and the emphasis on interconnectivity, they want to share data between their radiologists and their hospital systems and don’t want to be bound to any particular PACS system. The larger the organization, the more complex the environment, the more hospital systems are oriented toward vendor neutral archiving.

We also find that hospitals tend to like one copy on-site and one copy off-site. That way, they have the best trade-off of speed, accessibility, and cost. We also see organizations increasingly using the cloud for disaster recovery purposes because they don’t have a lot of data center resources available and don’t have a lot of geographic separation between their computing environment and their data. We also see them shifting them into an operational expense mode as opposed to a capital expense mode. Capital is in very short supply in hospitals and is very precious, and we see hospitals preferring to deploy their capital for patient care and for generation of revenue and not for secondary storage management. They are attracted to the cloud and our services because of the ability to pay as you go on a usage basis, with a variable cost.

IE: What would you say to potential customers who want to purchase this type of technology, but aren’t sure whether to take the plunge?

Rubin: What we normally do is we help the customer analyze it, so they can compare the cost to manage their own environment versus going to the cloud. The reality is that the volume of information in health care is growing 30% to 40% a year on a compound and annual basis. So it’s not a question of if you do something, but what do you do? What we have been finding is that there are two trends. One, the hardware acquisition cost per terabyte is going down, with technology and better storage, etc; the cost to manage storage, which is a function of volume, is going far faster than the efficiency gains in storage. So right now, it’s around 3 or 4 to 1. So for every dollar you spend on storage hardware, you need to spend $3 to $4 on managing that storage. And that gap is widening. Therefore, it places a lot of pressure on the IT organization in terms of management.

Elaine Sanchez is a contributing writer for Axis Imaging News.

More ED Patients, More ED Imaging Needs

ED patients already make more use of imaging than most other categories of patients. Studies show 30% to 60% of ED patients will require some kind of imaging study: general radiology, CT, MRI, and ultrasound imaging.

Research also shows that imaging use is on the rise. CT volume, for example, has doubled, with 10% to 20% of ED patients undergoing CT scans. Use of MRI has risen to almost 10% of ED patients. They are also undergoing more ultrasound scans and general x-ray imaging.

Modeling a department with streamlined operations can determine the effect of imaging capability on LOS and other performance measures.

Once the operational recommendations of a model have been incorporated, it is time to evaluate the effect of an ED imaging capability.

—K. Culp