Not long ago, the idea of sharing radiological images and exams using the Internet seemed impractical. Patients worried that secure information within their personal health records (PHR) would be compromised, and radiologists found it cost-prohibitive. But times have changed. A growing consensus believes that a constellation of tools, located remotely but connected by the Web, is the solution to securely and cost-effectively sharing PHRs. This complex yet efficient computing infrastructure is called “the cloud.”
The Cloud Defined
According to the National Institute of Standards and Technology, “Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.”1 In other words, the model utilizes distributed resources to prevent single points of failure when it comes to elements like servers, routers, and circuits.
A commonly known example of cloud computing is Apple’s iCloud. This service allows users to save such data as applications, photos, and music in off-site resources. Not only does this structure make it easier to back up files, but users can access the same files on multiple devices. In addition to this flexibility of access, users don’t have to worry about losing data if an individual device is compromised.
While Apple and other manufacturers have recently marketed cloud computing as a new advance, the technology has been around for decades; only recently, however, has it been embraced by radiology. This shift is due to several factors, including cloud technology’s widespread adoption in the business world and challenges necessitating the need for practices to be more cost efficient, such as the floundering U.S. economy and a decline in medical reimbursements. Moreover, providers use encryption technology on the order of that used by banks, which is perhaps one reason patients are now more comfortable sharing their PHR over the Internet.
Making Data More Accessible
The abundance of PACS that exist — each with a unique interface and permission restrictions — makes it difficult for providers outside of an individual health-care system to share patient data with each other. This is a concern considering the fact that it is not uncommon for patients to visit multiple facilities for a variety of tests or exams. In addition, patients often seek second opinions from physicians who are not members of the same enterprise or health-care system. For these reasons, it is critical to make the patient’s imaging and exam history available to any facility that needs it.
To solve this problem, cloud computing removes the need for on-site IT infrastructure, and by moving patient data to a central database, the technology enables the efficient sharing of data across organizations. In 2008, Gary H. Dent, MD, founded South Georgia Radiology Associates (SGRA) in Baxley, Ga., with a long-term plan to use this technology. To fulfill his mission of providing radiological expertise to under-served areas in southeast Georgia, Dent needed to partner with two facilities, each with different PACS systems. He found that it quickly became too time-consuming to log into each system to review studies.
His solution? He set up a primarily Web-based approach that circumvented the need for on-site network connections or servers.2 He configured one interface, a cloud, through which providers could upload and share studies. Now the practice’s nine radiologists view studies using the single, cloud-based PACS, cutting reading turnaround time from days for each study to an average of 15 minutes. In addition, images and reports are accessible through the PACS by referring physicians who are given approval to access them. Dent explains, “If a patient is transferred from one hospital to another, even though they’re not in the same hospital system, I can study their exams directly. This is because, since SGRA is the service provider for both facilities, I have access to that data.”
Just as Dent’s approach helps his practice overcome barriers to efficient health care, the RSNA Image Share network strives to make the process of sharing images more seamless. The project was initiated by David S. Mendelson, MD, FACR, from the Mount Sinai School of Medicine in New York, along with the RSNA and the National Institute of Biomedical Imaging and Bioengineering. The RSNA Image Share network is designed to allow consumers to control the process of sharing their images and reports “anytime, anywhere, and in a secure, safe environment,” says Mendelson. Through the use of cloud computing, RSNA Image Share allows patients to not only view their own images and reports but also to supply copies to their providers.
While the mechanics of the RSNA Image Share program are complex, the impetus for the project is clear: “You do everything else on the Internet — you shop, share videos, and do your banking — so why can’t we do the same thing and put images and reports in the cloud?” asks Mendelson. The process is fairly straightforward. Patients first request their exams and reports be transferred to an image-enabled PHR, which includes a Web-based PACS viewer. Then, according to Mendelson, “Patients can … sign into their PHR, launch a Web viewer, and view their images.”3 Or, if they would prefer to forward their health data to a physician, they can email a link “that will enable the provider to look at the images on the Web or download them to a local workstation.”
Reliable and Cost-Efficient
Besides allowing for the efficient sharing of images, cloud-based computing has become a reliable and cost-effective way of doing business. The old model of building in-house IT infrastructure required a significant capital investment in hardware — from servers to routers to switches. Further, building redundancy into the architecture to avoid single points of failure was expensive, and those costs were on top of what was required to maintain and staff a facility to house it all. But with the advances in cloud technology, reliability is on the rise, while cost concerns are waning.
The business world is taking notice of these changes, as is the College. The ACR IT Department is in the process of migrating the ACR website, along with several key applications, to the cloud. As Matt Jordan, ACR director of IT infrastructure, explains, moving an organization’s IT infrastructure onto the cloud makes a lot of financial sense. As the ACR has to maintain a higher level of availability, he says, it becomes more expensive to ensure there are no single points of failure in the system. “However, if you move over to cloud-based services, internet connections are redundant by design,” which translates into cost savings.
One of the College’s most robust programs, which has been migrated to the cloud, is the Transfer of Images and Data (TRIAD™) application. TRIAD™ allows users to search, download, share, and view available Digital Imaging and Communications in Medicine (DICOM) image series.4 Frank Shi, ACR senior IT manager/architect, describes the application as a cluster of resources, most of which reside on the cloud. “Over the past two years, TRIAD™ has evolved into a comprehensive platform to support a variety of ACR initiatives,” Shi adds. One such endeavor is the ACR Dose Index Registry®. The registry houses dose information related to CT scans from facilities nationwide. Data collected allows facilities to benchmark their CT dose indices.
The cloud makes complicated applications like TRIAD™ affordable and reliable since it replaces the need to install expensive equipment and hire a staff to maintain it. In addition, cloud computing has proven to be a safe way to cut image reading turnaround time from days to minutes, and it empowers patients to be more involved in their own health care. The ACR is looking at opportunities to work with some of the above projects to employ standards based solutions and converge these solutions on a common platform so that they are easily available and affordable. All of this bodes well for a future in which health-care providers and patients can work in closer cooperation to improve care. //
1. Mell P, Grance T. “The NIST Definition of Cloud Computing.” Available at http://bit.ly/NISTCloudComputingDef. Accessed Oct. 17, 2012.
2. South Georgia Radiology Associates Expands Practice With Cloud-based RamSoft PowerServer PACS Hosted by Radius. Available at http://bit.ly/CloudSGRA. Accessed Oct. 9, 2012.
3. Mendelson D. Image Sharing: Where We’ve Been, Where We’re Going. Available at http://bit.ly/RSNAImageSharing. Accessed Oct. 12, 2012.
4. ACR TRIAD™ website. Available at https://triad.acr.org. Accessed Nov. 5, 2012.
Chris Hobson is a staff writer for the ACR Bulletin.