Cloud computing technology—a market that Merrill Lynch values at $95 billion over the next five years—has recently begun to move into healthcare. However, questions remain about how facilities and departments, including radiology, will fully take advantage of these zero footprint solutions.
In provider settings, cloud computing is currently being utilized to allow practices to flex their resources to the height of their capabilities, according to John Moore, managing partner at Chilmark Research, a healthcare technology industry analyst firm.
“Smaller practices and health information exchanges are often using applications that are based in a cloud computing model, or software-as-a-service [SaaS] model,” says Moore. “Large hospitals and IDNs are increasingly looking to provide a repository for the massive amounts of data that they need to store and access, on an as-needed basis—more of a utility service.”
Moore believes that hospitals will initially adopt cloud computing for data storage and archiving purposes, transferring the costs and maintenance of in-house hardware, such as PACS, to a cloud service. “Therefore, the provider can still access the records or images, but they won’t have to store them on their servers,” he says. “Particularly in the imaging space, there are enormous amounts of data that are produced with the newer scanners. The question will be where to put them as the vat continues to grow.”
In addition to data archiving, cloud computing in its current form involves image sharing between institutions, according to Garry Choy, from the department of cardiothoracic imaging and informatics at Massachusetts General Hospital in Boston. “Numerous vendors are releasing cloud-based solutions to enable on-demand access of imaging data from anywhere, such as teleradiology setups and mobile applications for smartphone access,” he says.
“At Mass General, we are exploring better ways to use cloud-based technologies for image sharing and elimination of hardcopy CD-ROM-based image sharing between institutions,” Choy says.
Moore adds that cloud computing technologies will benefit from the influx of funding from the HITECH Act, because the American Recovery and Reinvestment Act does not specify the required technologies, except that EHR systems need to meet the meaningful use definitions.
“The ambulatory market, which happens in physician offices of five or fewer physicians, will be very challenged to adopt and install an EHR/EMR system, as well as manage the upgrades. They will, as a result, turn to a SaaS model for a given application,” Moore explains. “Just about all the vendors now offer a SaaS solution, and if they don’t today, they will in the near future.”
Health information exchanges (HIEs) are mostly cloud-based technologies, and “there’s a lot of money—about $500 million—to be distributed from the Office of the National Coordinator for Health IT [designated from ARRA] going into the HIE market,” Moore notes. “These funds will assist with applications that will be in the cloud and particularly help HIEs with care coordination, as defined by meaningful use in the HITECH Act.”
“Some emerging applications that would make a big clinical impact definitely include using cloud computing to eliminate the need to transfer images between hospitals via CD-ROM,” Choy says. “Cloud-based image access of a patient’s entire medical imaging record would eliminate the need for repeated unnecessary exams, lower radiation exposure, decrease healthcare costs and simply provide better quality healthcare.”
To date, there are few current models of how cloud technologies allow for the sharing of images, beyond current DICOM standards and HIPAA compliancy.
Clouds on the move
Radiology departments in Montana have already discovered a way to put cloud computing to use—and eliminate the transfer of data in hard copy form. The three facilities—Great Falls Clinic in Great Falls, Kalispell Regional Medical Center in Kalispell and St. Luke Community Healthcare in Ronan—are currently sharing live patient data via eMix (DR Systems), as part of the Image Movement of Montana (IMOM), a grassroots organization comprising 30 Montana healthcare facilities.
In early 2009, the idea was born during a discussion about the difficulty of sharing images among providers at a statewide radiology managers’ seminar. “We were lamenting the limited nature of our technology,” explains Bill O’Leary, PACS administrator at Kalispell