The Next Frontier: Cloud Storage

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 - Cloud computing
Data are growing in size and scope. Radiology departments and imaging centers face unprecedented bandwidth challenges that stem from the need to store exponentially growing datasets. With bandwidth costs increasing and servers consuming valuable square footage, radiology is on the lookout for a new solution. Cloud storage may fit the bill.

One way to alleviate storage pain points and free up some servers is to shift storage to a cloud storage model where images can be virtually stored and pulled on an “as needed” basis. While only 2 percent of healthcare organizations now use some form of cloud computing, 73 percent say they are moving toward migrating applications to the cloud, according to a February report from Software as a Service (SaaS)-based enterprise management company Mimecast. Storage was adopted by 22 percent of total respondents who had already adopted cloud computing (all respondents including, but not limited to, healthcare organizations). No figures specific to radiology or oncology, however, are yet available.

Cloud storage could lessen multiple IT challenges. Taking archives offsite reduces bandwidth pressures, and it allows IT staff to focus on what’s going on in the hospital instead of in the cloud. Cloud storage offers safety and redundancy as an offsite storage solution. Radiologists and patients benefit from improved access to images. The economic advantages are slightly more subtle. Facilities can re-purpose space to make room for clinical beds. Additionally, because reports are easily retrievable, redundant testing can be diminished.

Early adoption pays

Some facilities are already reaping benefits from cloud storage. In 2001, the 926-bedin Washington, D.C., partnered with InDex (InSite One) to store image archives prior to implementing PACS, says Keith M. Horton, MD, director of informatics, department of radiology. Currently, the facility has a PACS, and the hospital, along with nine hospitals in its , stores and accesses images through a cloud archive service.

Originally, says Horton, the organization began using a per-click program for image retrieval where every image was housed and charged for. After buying the storage hardware, Horton realized that the cost of constant software upgrades took a mighty toll from the capital budget. In addition, the facility was contemplating expanding its server room and needed a mirrored server room as a failsafe. “The server room was taking up a lot of space where patients could be treated,” says Horton.

The switch to a fully-outsourced image archive allowed Washington Hospital Center to conserve existing clinical space and bypass expansive server farms. “We can use the hospital square footage for what it’s supposed to be used for: taking care of patients.”

About 275,000 exams are performed at the hospital center each year and sharing cloud storage access for image archiving across its MEDStar environment has reduced the number of redundant tests performed on patients about 10 percent, says Horton. “You never know where patients are going to show up. For us, we get patients who travel from one hospital to the other,” says Horton. “Those sister hospitals can obtain patient images [in the cloud]. If other hospitals come online and share images in a secure pattern, I think that would make medicine more efficient.”

The switch to outsourcing image archives also yielded an administrative benefit which allowed the facility to avoid hiring an additional FTE or two to maintain its image archive. Currently, Washington Hospital Center has two full-time administrators who are able to focus on the clinically relevant portion of PACS, while offsite technologists attend to the backend needs of managing the cloud storage architecture.

“It gives you some comfort [to not worry about the backend processes] and allows experts in those fields to concentrate on their areas of expertise,” Horton says.

Proof of concept

“Old [image retrieval] standards no longer suffice,” says David L. Siva, director, medical information systems & technology at Daughters of Charity Health System, a regional healthcare system of six hospitals headquartered in Los Altos Hills, Calif. Previously, a 24-hour retrieval time sufficed. “Now anything more than 30 to 60 seconds is considered absolutely unacceptable,” he says.

According to Siva, the clinical expectation for study retrieval has changed while, simultaneously, datasets continue to grow in size and number. “There’s a large spike every year with data growth and there’s a significant change in some areas like pathology where the data sizes are going to be exponentially greater,” says Siva.

Daughters of Charity uses onsite storage with a Centera platform (EMC) for longer term storage of studies five years or older. The health system completes 410,000 imaging studies annually, which generates approximately 21 terabytes of data per year for the six hospitals.

Siva’s facility is undergoing a proof of concept test with EMC and Symantec in a co-development application agreement to determine if cloud storage is the appropriate method to house older images that are rarely used. “We have operational needs for a lot of data to be stored locally because of bandwidth issues,” says Siva. That is, the site needs to compensate for bandwidth limitations by optimizing storage.

The initial cloud storage strategy is to store offsite records that are a certain age or older. The organization is still defining the formula to determine what particular studies to retain and the frequency of retrieval to assess how cloud storage might be useful.

According to Siva, the initial need to validate cloud storage was financial as the organization aimed to mitigate $250,000 in annual storage costs. By outsourcing storage, Siva notes that costs related to hardware, management and support could be decreased to a low-cost, low-retrieval speed subscription fee for long-term archiving of images that the system rarely uses. “The goal is to manage expenses better for expected growth,” says Siva.

A team effort

Prestige Imaging, a Dallas-based diagnostic image provider with eight facilities, recently implemented Fusion RIS/PACS MX (Merge Healthcare) to flip RIS/PACS from a large fixed cost to a variable cost, says Matt Purser, president. Since last November, Prestige has sent 1,000 studies monthly to cloud storage. Switching RIS/PACS from a fixed cost to a variable cost is “key moving forward with continued economic pressures on our industry,” says Purser.

Prestige Imaging outsources IT with cloud storage, and the practice realized a hefty drop in IT workload after the transition to cloud storage. “We monitor on a per hour basis as far as usage of IT individuals and it decreased within 60 days of the implementation of this project and the product itself,” says Purser.

Setting the stage for such gains requires upfront planning. It’s important to understand day-to-day operations and various workflows between disparate groups before implementing a cloud storage system, advises Purser. At Prestige, various groups, including front desk/schedulers, facility managers, radiologists and transcriptionists, were consulted and workflows were reviewed.

“A company can [put greater] focus on creating revenue growth if it’s not worried about the nuts and bolts of its system,” continues Purser. At Prestige Imaging, cloud storage has helped optimize workflow, improve efficiency and trim costs. Each individual improvement helps fuel revenue gains.

Raining benefits

Although cloud storage is fairly new in the healthcare arena, it is packing a powerful punch. Many facilities are turning to cloud storage to save space and reduce costs, and those that have made the transition find that cloud storage delivers on both fronts. It also facilitates better use of clinical resources by enabling rapid image retrieval and maximizing hospital real estate for clinical use rather than storage. Finally, cloud storage streamlines IT management.