There are a variety of different benefits of moving medical imaging, patient data, and healthcare data to cloud-based servers for healthcare providers. In this article, we take a look into some of the different benefits and risks of cloud-based imaging for the healthcare system.
The UK government first published the Cloud First policy back in 2013. That evolved into Public Cloud in 2017. There are two different types of cloud service; public and private.
Public cloud is cloud computing that’s delivered via the internet and shared across organisations by large providers that include Microsoft Azure, Amazon AWS, and Google Cloud. Whereas privately managed cloud services are cloud computing that is dedicated to your organisation and generally provided by your PACS vendor. In this case, it is often their own cloud infrastructure within a data secure centre.
The main benefits of moving medical imaging to cloud centres for the health system are around not having ‘on-prem’ (on-premises) hardware to resource and maintain.
Essentially it is outsourcing your IT whilst pooling resources in parallel. It also allows you to move into a ‘Software as a Service’ business model, also known as a SaaS model.
UK national policy advises that healthcare organisations should evaluate cloud solutions first and foremost, before considering any other option. Organisations are free to use other options (no procurement restrictions apply) but need to demonstrate that alternatives offer the right levels of security, flexibility and value for money.
Cloud First has taken time to evolve. To date, PACS and RIS have predominantly been through private cloud services (provided by the PACS vendors). Public cloud technology wasn’t—until very recently—sufficiently developed for the high demands of medical imaging (e.g. a three-second retrieval time KPI for a 1000-image CT scan).
However, the public cloud space has now been evolving rapidly. Several leading PACS solution providers now offer to host their solutions through a public cloud (and are even moving away from their own private cloud).
Another significant benefit of the cloud is the deployment (of software tools) at scale. In other blogs, we describe a range of modern efficiency and report assisting tools (particularly AI, advanced visualisation and remote access tools) that in the current local/silo’ed arrangement require deployment per site.
However, with cloud servers, these tools can be deployed at scale covering multiple/all sites. Similarly, training and outcome monitoring can deploy at scale too.
Providers wishing to engage with UK Integrated Care Systems (ICSs) need to present products that can be integrated into the ICS Cloud environments, or at the very least, be capable of efficiently and effectively interoperating with the services within the cloud environment.
Several UK imaging networks and ICSs have moved or are in the process of moving to a private cloud (with provision to move to the public cloud), or are creating a digital ‘Landing Zone’ within the public cloud through AWS (Amazon Web Services).
This ‘Landing Zone’ is comprised of several layers which are all built around the Six Pillars Architectural Framework. Full details of the Six Pillars Architectural Framework can be found here.
Benefits Of Moving Medical Imaging To A Single System Cloud Approach
Benefits over multiple instances of a third-party-hosted, single-tenancy application include;
1. Lower Costs Through Economies Of Scale
With a single-system-hosted solution, suppliers and partners must build out their individual local data centres into the public cloud to accommodate new customers such as large ICSs.
In a multi-tenant environment (Single System), organisations get access to the same basic software—so scaling has far fewer infrastructure implications.
2. Shared Infrastructure Leads To Lower Costs
ICS cloud imaging platforms allow all partner organisations to share the cloud infrastructure and data costs. ICS organisations don’t need to add individual applications or hardware as they use the ICS digital shared platform.
3. Ongoing Maintenance And Updates
ICS organisations don’t need to pay costly maintenance fees to keep their software up to date. New features and updates are included with any new software releases and are rolled out centrally to all.
4. Reduces Testing Across Multiple Sites
New developments and configurations can be centrally tested once in the ‘pre-production’ cloud environment, which reduces the demand for on-premises testing across multiple sites.
5. Ease Of Scalability
Public Cloud requirements can be auto-scaled easily. They can be scaled up and down quickly based on demand and requirements, as opposed to private cloud scaling which can be slow and rigid.
Medical Imaging Cloud Storage Considerations
It’s odd to think that the biggest initial barriers to PACS were network speeds and storage costs!
Despite an explosion in imaging data—both in volume and complexity—storage for radiology is now a minor consideration.
You could easily have 20 years of radiology imaging data covering a population of 4 million and not even reach 1 petabyte of data in that entire time period.
However, you do need to consider storage when it comes to other ’ologies’ that are advancing quickly.
PACS was traditionally a radiology imaging system that mostly contained radiology images. However, that is going to change along with the digitalisation of other ‘ologies’.
We predict that similarly to how radiology networks have evolved into imaging networks—eventually the acronym ‘PACS’ which stands for ‘picture archiving and communication systems’ will be replaced by a different acronym in relation to a general ‘Imaging System’.
Digital pathology is set to dwarf radiology data in comparison, with cardiology not too far behind. In fact, it’s kind of ironic to see the barriers radiology PACS was navigating 10-15 years ago. The network speed and storage costs as mentioned above, are now key considerations and barriers for digital pathology.
For example, can a group of hospitals afford to spend large sums on storage annually and will their Wide Area Network (probably somewhere between 1Gb and 10Gb) be able to cope with DP images? Lifecycle management in these instances is key.
In radiology, the general protocol is to ‘store everything’, whereas this may not be the case in DP (with images retained on average for just 12 months). It’s apparently cheaper to store the actual pathology slides than the images!
The Risk With Medical Cloud Imaging
As with all systems or technology, there are risks to medical cloud imaging. Medical imaging is a vital service in all hospital systems, nationwide and internationally. When a PACS or radiology system goes down for longer than 30 minutes, you are looking at a critical incident which could result in ambulances being diverted to other sites.
However, considering that most hospitals in a specific region will be connected to the same cloud—the consequences are no longer isolated and could easily be catastrophic across a whole region.
This begs the question—are public cloud providers aware of the critical nature of imaging systems’ uptime and the importance of patient care, health data, and electronic health records for healthcare professionals and their patients?
Is image data storage for a group of hospitals, just a small fish in a big sea for these very large public cloud companies?
Compared to dedicated PACS companies who know the importance of uptime and its consequences. This is why dedicated PACS companies have proactive monitoring and dedicated response SLAs to match the critical nature of these systems and their uses.
As with any cloud provider, a central risk factor is within the connection. A good recent example is the WannaCry ransomware attack. Trusts disconnected outside network access to halt the attack, which helped to protect the cloud.
One approach to mitigating the risk is with local ‘BCPs’ (Business Continuity PACS) at each site. They will generally have reduced functionality, such as 3D, and their capacity in the event of cloud or network access failure is generally set at roughly 33%.
If there is an incident big enough to bring down public cloud access, other systems and services will undoubtedly be affected too, and capacity in the hospitals will be significantly reduced accordingly, such as in the WannaCry cyberattack.
Full risk mitigation would be a full on-site backup, but this isn’t very cost-effective. It potentially doubles the cost and almost negates the requirements and benefits of the cloud in the first place.
The best solution is to get the right balance between fully using the cloud with high risk (but reduced costs and associated benefits) and mitigating risk through hybrid comprehensive solutions.
Another key consideration needs to be the costs of exiting and leaving the public cloud if needs be. You’ll need to enquire about how much it costs to get the data out (or back) if the need ever arose. For example, if circumstances change and confidence in the public cloud disappears due to security breaches, what will the exit strategy be and what is in the contract and small print regarding leaving the public cloud? What happens when cloud become ‘cloud cuckoo land’? (to borrow a very famous PACS expert’s favourite saying!).
Why Are Healthcare Organizations Moving To The Cloud?
Healthcare organisations are generally moving away from on-premises (on-prem) medical data storage as it’s expensive and laborious to source and maintain.
The main issues are the space that’s needed, and the lighting, heating, and cooling costs. Combined with the 24/7 maintenance support required that increases cost too. It’s much easier and more cost-effective for healthcare organisations to outsource storage on cloud servers, and to pay specialist companies the associated costs.
What Are The Advantages Of Adopting Cloud Computing In Hospitals?
- Less on-site space is needed, and therefore lower property and land associated costs.
- Lower lighting, heating and cooling costs.
- No need for 24/7 on-call staff and experts to provide the uptime that is required for hospitals and their intricate systems.
- It is much easier and cheaper in general to outsource and pay the associated costs to specialist cloud servers.
What Are The Benefits Of Cloud Computing In The Healthcare Industry?
Apart from solving various issues and being more cost-effective, with cloud computing several systems and sites can pool or farm their resources all into one provider or centre. This helps to save on cost, due to the collective entity, as opposed to individual and isolated installs. It also better enables more specialist expertise at the larger centre.
Conclusion
We hope this article on the benefits of moving medical imaging to the cloud was helpful! If you have any questions, please feel free to leave a comment or email us.
If you’re a healthcare provider, be sure to check out our bespoke range of services that can help to enhance your efficiency as a healthcare institution.
About The Author
Pauric Greenan is an experienced PACS consultant that has been PACS lead on several high-profile PACS projects in both the UK and Ireland. Pauric is internationally available for PACS consulting. Contact him here for more details.
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