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A popular phrase known as ‘working in the cloud,’ has been tossed around the medical community for quite some time now; however what sort of weight does that phrase carry in the field of Radiology?

Professor of radiology at Washington University in St. Louis, Fred Prior, PhD, explained the concept at an RSNA 2013 session; firstly describing what a cloud is and how it works.

“Think of it both as a set of services delivered over the internet as well as hardware and systems that provide those services which you don’t necessarily own. The services are provided through remote data centers that you will never see. Many of the services are free, but for those that aren’t, you pay for what you will use. For example I can temporarily use 1,000 machines from the Amazon cloud, use them for 10 minutes and give them back. I don’t have to actually buy 1,000 computers,” he said.

To view the Cloud, Prior discussed how the model runs on a software that is supplied on a provider’s infrastructure where “you don’t know anything about it, you don’t manage it, but you simply “lease” it for a reasonable fee.”

Prior notes that he utilizes the software tools in the private cloud so they can support several applications on the same hardware; for private clouds can be shared by a group of organizations. While public clouds can be used by any individuals either free or on a pay-as-you-go system.

During the session, Prior explained why a health institution might apply the Cloud computing technology. First off it significantly lowers IT costs, “You can make better use of a small number of physical resources. If you’re having someone else manage your computing hardware in their data center with their IT staff, it could go a long way in reducing costs,” said Prior.cloud comput

Second, it automates storage management i.e. a physician can make the necessary adjustments to storage as they see fit, rather than paying for fixed storage.

Third, it vastly improves scalability, permitting access to hundreds of servers in mere seconds. And finally are very user-friendly and easy to navigate.

When asked how it serves radiologists and radiology as a whole, Prior noted the following,

“There are cloud versions for services including PACS, RIS, and EHR. Cloud computing evolved from the application service providers in the early 2000s that sold deep storage and enterprise archiving. In the ‘60s and ’70s, a large insurance company might have a huge mainframe and use only a small portion of it and they offered “time sharing,” to help cover the costs. What makes cloud computing different is that now we’re all wired and we’re used to being able to stream information to our devices. As the amount of data that needs storage multiplies, physicians are seeking better and cheaper ways to manage it.”

However, Prior asserts that one has to ask themselves these three questions, when dealing with the challenges encountered through the Cloud technology;

1-     Does your network support cloud-based imaging services? Moving images from a PACS requires extensive bandwidth. “When you sit down at a PACS system and you say ‘display a case,’ you expect something will be on that screen in under two seconds. Even our institution [Washington University] that has very high bandwidth connections, we don’t have enough bandwidth to move data rapidly in and out of our institution. That’s because the network is internally focused rather than designed to move information externally. Know how yours is set up,” stated Prior.

2-     Can you protect patient privacy and security at the HIPPA level on a cloud? If a health institution puts data on a cloud, it must be encrypted and must comply and meet with HIPAA. The cloud provider should be in the same agreement. “If we do violate patient privacy the penalty is up to $25 million per incident… Make sure your risk is shared with your service provider,” said Prior.

3-     Will this save you money? “Some financial advantages include no major capital investment and you can manage obsolescence. If you buy a physical computer, it is quickly obsolete. If you give that problem to someone else, it saves you money. Software licensing may or may not save you money because you still have to license the cloud software and it depends whether it’s a usage-based software or how it’s set up,” said Prior.

“The biggest savings may come in system administration. You still have to have an IT staff, but it can likely be smaller. Financial literature suggests that it may be a cost-effective storage model if you need 10 terabytes of space and use it for up to nine years. That formula however, is not specific to radiology practices,” Prior continued.

“It basically comes down to — it may make sense for a smaller institution, but for a very large institution like ours, it makes more sense to keep it internally. If you trust all of your data to a cloud service provider, and you are legally required to maintain that data for 30 years, what happens if the provider goes out of business? How do you get it back and what are you going to do with it?” he concluded.

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