How many people nowadays buy physical CDs or DVDs, or even physical books for that matter? We are increasingly reliant – whether we appreciate it or not – on web-based data and services, more and more of them located in ‘the cloud’.
Cloud computing is the practice of using a network of remote services hosted on the internet to manage, store and process your data, rather than relying on a local server or, at a more micro level, the hard drive on your PC or laptop. It means that, for example, rather than having to rely on data being physically stored on your workstation or in your hospital, you can access it anywhere, any time, online.
For healthcare professionals across the board, the potential of cloud – the ‘always on’ ease of access and the opportunity for much simpler, neater data storage – has been readily apparent for some time, albeit with enthusiasm tempered, quite rightly, by concerns about what this new technology means when it comes to patient data security and the permanence of patient record-keeping. There will often, for example, be serious questions to be debated around whether it is still necessary to maintain some form of physical data or record back-up ‘just in case’.
Benefits of cloud computing for hospitals
The potential of cloud computing for picture-archiving and communications systems (PACS) within diagnostic imaging is also rapidly becoming apparent to many hospitals, as Maarten van Leeuwen, a radiologist at Nij Smellinghe Hospital in Drachten in the Netherlands, points out.
"One of the key benefits is that patient records are much more available," he says. "In a conventional system, you can have a patient come to a centre and they have not brought all the data with them and this can cause delays. This is especially the case in larger hospitals, where they are more likely to have a lot of external patients coming to them for a second opinion.
"Most of the time, the patient will be given a CD to bring along and, more often than not, the CD then gets lost. Often I’ll find it lying around in the department. So doing it this way is better for the patient and the quality of care you can provide.
"There is a growing role for storing PACS data and other hospital data in remote locations. In our hospital, for example, we have already used remote storage for a few years together with local data. So all the data stored locally is also backed up in the remote data centre. We use a closed-circuit ‘private cloud’ with our PACS and radiology information system (RIS), specially built to use remote data with data-streaming for PACS and a web-based RIS," he adds.
The hospital is also connected with other hospitals to share cardiology and PET CT data, while all radiologists can access the system from their home workstations.
"We are going to see more and more technology being stored in remote locations because it is getting so much easier and the infrastructure now is so much better," explains van Leeuwen. "Comparison with old patient studies is very important for radiologists. Also, when patient are transferred to other hospitals, it is important to have quick access to all the imaging studies, for example to make good reconstructions from CT data. Most of the time this is not possible when using CDs outside office hours. Having a workstation at home guarantees 24/7 availability for the radiologist to have diagnostic imaging data.
"For patients, it is easier now to travel between hospitals for specific treatments because of the benefits of data being more easily shared," he adds. "The quality of care is higher for the patient because of the direct comparison of old data in other hospitals and, for example, when an operation is planned in another hospital, imaging data is available directly. This is a situation that happens in our region a lot."
"Cloud has been starting to enter into medical imaging for around two to three years; we launched our first cloud service four years ago," agrees Patrick Koch, business director, Vue Cloud Services, healthcare at provider Carestream Health (which supplies Nij Smellinghe Hospital, among others). "The main benefit is simply that, with cloud, users and customers can outsource ownership and responsibility of the system to the vendor. So there is a financial benefit, but it is also always up to date and always available.
"A cloud-based PACS approach allows customers to work differently," continues Koch. "With PACS, a lot of people at the moment have just a mono-site. But as more organisations merge or multiply or collaborate, cloud enables a smoother communication. It makes it easier to collaborate when you have multi-users or stakeholders; it also makes the workflow more transparent, something that is of course becoming increasingly important within healthcare organisations. It can lead to advances in how results are distributed; rather than having to have them on a CD there will be a link embedded in an email."
Possible pitfalls and security concerns
So what, then, about possible pitfalls? Van Leeuwen, for one, suggests network speed could feasibly be an issue, especially considering the size of files being accessed, though he adds that, at his hospital, this is not a significant issue.
Security, of course, has to be the other key concern, though again, in the years the system has been in use at van Leeuwen’s hospital, it has not yet been an issue, with a ‘hack test’ performed every year. Nevertheless, the fact that the application of PACS varies from region to region, and in some cases facility to facility, one of the key barriers that needs to be overcome – or at the very least addressed head-on – is concerns about quality and security.
"It has to be secure, of course," advises van Leeuwen. "You have to look carefully at what kind of open system you have and who can log on to it externally. We, for example, have a closed private cloud system, which is probably a good base to start from to minimise unwanted access. You have to look carefully, too, at the provider and its track record."
"Because security is such an issue with cloud-based systems – and the question that is always asked – in my opinion, it is more of a priority for vendors in this area," argues Koch. "What’s more, in many respects, clinical information is probably more secure in the cloud than in a local system. It’s a bit like the difference between putting your money in a secure bank and thinking it will be secure because it is under your bed.
"The security for one hospital might be quite different to the security for another," he adds. "But we have to make sure we deliver a very strong level of security all the time; we have very secure data centres. We are constantly auditing security and closing any gaps; we are constantly looking to improve."
Key concerns that need to be addressed by a hospital looking to move to a cloud-based PACS include the feasibility of data being able to be accessed by third parties and whether the image quality is going to be impaired through the use of a remote system. The other side of this coin, however, is to consider whether conventional or CD-based systems are in fact any safer, as evidenced by the comment cited above regarding CDs lying around.
"There always will be a trade-off between accessibility and privacy issues," van Leeuwen advises. "Since accessibility of patient data is of growing importance, and there is a tendency to divide patient populations into regional ‘expert centres’, I think this outweighs most of the privacy issues. Of course, there should always be some monitoring or logging of who uses the data.
"For us, image quality is not impaired," he adds. "We use 3MP DICOM-approved monitors in the hospital and at home. Image load speed is, for me, the same at home as in the hospital."
The future of cloud-based PACS
Given the rapid pace of change in this field, what, then, can we expect to see in the future; how will cloud-based PACS evolve from here?
"In the future, I expect data to be more and more accessible," predicts van Leeuwen. "To start with, all patient imaging data should be available in the surrounding hospitals. Patients should have a more transparent choice about the degree of privacy of their patient data when entering a hospital.
"Another interesting development could be that patients could obtain their own patient records and imaging studies, thus becoming a bit more responsible for what happens with their bodies. Experiments on this matter already take place with good results. Also, I expect much of quick access to a second opinion from imaging experts in difficult cases. Of course, there will be security drawbacks now and then but, as in the rest of society (for example in banking or government), this will make the process only better in the end.
"At our hospital, we are increasingly able to send images to get second opinions on issues, and that is really helpful in terms of speeding up diagnosis," he adds. "Patients, too, are getting greater access to their records."
Another interesting development could be ever-greater access through mobile devices, enabling clinicians to access data directly on the ward, predicts van Leeuwen, adding: "We are just at the beginning of this."
