Head in the Clouds

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As a vendor at the RSNA, it’s always important to be perceived as being on the leading edge of technology. As the exhibitions get planned, the sales and marketing folks push to trot out the newest, the latest and the greatest. The product development teams somehow always seem to forget that the RSNA happens unfailingly at the same time each year. Despite RSNA being the centerpiece for many organizations’ strategic planning cycles, the bigger you are, the harder it is to coordinate all the timing, delivery, and messaging… and more important the ability to make it work (repeatedly) on command! As vendors’ Thanksgiving travel plans are made, dreams emerge for the mythical PowerPoint to software converter, and fog begins to get sculpted. Buyers also dream for a realistic portrayal of what’s available and what is the next solution to the myriad clinical and business challenges brought in by the endless forces of change. The “Cloud” seems to offer a perfect opportunity to balance all these forces. With the seemingly limitless potential of Cloud-based offerings and the indelible mark the term has already made in consumers consciousness. It’s a perfect way to grab attention. Does the Cloud really represent a revolution in computing? The convergence of remote hosting models, web architectures, and server virtualization has made Cloud technologies viable. Our money is already in the Cloud, and now, much of our music. Much of our holiday shopping will be even done via the Cloud. The potential for consistent performance, elasticity of resource availability and reliability is clear. Bandwidth and web content delivery are now such that real, meaningful functionality can be delivered securely over the wire, even for imaging. The economics are promising, and the security concerns, although not insignificant, seem manageable. The Cloud has already started a domino effect of change within the consumer technology econo-sphere. It certainly qualifies as a revolution. It’s also very easy to demonstrate… and, gasp, fake. Slap a little Cloud on the back end of every product, throw a server in the sky and put a nice little icon in the center of every PowerPoint slide, and off you go! Sifting through what is real and fake is a daunting task, even from the perspective of an insider. The notion of outsourcing IT infrastructure to a data center is certainly not new to our industry, nor is the idea to obtain software technologies as a per use service. We’ve called them Application Service Provider (ASPs), or Software as a Service (Saas). Why then is the Cloud different, and so important to our beloved industry? This is the age of consumerism. In health care, patients are demanding to take a more active role in their health care process. As our economy struggles, the growing cost of health care is a centerpiece to our political process. Increasingly quality of service, transparency, and access will become differentiators for providers who seek to attract health care consumers. The Cloud seems to be a perfect solution for this… download an app, log in, and presto; you have access to your health care data. Well almost, but I’d suggest that between the various image sharing platforms demonstrated at McCormick Place and efforts of the RSNA and National Institute of Biomedical Imaging and Bioengineering (NIBIB) we’re off to a good start. Optimistically speaking, wherever our health care reform process is leading, better care and more cost efficiency can be expected. Care gets better with better communications across care settings. The trend towards accountable care organizations and the associated alignment of care settings ranging from acute to point of care will continue to demand alignment of the software and tools to facilitate this communication. The consolidation of all of this data is a real stepping-stone into converting this data into meaningful evidence. Imaging is no longer constrained to the department, or even, radiology controlled settings, and the value this data has for the medical record is uncontested. The Cloud is an ideal place for this data to come together, or at least spend a little time on it’s way somewhere else. Our economy is also in transformation. Many of us stepped over the news of a $10B potential IPO for Facebook sitting in front of our hotel room door on the way to the meeting. This online migration of our economy has affected the media, the way we buy things, well, almost everything. The evidence that this change is affecting the imaging world was squarely evident this year at RSNA, and much of it, well, was in the Cloud. When you’re building a top-secret aircraft, you don’t have to always produce the aircraft: Sprinkling the airplane parts across the desert and telling the world one crashed is sometimes enough. The parts of whatever our industry is building were sprinkled all across the show floor. The challenges that health care is facing and the demands for better care will demand a different approach. The mixture of new, more quantitative imaging procedures, legacy systems, information domains, and diverse care settings is stretching and changing the definitions of and boundaries between the traditional imaging IT systems we have become so comfortable with. The Cloud is helping to solve the challenge of aggregating and adapting the past information infrastructure, while enabling a new future. Given the number of Cloud-based offerings and new RSNA vendors for 2011, the Cloud is disrupting our industry, by forcing established vendors to keep up and enabling new vendors with novel approaches to quickly emerge and actually drive this change. The Cloud however hasn’t changed the basic need for a physician to care for the patient. Just like being a Facebook friend is a far cry from being a real friend, a Cloud-based physician just doesn’t cut it. As our industry adapts around the forces of change demanded by economy, technology, regulation, and the human condition, the Cloud will become an enabler to the physician in order to improve the human touch of medicine. Robert Cooke is an imaging informatics expert and 25-year veteran of the medical imaging industry. He can be reached at bob.cooke@gmail.com.