Cloud-based Image-sharing Solution Gives On-demand Access to Images
Andrew RosenzweigStreamlining interaction between imaging departments and referring clinicians not only saves time, lives, and duplicate studies, but can also improve productivity. One of the most powerful new approaches to eliminating the physical and networking barriers to image sharing is the use of cloud computing. At the 2011 annual RSNA meeting in Chicago, Illinois, held November 27–December 2, a leading supplier of CD image-burning technology, DatCard Systems (Irvine, California), introduced a next-generation, cloud-based image-sharing solution, Agilisys Adaptive Image eXchange (AIX). The solution will also be offered in a tight integration with Synapse PACS from FUJIFILM Medical Systems USA (Stamford, Connecticut), providing radiologists with the ability to share images within the PACS user interface. Andrew Rosenzweig, vice president of sales and marketing for DatCard Systems, says, “We’re not your standard storage box.” Rosenzweig says that AIX can bridge differences in disparate PACS environments worldwide because it is designed for easy, secure end-user access. In a world in which teleradiology, remote night coverage, and nontraditional scheduling are the norm, the imaging department is being asked to adapt by providing always-available patient data, no matter how large or expensive those data are to store and transmit. Cloud computing works by leveraging infrastructure as technology, and AIX demonstrates the everyday potential of this concept by tapping into the infrastructure of Savvis® (Town and Country, Missouri), which includes more than 20,000 fully managed private circuits and a tier 1 OC-192 Internet backbone with more than 17,000 miles of fiber. Savvis operates data centers in the North America, Europe, and Asia.
This screenshot of the generic Agilisys viewer features a standard set of tools; the Synapse version includes icons that allow the radiologist to upload an image to the Agilisys cloud or burn it to a CD.
The backbone of the company’s HIPAA-compliant data center supports a distributed hosting solution that securely retains and displays patient images, within the cloud, for up to 90 days. Practitioners at hospitals, imaging centers, and ambulatory clinics within an AIX subscriber health system have fast, easy access to DICOM data in any modality through a zero-download viewer that is also stored within the cloud. “Whether you send a CT, MRI, or nuclear-medicine study, whatever it is, we’ll take it, store it, and enable you to go back and retrieve it,” Rosenzweig says. “You don’t have to load anything. The viewer itself isn’t sitting on your device; it’s sitting in the cloud.” Data Standards Using a cloud-computing solution means that images are no longer restricted to being shared, managed, or audited within the network on which they are stored. Distributed technology allows for workflow-based access designation while retaining patient privacy and data security. “Breaking down barriers between imaging facilities and clinicians means improving the way images are delivered,” Rosenzweig says. “Cloud technology offers a new media conduit for image access.” Providers contribute clinical images and content to be viewed by authorized recipients under a subscription model. The underlying technology for data transmission uses AES 256-bit encryption (with unique keys) and SSL. DatCard Systems believes that its end users should define the term length for clinical data storage. Although the standard is 90 days, DatCard Systems is capable of storing clinical data in perpetuity, at the user’s request. Data-remnant management is of paramount concern, and when a customer states that an image is no longer needed, that image is deleted and no longer exists, beyond the audit trail. DatCard Systems employs the US Department of Defense data-security standard for data-storage management. “We—as a society and as health-care providers—want to make sure that data are accessible, are auditable, or have been truly deleted by design,” Rosenzweig says. “Any time we can simplify the exchange of clinical information, we improve the delivery of care for clinicians and patients.” The Next Digital Step In spurring adoption of AIX, the company will leverage its partnership with Fujifilm, as well as the more than 700 PacsCube clients benefiting from its installed infrastructure. “Fujifilm not only is our top reseller, but it was the first company we went to with the design and approach we had in mind,” Rosenzweig says. Tightly integrating AIX with Fujifilm’s Synapse systems has given technologists, administrators, and radiologists a choice between directly accessing and distributing images (through the cloud) or burning them to CDs/DVDs through the Synapse user interface. “This is technology driven,” Rosenzweig says. “We don’t hold onto film today. We don’t use protractors and markers to make measurements. The cloud is viable: It’s here, it’s advanced, and it’s of very significant value to health care. We believe the adoption of cloud image management will continue to evolve and grow, over time.” Rosenzweig says that next-generation image-sharing technologies such as AIX can help lower health-care costs while improving patient outcomes. The current cost model for AIX subscribers will be package based. Packages encompass primary images, relevant prior studies, diagnostic reports, and associated clinical documents. “We have learned that per-study pricing models both are expensive and ignore the way referring clinicians review data,” Rosenzweig says. “A decade of CD image distribution has taught us this.” Image distribution is an economic and quality-of-care imperative. Access to images, however, will require release of information and HIPAA compliance for true adoption. “The age-old story is how you access the content,” he continues. “We’re talking about global access for any recipient.” Matt Skoufalos is a contributing writer for