PACS Backed by the Cloud
David FinnWhile cost reduction initially prompts many health-care organizations to investigate cloud computing, there is an even more compelling reason to use it. By making your internal IT resources available for projects needing immediate attention, you enhance your agility, according to “Cloud Computing: Taking It to the Next Level,” presented on February 21 in Orlando, Florida, at HIMSS11, the 2011 annual conference of the Healthcare Information and Management Systems Society. David Finn, CISA, a former health-system CIO who is now health IT officer for Symantec (Mountain View, California), explains that a newly nimble, cloud-backed IT department can then support the organization during acquisitions, service-line expansions, and volume increases. Brian Comp, MBA, PMP, chief technology officer, information services, for Orlando Health in Florida, adds a real-world view of Orlando Health’s expectations for cloud storage. While Finn and Comp both cite major cost savings for cloud users, they point out that increased agility should probably be ranked first among several additional benefits, even though its dollar value is difficult to quantify. Because the IT department can respond to unforeseen needs immediately, without the need to acquire more equipment or hire additional staff, the organization can take advantage of opportunities as they arise, with none of the delay that would be necessary if it had to wait for traditional, on-site IT support to be readied. Cloud Basics Finn says, “The cloud means different things to different people, and not all clouds are alike. Cloud is a term used to describe a very broad range of computing models and technologies, and with all that hype, there’s a certain amount of confusion. The cloud consists of scalable and elastic IT capabilities, provided as a service, using Internet technologies. Typically, these services are metered in a pay-as-you-go model.” Finn adds that within the broader category of cloud services, three separate types are emerging: software, platform, and infrastructure. The first two are less typically applied in health care, but providing infrastructure in the cloud has become more common. He says, “Infrastructure as a service includes storage, servers, databases, archiving, and services of that nature. The specific technologies are less important. What makes it a cloud is the service. The potential for the cloud to transform the IT landscape is less about the technologies and more about the service.” For example, Finn says, the elasticity of cloud services can allow an organization to purchase a chain of imaging centers, knowing that it can obtain immediate storage from the cloud-services provider for the centers’ data output, with no need to purchase additional archiving capacity of its own. Storage can be purchased as needed, from the operating (not capital) budget, with no time required to acquire and deploy on-site storage. This kind of cloud storage is not the off-site deep archiving often used as part of disaster recovery plans in the past, with slow data retrieval unsuitable for immediate diagnostic use. Depending on the institution’s needs, cloud storage should be able to provide clinicians with images as quickly as the organization’s own data center can. Therefore, cloud storage can be used for PACS images and reports generated today, not just as a backup for older studies. Cost Considerations “Locating IT services in the cloud is big business,” Finn says, adding that US cloud computing is expected to be worth about $42 billion per year by 2012. The actual figure might be even higher by then; Finn says, “There was an uptick during the economic downturn because there are savings. By using cloud computing, organizations can tap into cost savings over traditional self-hosting models (with self-maintained infrastructure and software) and can enhance system performance.” Obviously, cloud computing eliminates expenditures for hardware, maintenance, and software, but there are additional savings to be found in the form of reduced operating expenses, Finn says. It’s not necessary to hire staff for routine IT tasks, and the reduction in software licensing fees can be considerable. “A lot of cloud services are sold as a subscription, so the traditional model of paying capital dollars for licenses and then depreciating those is going to change,” he adds. In comparing cloud-based and on-site storage costs, it is also necessary, according to Finn, to examine areas that CIOs don’t usually see. Electricity costs and cooling costs for the data center, for example, are part of the total cost of ownership (and can be considerable), but are often forgotten, along with the cost of space used for hardware. In some institutions, the piecemeal implementation of PACS and other information systems has created rivalry for IT control (as well as unnecessary duplication of services). Radiology, cardiology, and other specialties might have their own IT groups, Finn notes, and this can create problems as they wrangle over “who has responsibility for what. If you move into the cloud, everyone agrees on who is responsible,” he says. Using the cloud can also overcome “insufficient operational focus or lack of skills: You may not have the expertise in-house, or might not want to invest in it,” he adds. Because many organizations are now focusing on the implementation of electronic medical records, computerized provider order entry, and other time-sensitive IT obligations, Finn says, moving to the cloud can let them allocate their resources (especially expertise) in more effective ways. This makes storage and routine operations, which do not make the best use of in-house capabilities, ideal candidates for cloud-based services. “Free up your resources to work on your mission-critical issues and let the routine operations move somewhere else,” he says. Privacy and security issues are commonly cited as concerns in the adoption of cloud computing, but Finn states that reputable cloud providers can prevent problems. Through ISO certification and adherence to other security standards, cloud providers can guarantee that patient privacy is maintained. For example, encryption methods can be employed that allow only preapproved health-care providers (not the cloud company) to unencrypt and read the data being transmitted and stored. Orlando Health Orlando Health is a 1,780-bed, not-for-profit private health network with 14,000 employees, multiple inpatient and outpatient facilities located across Central Florida, and 2,000 affiliated physicians. In this busy network, Comp says, “We were seeing a growing demand on our IT budgets—both capital and operating—and a significant requirement for us to keep up with digital imaging. Every couple of months, we were going back to the CIO and the CFO, asking for more money.” Two self-hosted data centers in Orlando handle more than 200 terabytes of data for Orlando Health; about 25% of the health network’s total data storage is needed for PACS and for a separate cardiology PACS. “Clinicians have significant expectations concerning the availability of the PACS and cardiology PACS; they can never go down,” Comp says. The information services department began trying to find what Comp calls more realistic ways of working with the demands being placed upon it. He says, “Approximately $1 million to $1.5 million per year was being allocated to storage growth in the IT capital budget; this made us look at things differently.” As reimbursement changes, the ongoing capital investment is becoming harder to find, Comp says, and operating costs are increasing at the same time. “The ever-increasing need for power supply to the data center is causing us planning problems. Power and cooling are significant issues for us here in Florida, with costs probably running three to four times what they are in the Midwest. Our floor space is also increasingly in demand; we’re trying to offset that with virtualization, but it’s a challenge,” he says. In storage planning for PACS, Comp says, Orlando Health sought more than just a lower total cost of ownership. It also required the same performance levels that could be provided by its own data centers, with no compromises in data security (and perfect compliance with all privacy regulations and standards). “In our long-range plan for the next five to 10 years, our first step is to move our long-term storage to the data center of the cloud provider,” he says. “We reduce the requirement for capital investment, we should be able to reclaim some electric power, our data-center floor space will be freed, we are hoping that our technical-support needs will be at least somewhat reduced, and we will be able to maintain our failover capability. If we have a loss at a primary data center, we want to be able to continue to provide service to our clinicians.” Even though Orlando Health’s cost analysis excluded savings in electricity/cooling and in staff hours, Comp says, “Currently, we are looking at 25% savings over what we are doing today.” Impressive as that figure is, one of the most important factors in Orlando Health’s decision to use cloud-based storage was one to which it could not assign a price: By storing its data in the cloud, Comp says, the organization makes it much easier for other authorized users to obtain access. This allows the information to be made available to clinicians wherever they happen to be, using any device. Soon, if current trends continue, many of them (at Orlando Health and elsewhere) will be unlikely to settle for less. Kris Kyes is technical editor of