Cloud Emerges from Ether
While last year there was not much there there, to paraphrase Gertrude Stein, this year’s RSNA saw a number of medical imaging applications actually living in the cloud: image sharing, worklist, a specialty PACS, disaster recovery, and even a novel application to track individual physician RVUs. Image Sharing: Hamid Tabatabaie, president and CEO of Life Image, reports that LifeImage has exchanged 1,328,000 exams for 21,000 users in 48 countries, effectively killing 1,200,000 CDs. His claim is that every hospital in Boston and New York is using the service. Two things appear to be propelling adoption: Payors and provider profit potential. “We’ve had more payors stop by,” Tabatabaie reported from the show floor. “They know when they look at their actuarial that they are paying for duplicative imaging retrospectively. The way to stop that is to make sure the ordering doc has the image history. Because providers have become payors, they are acting as a catalyst for payor adoption.” Where a business model for image sharing formerly was lacking, possibilities are beginning to emerge, including the potential for radiologists to generate referrals through the company’s clinical social network, LifeImage Connections, introduced at RSNA 2012. Users are authenticated when the service hits their ELDAP server, or active directory, and only need to be authenticated on the first use. If you have been authenticated elsewhere, for instance, you can access the network as an unverified user with enough access to develop a one-time or persistent relationship for image exchange. Worklist: RadNet’s eRad PACS has located a global worklist application in the cloud that is proving to be a big hit with the company’s teleradiology clients, reports James Tollack, director of engineering. Since being acquired by RadNet, the nation’s largest imaging center company, eRad has focused on meeting the needs of the high-volume customer by rearranging its database tables to improve worklist responsiveness and database query returns. "We are heavily vitualized," he acknowledges, adding that there are about 50 customers in eRad's hosted cloud. PACS: The cloud is where Infinitt put its PACS solution for the 32 football clubs in the NFL, which just granted the vendor a 10-year contract. The company will also image-enable the ambulatory EMR used by the team providers, including orthopedic practices at some of the nation’s premiere institutions like Stanford and the Cleveland Clinic. Physicians can read using a mobile, zero-footprint viewer or access the images from the full medical record, says Deborah Reed. Disaster Recovery: While big-telecomm company AT&T wants to help health care store, share, and communicate health care data and images in the cloud, it has identified the path of least resistance as disaster recovery, says Barbara White. “We want to provide the vendor-neutral archive in the cloud, but what they are willing to pay for now is disaster recovery,” she says. “One of the things our customers tell us they find attractive is we own the network and the cloud is in our network.” The provider addresses latency through storage tiering strategies, sophisticated rules-based information lifecycle management, and redundant databases. Productivity: Lucid, the technology managed services organization owned by leading-edge private radiology practice Riverside Radiology Associates, Columbus, Ohio, has added a cloud-based RVU counting tool called RVU4U, to supplement its multi-site worklist solution. Simple to use (create an account, download and install the application), the application enables a positive approach to improved productivity by providing daily physician feedback. Practices can create a dashboard with names anonymized or not, to reveal stress points and opportunities for rebalancing work. “It can help a practice create a strategic direction for where they want to go over time,” explains RRA CIO Ron Hosenfeld. Has the little boy removed his finger from the hole in the dike? Will we see a groundswell of movement to the cloud in 2013? These questions bring to mind yet another Gertrude Stein witticism: “For a very long time everybody refuses and then almost without a pause almost everybody accepts.” —Gertrude Stein