Next-generation Archiving: The Case for the Cloud
James PhilbinArchiving and accessing medical images is an increasingly complex issue, and one that touches a rapidly growing body of caregivers—which is why cloud-based archiving, in spite of lingering disadvantages, will be the model of the future. That is the prediction of James Philbin, PhD, senior director of medical imaging at Johns Hopkins University, Baltimore, Maryland. Philbin presented his perspective on the future of cloud-based archiving in a June 8 session at the Society for Imaging Informatics in Medicine (SIIM) 2012 meeting entitled “Next Generation Archives: Local vs. Enterprise vs. Cloud; VNA vs. ANV.” Philbin notes that “cloud” has become something of an all-purpose term. “Whatever you imagine the cloud is, it seems to be,” he says. For medical image archiving and sharing, however, he narrows down the definition to mean CPU and storage virtualization services provided by a third party from a remote infrastructure. Functionally, he observes, there should be little distinguishing a cloud-based archive from one hosted in an on-site datacenter. “The key differentiator for the long term is who is managing the system,” he notes. With that differentiator, however, come critical questions about data control and security. Weighing the Benefits The promises of the cloud are myriad, Philbin says; among them are a more economically viable, pay-for-what-you-use cost structure and the scalability to add or subtract resources on the fly. Other advantages include high availability and redundancy; anything stored in the cloud is likely backed up to multiple datacenters, offering advantages from the standpoints of disaster recovery and business continuity. He notes that the financial industry already effectively leverages this form of archiving for sensitive data, but adds, “I think it’s going to take us a while to get there.” Why? For one thing, cloud-based archiving presents problems of its own. User-side hardware “edges” to the cloud are necessary to preserve data in the event of a network outage, and users also have concerns about performance when it comes to uploading and visualizing studies, particularly in rural areas where Internet connections are not as robust. The biggest problem, however, is more ephemeral, Philbin says; it centers around CIOs’ loss of physical control over where their data are warehoused. “It’s a real issue,” he says. “We’re really going to have to trust and have strong legal agreements with cloud providers.” As it is almost impossible for a CIO to know what’s happening in a remote datacenter managed by a third party, Philbin calls for good controls, reporting mechanisms, and dashboards for cloud-based archives to assuage in-house IT staff concerns. Security of patient health information is also a critical concern, but here, Philbin feels that cloud-based archiving has an edge. As he points out, cloud providers have a strong incentive to make their datacenters as secure as possible, and can leverage their scale to invest more heavily in security measures. “The business drivers will compel them to be better at security than we could ever hope to be,” he predicts. Enabling Factors Philbin notes that several emerging technologies will help push health care providers toward cloud-based archiving by enhancing its viability as an alternative to traditional datacenters. Zero-client applications are proliferating in the health care IT sphere, allowing, for instance, Web-based diagnostic viewers and workstation-free advanced visualization. These technologies once required dedicated software, but now, with the right Internet connectivity, could be accessed as services provided through the cloud, especially as GPU virtualization becomes more commonplace in the years to come. Increasingly, Philbin notes, health care providers also will use virtual desktops for diagnostic workstations, improving their security while lowering total costs. “This is a generic way to remotely render a legacy thick client,” he observes. Both the virtualized and the zero-client approaches can be used locally, but they also can be used in the cloud. As Philbin notes, today radiologists are often forced to diagnose using incomplete information, because prior studies are often spread over multiple health care providers and impossible to access. The results are redundant studies, extra radiation dose, and increased costs—all factors that have put imaging, and modern health care’s reliance on imaging, in the regulatory and payor crosshairs. With cloud-based storage, however, patients could theoretically build a unified medical record that would include all prior studies, and could grant access to it to health care providers as needed. “We need to create an ecosystem where it’s easy to move images between institutions,” Philbin notes. In addition, he says, extending visualization in the cloud would enable diagnosticians to have anytime/anywhere access to software that once was tied to physical workstations. “You can always get the study to the most appropriate physician,” he says, “and you can transfer studies to centers of excellence” if necessary. Looking Ahead Currently, Philbin says, the average hospital may have 10 megabits of bandwidth in some buildings or areas, but he expects connectivity to increase in the years to come, making cloud computing a more realistic alternative, even for rural and community hospitals. Even at 10 megabits, however, in experiments conducted by Johns Hopkins, images come through at 50 frames per second—a rate almost as good as that offered by a physical workstation. Meanwhile, the aggregate amount of medical imaging data that is stored by health care organizations is increasing by about 30% a year, he observes; organizations also are increasingly decentralized, underscoring the importance of not only storing and securing, but of transmitting medical images. “We have health care systems with increasing numbers of locations because of the aggregation of systems into integrated delivery networks,” he notes. “We also have constrained capital budgets; we’re mostly understaffed; and we have undertrained personnel.” These factors will soon add up to a perfect storm, Philbin concludes, that will make cloud-based archiving the most viable solution for the majority of health care organizations. “With the technologies we’ve talked about, cloud is a possibility almost everywhere,” he says. “If you have 5 or 10 megabits per second of bandwidth, then you can effectively work from the cloud.” Cat Vasko is editor of Health IT Executive Forum.