Cloud Computing for Imaging: Ready for Prime Time
Eric Slimmer, CEOSaint Mary’s Regional Medical Center, Reno, Nevada, first considered a cloud-based platform when its 12–year-old PACS was on its last legs. Facing a significant capital expenditure to replace it with another traditional PACS, the team at Saint Mary’s Regional Medical Center wondered whether it would be possible to achieve similar or better clinical efficiency with a pay-as-you-go solution. Dan Ferguson, MD, CMO, says, “We had been having a lot of technical issues with our PACS and needed expensive service contracts just to keep it running. Quite frankly, we needed another approach.” Eagle Imaging Partners, an 11-radiologist practice based in Oklahoma City, Oklahoma, found itself considering a cloud-based PACS out of necessity. The group was covering 12 facilities across a large geographic area. As Eric Slimmer, CEO, explains, “We’re an on-site teleradiology group, by which I mean that we provide on-site radiologists, but our practice operates like a collective teleradiology practice. We needed a solution that would allow our physicians to go to any of our locations and have the same access to our entire network of images, as well as the same workflow.” New York Radiology Alliance (NYRA), formerly S&D Medical, Bedford Hills, New York, was experiencing a similar issue in a very different environment. The 60-radiologist practice (which serves the greater New York City metropolitan area) wanted to consolidate workflow across the diverse array of facilities that it serves. These range from large hospitals to small subspecialty practices, but the group couldn’t find a solution that fit its specific needs, which could include enabling one radiologist to read for 15 facilities in a day. Jonathan Schwartz, COO of NYRA, recalls, “We had used a bunch of different systems, but they were all limited, one way or another, in the quality of their product. For a while, we were looking at building our own system, but the big vendors never quite understood our workflow requirements.” Hesitations and Solutions Today, all three organizations are managing their radiology workflow using the cloud-based vRad® Enterprise ConnectSM platform from Virtual Radiologic (vRad), Minneapolis, Minnesota, complemented by the company’s cloud-based vRad ResultsSM solution, which provides referring physicians with instant access to reports and images via mobile device or the Internet. Schwartz says that for NYRA, which is an alliance partner of vRad, turning to the cloud was the smartest option. “Radiology has become very competitive,” he observes. “A high level of quality is expected, and turnaround needs to be fast. Everyone needs more throughput to keep up with the increasing financial pressures. Without a solution like this, it’s not practical, it’s not economical—you just can’t do it.” Cloud computing is no longer in its infancy, but health care has traditionally been slow to place its trust in new technological solutions, Ferguson notes. “A cloud-based platform was a new idea for us,” he says. “It was something we had to get comfortable with—something that had to be proven.” For Saint Mary’s Regional Medical Center, that proof came in the customization of the vRad solution that occurred in the months after the system went live, in July 2010. “We had to do some redesign to meet the needs of the inpatient acute-care radiologists,” he recalls. “I think some people hesitate because they think they’re giving up local control. We felt very connected and in control, however—the vendor (vRad) met and exceeded our expectations at every turn.” He adds, “It took some effort for our radiologists to move to voice recognition over a period of several months. We’re very proud of them—they deserve a lot of credit for the success of this implementation.” From the radiology group’s perspective, Slimmer says, “The general hesitation, in my opinion, with cloud-based technology is that physicians will be waiting on images—they’ll be waiting because of network limitations, which has not been our experience.” Schwartz adds that uncertainty from hospitals can also play a role in a practice’s decision making. “There’s always the general reaction of, ‘We don’t want to use this software, it will be a nightmare for our IT department,’” he observes. “That’s where vRad’s technical and operations staff came in; our facilities found it was not intrusive, there was no heavy hardware, and there was minimal programming.” Advantages of the Cloud Ferguson says that the cost savings available using a cloud-based workflow solution were a deciding factor for Saint Mary’s Regional Medical Center. “We have capital constraints, as all health systems do,” he says. “The ability to pay as we go, rather than making a large capital investment, is absolutely preferable to us.” Other opportunities for savings were available as well. With vRad Enterprise Connect, Saint Mary’s Regional Medical Center radiologists have access to voice-recognition software, which has remarkably decreased transcription costs without an upfront capital outlay, Ferguson says. “We have no plans ever to return to a traditional PACS solution,” he says. “We don’t have to worry about growth now. We don’t have to buy any more servers. We’ll never have to worry about paying for upgrades. On many levels, it’s a very cost-effective solution, and it’s more efficient clinically.” Slimmer says that for his group, being able to access a unified workflow was critical, both from an efficiency perspective and in terms of patient care. “It became a risk for our physicians to keep working on different systems: When you’re constantly changing workflow, it’s easier to make a mistake,” he says. “Now, our physicians can sit down and log into the system at any location and have the same workflow they would have anywhere else.” Schwartz concurs. “Now, we have more effective workflow distribution and rules to route the right study to the right physician,” he says. “The increase in the quality of care is really the ultimate outcome of this. We’re able to offer fast turnaround on a high-quality final interpretation.” All three organizations also offer their referring physicians cloud-based access to reports and key images through the vRad Results solution. “In the hospital environment, there’s no question use that feature,” Schwartz says. “The days of clinicians coming down to the radiology department are over. Now, clinicians can just hop onto the system to access the information they need.” At Saint Mary’s Regional Medical Center, Ferguson says, Internet-enabled computer stations have been placed in physicians’ lounges and in operating rooms to take advantage of the easy access to reports and images offered by vRad Results. “Whether they’re in the acute care setting, in their offices, or even at home on call, it’s been highly helpful to them,” he says. For Eagle Imaging Partners, implementing a cloud-based workflow solution enabled the group’s rapid growth; since going live with the vRad Enterprise Connect solution, Slimmer says, the practice has gone from covering 12 facilities to covering 30. “The physical location of the physician is not important anymore,” he notes. “It definitely improves my ability to staff. Our use of locum tenens staff has dropped to zero, even as we’ve added new clients.” He reports that Eagle Imaging Partners managed to continue its operations during a February blizzard that crippled the state of Oklahoma. “It was two full days that most of the interstate highways were closed,” he says. “Had we not had this product in place, we would have been closed as well. It allowed us to provide continuity of care.” Schwartz shares a similarly inspiring story. A struggling New York City hospital, which was still using plain-film imaging and had never implemented a PACS or RIS, came to NYRA seeking cost-effective radiology services. “Even though this hospital has been through some financial difficulty in recent years, it came to see that it needs to have this so it can keep the hospital economical,” he says. “It will be able to cut its payroll costs, see more patients, and spend more time on patient care.” Schwartz concludes, “We can’t imagine doing business any other way. Anybody in the forefront of technology in the field can see that with the complex logistics of today’s radiology environment, the cloud-based approach is going to be necessary in the future.”