Head-to-head on the cloud

August 14, 2012 in Medical Technology

Cloud-based healthcare IT offers various advantages over conventional information and archiving systems. Until today, though, many healthcare providers are not really aware of this approach. Some even equate healthcare IT clouds with cloud services offered by Google or Amazon. HealthTech Wire has brought together Finn Kristian Mathiesen, a practicing radiologist and the Chief Medical Information Officer at the public regional hospital group “Sygehus Lillebaelt” in Southern Denmark, Peder Jest, Chief Medical Officer at Odense University Hospital, Denmark, and Ulf Andersson, Marketing Director for Carestream Health in Europe to share their views on cloud- based radiology.

Mr. Andersson, could you briefly summarize the advantages of cloud- based healthcare IT solutions like Carestream’s Vue portfolio over actually buying an RIS or a PACS?

Ulf Andersson: For radiologists, working with a cloud-based solution means being able to access images, use tools, and create reports wherever they want. They are not restricted to a particular workstation anymore. Cloud-based solutions also make it easier to implement collaborative care scenarios because they offer customizable worklists. On the financial side, cloud services are an easier way for the hospital administration to deal with funders, especially in public healthcare systems: They have annual running costs instead of having to ask for new IT investment budgets every couple of years. And for the CIO, clouds are attractive, too, because using a cloud means outsourcing part of the IT business, freeing up more time to concentrate on other issues.

Finn Kristian Matthiesen: Getting access to patient information independently from particular workstations does indeed help to organise radiology in the daily routine. At Sygehus Lillebaelt, we have five hospitals and more than 300,000 radiological examinations per year. We use a server-based PACS solution with streaming technology. Our radiologist can, for example, use an laptop to create reports and use tools like 3D reconstruction. This saves a great deal of time and streamlines processes considerably.

Peder Jest: From a hospital point of view, I very much agree that collaboration scenarios are becoming ever more important. A delegation from Odense University Hospital recently visited the Eppendorf University Hospital in Hamburg because we are very interested in international collaboration. Cloud-based healthcare IT solutions could certainly facilitate this kind of cross-border projects. But the providers have to make sure that the legal and ethical standards in the different countries are dealt with properly.

Finn Kristian Mathiesen: We simply cannot store documents in a Google cloud, for example. Recently there was a case in Denmark where an institution decided to use Google Office. This was ruled illegal. The minimum requirement is that providers must guarantee that medical data stored in a cloud does not leave the European Union.

In conversations about cloud-based services in healthcare, the Google or Amazon clouds are always mentioned very quickly. Is there any reason to worry that patient data will suddenly appear on a Google server in California?

Ulf Andersson: Absolutely not, and we have to be careful with the word “cloud” for exactly this reason. The question is helpful because it illustrates clearly the difference to the traditional IT world. But concerns of this type can also create unnecessary anxieties. When we at Carestream talk about our Vue portfolio, we refer to private clouds that Carestream runs exclusively for its customers. In Scotland, for example, we are running a PACS system for all public hospitals in the country at two data centers. This has nothing to do with the big public clouds of the internet world.

Cloud-based healthcare IT solutions turn investment costs into running costs. Is that an attractive concept from a hospital point of view?
Finn Kristian Mathiesen: I think it depends both on the size of a hospital and on its ownership structure. I tend to think that for big public hospitals like ours, it might be cheaper to run a system on our own. But the political process to get money for investments is indeed a problem. With a license-based pay-per-use system, we could get around this.

Peder Jest: I also think that this can be helpful, especially in times like these with limited investment budgets all over the place. If the healthcare IT providers succeed in presenting convincing business models, then the concept will take off. But there is some more work to be done in this field. At the moment, many hospital executives still know nothing about cloud computing. And if they do, they are often not convinced that it is financially viable.

Finn Kristian Mathiesen: We need a working business model, of course. What is often underestimated is the fact that centralized, streaming-based IT solutions help to better tailor the imaging hardware to what is actually needed. In our centralized “private cloud” network, we use streaming technology to access image data from our servers that are located at Vejle Hospital. One of the many positive consequences of this is that we no longer need as many expensive high-resolution monitors as we did before, though we still need them for chest X rays or mammographies, of course. But CT scans can also be streamed to lower resolution monitors, tablets or even smartphones.

A question to the provider: What do you consider the optimal size of a hospital to draw benefit from cloud-based radiology solutions?

Ulf Andersson:
I think cloud-based services can be attractive for hospitals of any size. If I were a CIO in a big hospital, I could imagine it would be attractive for me to pick a vendor and buy the big information systems like PACS or RIS as a service. With these big systems up and running, I – as a CIO – can concentrate on other issues. On the other end of the spectrum, I do not see a compelling reason why small private clinics with four or five doctors should actually buy a PACS instead of using it as a service. In the first place, purchasing a PACS is expensive. Furthermore, somebody has to become an IT guru to maintain the system and so on. Outsourcing this stuff saves a lot of energy.

Peder Jest: I have another point. In Denmark, and I think in many other countries, even small institutions have to be accredited for quality-control schemes. At the moment, there are surveyors who visit the institution every two or three years to do the quality control on site. With cloud-based systems, this time-consuming process could easily be centralized and even made transparent to patients.

Thanks very much to all of you for this informative discussion. (HTW)


This article originally appeared at HealthTech Wire.

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