Taking Medical Image Sharing to the Cloud

When the CT images came through to Children’s Hospital of Boston, the attached physician’s note indicated the patient had an epidural hematoma. The diagnosis was accurate, but doctors had grossly underestimated the severity.

“When our radiologists looked at the images, they decided the epidural hematoma was much larger than the referring physicians thought,” said Richard Robertson, MD, Children’s Hospital’s radiologist-in-chief. “Rather than wasting time admitting the patient to the emergency department, we routed the child directly to the operating room.”

Providing the best care hinged on viewing the scans prior to the patient’s arrival, Robertson said, and he credited cloud image sharing with having that ability. It’s that early access to imaging studies that gives doctors a jump start in treating patients with urgent needs.

As a significant shift in practice, online image transfer eliminates the possibility that an image-containing CD will be lost when patients visit a new provider or clinical setting. If a patient forgets the CD or if it is misplaced, you face having to either postpone service or repeat scans - and that’s expensive. According to a 2008 McKinsey Global Institute report on diagnostic services, duplicated studies accounted for $26.5 billion in unnecessary healthcare costs.

But data exchange via the cloud isn’t a new idea. Financial advisory firm Merrill Lynch estimated in 2008 that cloud computing was already a $95 million industry. As a $56.5 million-subset, cloud-based image sharing is also quickly gaining popularity, and business intelligence firm GlobalData anticipates it will grow by an additional 27 percent before 2018. At the November 2011 RSNA meeting in Chicago, several vendors unveiled cloud-based systems as the technology gains ground in the imaging field.

How It Works

In most ways, the cloud is synonymous with the Internet. However, images sent via a cloud image sharing solution can only be viewed within that system rather than being freely and publicly available.

In most cases, cloud image sharing strategies closely resemble your PACS, said Florent Saint-Chair, the general manager for eMix, the cloud image sharing solution for San Diego-based vendor DR Systems. The cloud platform hovers above the PACS like a membrane, allowing you to both receive outside images and send your images to other providers .

“Cloud image sharing is a very cost-effective solution because it doesn’t require monetary investment in a lot of hardware,” Saint-Clair said of the cloud solution that has about 350 hospital customers. “It’s an excellent way to go for groups or hospitals that don’t want to solely own an image sharing solution.”

Sharing images is a one-step process for hospitals or clinics that are part of the same cloud network. For unaffiliated hospitals, it’s almost as easy, Saint-Clair said. After confirming the identities of each provider, cloud image sharing can proceed over a virtual private network (VPN). As part of this connection, the provider receiving the image uses a password sent via email to log into the cloud server and see the studies.

According to Hamid Tabatabaie, CEO of Massachusetts-based vendor lifeIMAGE, cloud image sharing can also free up space in your PACS. Instead of downloading the image into your system, you can read the image within the cloud sharing platform and delete it when you no longer need it.

“Cloud image sharing solutions are really the custodian of images that are shared between providers,” he said. “It’s quickly becoming an accepted way to handle data.”

Cloud Sharing Benefits

Patients, providers, and facilities all benefit from cloud image sharing, Tabatabaie said. Many times, patients don’t always see their diagnostic studies, but loading images to a cloud server gives them easy access.

But Children’s Hospital’s Robertson said providers will likely see a greater number of opportunities from cloud image sharing.

“Working with a cloud image sharing platform allows for a lot more collaboration, and subspecialists can become involved in interpreting exams,” he said. “For example, most pediatric scans are done by radiologists at non-pediatric facilities. Having the ability to bring in experts improves our ability to provide care.”

Additionally, being able to send current and previous studies with patients during transfer can diminish radiation exposure and reduce costs, he said. Cloud sharing is also more efficient than sending images any other way, said Michael Trambert, MD, lead radiologist for PACS reengineering at Cottage Health System and Sansum Clinic in Santa Barbara. Sending images via cloud ensures they arrive quickly, and hooking sender and receiver into the same system means receivers can always read the studies.

According to Tom Hansley, system support manager for diagnostic services at Rex Healthcare in Raleigh, NC, using cloud image sharing has helped the hospital partner with other facilities and practices to improve patient care . Since launching its cloud solution in May 2010, Hansley said 84 percent of Rex’s referring physicians have enrolled in the image exchange, often reducing the time it takes for patients at outlying practices to receive a diagnosis.

“It’s the biggest trend we’ve seen with any new technology,” he said. “Our local healthcare facilities have used it to improve image exchange. They’re notified via email that there’s an image in the cloud, and they’re getting used to viewing them there.”

Challenges to Cloud Sharing

Although cloud sharing makes image transfer faster, often streamlining and improving patient care, the biggest stumbling block to widespread use is still fear and unease about the technology, said Nadim Daher, industry analyst with Frost & Sullivan North American Healthcare Practice.

“No one wants to be the first in their area to dive in and experience a scandal or data breach,” he said. “But we’re seeing that once institutions do get started, their comfort levels increase.”

The first hurdle for many facilities and practices is having the proper high-speed bandwidth needed to quickly transfer images. The Health Information Technology for Economic and Clinical Health (HITECH) Act calls for this level of technology for all healthcare providers - urban and rural - but achieving the goal has been slow-moving in some regions.

“The irony is the rural providers who could most benefit from cloud sharing over high-speed access are the ones that have less capital to play with,” Daher said. “They simply don’t have the funding to get started on it.”

Many providers also express concerns over patient privacy , said Jeff Surges, chief executive officer of Merge Healthcare. Merge is set to launch its cloud image sharing solution, Honeycomb, in the first quarter of 2012. For connections to providers outside the cloud network, some systems increase security by sending a password via email. In addition to requiring a VPN to ensure the image transfer is secure, many cloud solutions password protect the transmission. The receiving physician can only access the study after entering the password provided in an email.

It’s important to find the cloud solution that fits your security needs and will comply with the requirements for health information exchanges, he said.

In addition to the proper technology, practices must have trained staff onsite who can implement and operate the systems responsible for accepting and sending out digital images to the cloud. Depending on the practice, Daher said, this responsibility can fall to either your PACS administrator or separate IT personnel.

Cloud Sharing Impact

Front-line testing for cloud imaging sharing platforms has shown tangible results. After launching eMix, according to Saint-Clair, Virginia Commonwealth University expanded its diagnostic services to six additional facilities - five in Virginia and one in Rochester, N.Y.

Rex has also used cloud image sharing to directly impact its patients’ care remotely, Hansley said. In one instance, the hospital established and loaded images for a patient who forgot the CD when seeing a specialist at the Mayo Clinic. The technology has also impacted healthcare for the local minor league baseball team.

“We have the Cleveland Indians farm team, the Mudcats, here, but the team doctor is in Cleveland,” Hansley said. “Before using cloud sharing, we’d create a CD whenever a player was injured and then wait 24 hours for the doctor to get it. Now, it’s a matter of minutes for the doctor to get the images and make a diagnosis - almost as if he were in the hospital here.”