Leading Views

PACS Cloud Computing

Q & A with Alan Schweitzer,
CTO Radiology Consulting Group

Cloud computing, is it just the latest tech buzzword du jour? Or is it here to stay? Whatever it is, it continues to be a hot topic at conferences, and some of the computing industry’s biggest players are moving into it, but what exactly is it? And what does it offer the PACS community if anything? To find out, we talked with Alan Schweitzer, Chief Technology Officer for the Radiology Consulting Group, and the Imaging Business Development Group at Massachusetts General Hospital in Boston. He is an expert in PACS and voice recognition strategic planning, networking and radiology information systems.

Q. What is cloud computing as it pertains to PACS?

A. In my mind it is having the IT infrastructure (hardware and software) at a data center that is not physically co-located where the primary users are. It is typically provided by a third party, so the users don’t own the technology, they rent it. 

Alan Schweitzer, MEE

In the PACS world what has enabled cloud computing is the availability of much higher bandwidth and the adoption of image compression technologies.  During the early days of PACS implementation, even if you had some component (typically the “deep” archive) that was housed in a remote data center that you may have shared with other applications and/or rented from a third party, you still needed a significant storage component and dedicated workstations in-house to give you an acceptable response time.  With higher bandwidth, compression technology and thin-client architectures, that is really no longer the case. 

Q. How is cloud computing different from an ASP or application service provider model?

A.  They are similar.  ASP is a term that is 10 or 15 years old. In my mind ASP was more of a financial rather than a technology distinction.  An ASP could provide hardware and software within the user’s facilities or a combination of onsite and offsite components and charge “rent” as an operating expense rather than require a large capital purchase.  Cloud computing generally implies that the hardware and software are housed in a remote data center and are accessed using a web browser.  ASP often translated into something that currently resembles a cloud-computing model, but it didn’t necessarily represent that. 

Q. What are the advantages of using cloud-based PACS?

A. The primary advantages of cloud-based solutions are low start-up costs, the ability to deploy rapidly, minimal investment in infrastructure such as a data center, and the ability to transfer back-office support responsibility such as server support and backups to a vendor.  Most of the cost is translated to operating cost that for many enterprises is more easily justified and absorbed.  For many enterprises, information technology is simply not their core competency and the more of this they can transfer to a vendor the less they will be distracted from doing what they do best.

Q. In an article for Executive Insight, you suggest that cloud computing might be an affordable way for smaller organizations or those with tight budget restrictions to install and implement a PAC system. How much less costly is cloud computing?

A.  One needs to do a total cost of ownership analysis over the anticipated life of the system to answer that question, and the answer is typically "it depends on your environment."  If your organization already has a data center with space to house the PACS servers and a support group that services the server hardware, system software, and has automated routine backups, adding PACS is usually a relatively small incremental cost to this infrastructure.  

If this doesn’t apply to your organization, the startup and personnel costs to provide these can be significant and the likelihood is that you will skimp on these infrastructure investments and not be able to support best information technology practices such as disaster recovery and business continuance planning.  This typifies many of the late adopters who are only now getting around to implementing PACS.

In my role with the Imaging Business Development Group at Massachusetts General Hospital we did a pretty thorough review of several offers of cloud-computing PACS solutions simply because I knew that the climate for capital expenditures was pretty abysmal at the time that we were looking to upgrade our infrastructure.  This is a somewhat unique application and for various reasons that were more related to workflow, we ended up with a hybrid solution that leverages Mass. General’s existing PACS but includes some cloud components. 

Q. For organizations with older PACS Systems that are contemplating upgrading to newer technology, is cloud computing likely to be considered?

I don’t see a lot of that, particularly for the large facilities since most have already made the investments in infrastructure that I mentioned earlier.  There may be components of a PACS system that older facilities are considering such as disaster recovery. The idea of having a longer-term storage and/or disaster recovery component offsite can be attractive since it gives an extra measure of insurance in the event of a natural disaster. 

Cloud computing can offer solutions for data sharing among disparate organizations and I think we will see more adoption of this.  The current standard of practice is to exchange images via CD’s but this has been fraught with complications and doesn’t leverage the electronic transport that PACS is capable of.  There are now vendors who offer cloud-based solutions that enable an organization to upload selected imaging studies to the cloud so that a recipient organization that is authorized to do so can download the studies to their PACS for consultation or prior comparison.

Q. What are the security risks with a cloud-based PACS and are they different than the security risks of conventional storage and retrieval systems?

They are both similar and different.  With cloud-based solutions you are trusting proxies to be vigilant about their security, and don’t have much control over how they do that.  Pragmatically speaking, however, I think that most organizations are more concerned with legal liability than with anything else. Granted that it can be costly and painful to send out letters to thousands of patients to tell them that their data has been compromised, but the primary concern is about litigation.  My opinion is that if you’ve taken every precaution to secure your data and can demonstrate that, that is essentially the best you can do, and if you can transfer some of that liability to a third party that is not necessarily a bad thing.

Q. What other recommendations do you have for PACS administrators contemplating a cloud-based solution for their PACS?

The elephant in the room that isn’t discussed enough during PACS decision-making is what happens if you have to switch vendors. This is equivalent to discussing a pre-nup during an engagement.  The biggest pain in switching vendors is migrating data.  The downside of cloud computing is if you do have to migrate, with a cloud-based PACS you typically have to do it over the Internet, which is significantly slower than over a local area network, so it can take months or even years depending on how many studies you have archived.  That can represent a significant cost and a big impediment to switching vendors. 

An organization considering a cloud-based solution might want to consider selecting their  PACS archive vendor separately.  This would eliminate the data migration requirement in the event of a PACS replacement.  Of course, this applies whether you are talking about a traditional PACS implementation or using cloud-based solution.


by Michael O'Leary