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Facilities Use Cloud Computing to Share Radiology Images

 |  By HealthLeaders Media Staff  
   December 15, 2009

It started with a simple goal: to send radiology images to healthcare facilities throughout Montana in a manner that was cheaper and more efficient than using FedEx to mail CDs overnight. About 30 healthcare organizations in Montana joined the grassroots organization called the Image Movement of Montana.

The group needed a solution that would work not only for more tech savvy facilities with picture archiving and communications systems, but also for folks who don't have PACS and would need to access images on a PC, says Gayle Knudson, radiology manager at Great Falls Clinic and IMOM co-founder.

After looking at several different vendors' product demonstrations, the group chose to implement eMix, a new cloud-based technology to securely share radiology images and reports, from DR Systems. With eMix, providers can send full-res images to other hospitals, referring physicians, or even patients "using the Internet and a standard SSL connection with secure encryption," says Bill O'Leary, regional outreach and PACS administrator at Kalispell Regional Medical Center and IMOM co-founder.

I've read a lot recently how other industries are using cloud-computing technology to improve business processes. But this is one of the few healthcare examples that I've heard about. Here's a strategic look at how IMOM is using the eMix technology and why they determined cloud-computing was the solution for them.

How it works
Organizations pull up the image on their PACS that needs to be sent to a patient or another facility and send it with the eMix client that sits on their desktop. The image goes to an offsite eMix server in San Diego where it is temporarily stored until the receiving physician or radiologist accesses it. That provider, who is sent an e-mail notification, can choose to simply view the image on his or her desktop, burn it to a CD, or push it out to the facility's own PACS.

IMOM is currently beta testing the system at three diverse locations in Montana—Kalispell Regional Medical Center, a regional healthcare delivery system that uses a PACS from DR systems; Great Falls Clinic, a multi-specialty practice that uses a PACS from McKesson; and St. Luke Community Healthcare in Ronan, a critical access hospital that uses a PACS from Amicas Inc.

The challenge with some of the other proposed solutions was that they required the organizations to put in a server, a router, and VPN connections between several facilities. "They were all capital out of pocket upfront," says O'Leary. The eMix solution works because anybody can use it and there is no upfront cost. "The cost is when you download data," he says, explaining that the size of the data determines what your charge will be. Organizations can pay per image or they can set up an account to pay a set rate for say 40 gigabytes of transfer data per month.

The cost of sending 200 megabytes of data one time is less than $2 versus the $10 to $12 it costs to send an image on CD with FedEx, says O'Leary. He expects the technology will save his organization roughly 50% of its FedEx rate. Kalispell Regional, which is in a resort area, probably has one of the higher use rates of CDs than other facilities, he acknowledges.

Questions and concerns
But what about security and the capability of the technology to meet the needs of such a diverse set of providers? The concerns that many providers have about cloud computing is the security of patient information. eMix has security measures in place at its data center, such as limiting the number of people who can access data, biometric scans to confirm people's identity, and network level security between end users and the data in database and content servers.

No data is stored on Web servers and all of the data is encrypted when in motion. Providers and patients trying to access the data have to go to a secure Web browser, log into the system, and then they can download the exam. eMix can track and audit everything that happens to the exam until it is downloaded, from there it depends on each individual provider's security protocols and guidelines.

The other question many providers have is how long the image stays on the server. IMOM is still in the process of determining the length of time an image will stay active on the eMix server before it is purged, but one thing is certain—this is not intended to be a repository, says Knudson. "We are not in the PACS business," she says. "We can't go to rural Montana to a 10-bed hospital and say it will cost this much to play the game."

Meeting the needs of such a diverse group can be a challenge, but so far eMix has resolved any issues that have arisen, says Knudson. For instance, at first the group thought providers would need Internet Explorer IX 8, but the system can be used on Internet Explorer 6 or 7.

"That is important when talking about rural America," says Knudson. Currently, IMOM, which plans to fully implement the system in the first quarter of 2010, is trying to figure out how to send images to more than one computer within a facility.

This model seems like a no brainer for rural regions like Montana. Even though some providers may have to deal with a slow DSL connection, the technology is still faster than FedEx, says O'Leary. It also provides a full-res image, which is what radiologists and physicians want. Kalispell Regional has already been using a Web-based product to share images with physicians, but those are compressed images.

"They can view the images, but can't send them to their PACS or compare to full res images," he says.

O'Leary says this type of exchange offers benefits to metro areas, as well as, rural. "Everyone has problems sending data," he says. "There is no downside to it. You don't have any overhead costs or costs for setting up the applications. You don't have software and hardware; it is using standard Internet connections. And you can save money and get images to other facilities immediately."


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