Ahead in the Cloud: Imaging Cloud Applications and Ideas

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The data-intensive nature of radiology has long kept the specialty on the cutting edge of IT. That’s why cloud computing is a relatively old concept among imaging-informatics veterans. While the term might be showing signs of wear, its applications are just getting started. Teleradiology and other forms of telemedicine are generally good uses for the cloud. Others include image sharing within and across enterprises, as well as what James Philbin, PhD, calls visualizing information, which amounts to clinical and diagnostic viewing from the cloud. Philbin is codirector of the Center for Biomedical and Imaging Informatics at the Johns Hopkins University School of Medicine. He says, “Radiologists can read a cardiology study from another hospital in their system that’s 500 miles away or 30 miles away; physicians become independent of the location where the imaging study is actually performed. That’s where you’re going to have the biggest impact—and work can be scheduled for people at different locations across an institution.” To reduce the cloud to mere hardware or software is a disservice, in 2013. William F. Rowell, vice president and CTO, Companion Data Services (CDS), says, “There is so much misinformation out there stating that the cloud is technology, but it is not. Cloud computing is a business decision on how you will consume IT resources. It is multiple delivery mechanisms for IT services.” Within this broad realm are public, private, community, and hybrid cloud versions that are all essentially methods of service delivery. From a radiology perspective, the cloud can provide a central area where images—and image-management and visualization systems—can be securely located. Playing It Safe Why, then, isn’t more health-care information deployed to a cloud? Security concerns are shared by all data-sensitive industries, including energy and finance. While those industries have addressed this concern by deploying the more expensive option of private clouds, too much security limits accessibility in the health-care sector (and increases cost). Rather than inhibit accessibility, Rowell believes that cloud security should make possible the use of images in a more community-oriented manner. He explains the use of a community cloud (versus a private/public cloud) regularly to CDS clients, including CMS, in an effort to lessen the complexities of securing data in a public cloud—and to lower the cost of a private cloud. Today, CMS uses a private cloud and traditional hosting. Rowell points out that switching CMS to a community-cloud concept would be no small change, considering that CMS, the DHHS, the Centers for Disease Control and Prevention, the National Institutes of Health, and other health-care agencies would have to come together to reduce cost and increase flexibility. According to Rowell, CDS is one of three enterprise data centers (CDS, HP, and IBM) for CMS. CDS processes 62% to 65% of Medicare claims for the nation. In the same data center, CDS hosts the CMS National Level Repository (containing information about meaningful-use participants and payments) and the 1-800-MEDICARE National Data Warehouse. “The public cloud is not considered a residence where sensitive data should be placed, due to the increased risk of exposing the data,” Rowell says. “Therefore, the approach is being taken to deploy private clouds,” which are open only to the users who create them, he explains. In Rowell’s experience, private clouds are an expensive option that not all providers and organizations can undertake. This is where a community cloud brings value to users. “The community cloud is like the public cloud in that resources are pooled and shared; thus, it costs less than the private cloud,” he explains. “If it costs less, and more members continue to reduce rates, the adoption level is higher. Likewise, the community cloud provides the security of a private cloud for its members—again, encouraging more consumption.” Private clouds are secured based on the requirements of the consumer and of the cloud service provider. Since there is no sharing of storage, network, and computer resources, the consumer pays a higher price. “Public clouds are just that,” Rowell adds. “They are open to anyone with a credit card, and the security is always an unknown. The prices, however, are normally commodity based. Community clouds are the best of both worlds, but the most difficult to get started. The issue here is finding a community of interest