Radiology being transformed by cloud, proponents say

If digital cloud technology proponents have their way, the field of radiology will be transformed, with major changes in who does the work of reading images, and where and how it's done.

Instead of storing images on local IT infrastructure and sharing images through physical means such as compact discs, cloud radiology allows storage and transmission of images through an off-site network of computer servers. This model makes it easier to back up files and access those files through multiple devices, without the fear of losing the data if an individual device is compromised.

Experts say that will enable hospitals, medical groups and health IT firms to organize radiology practice in different ways that reduce costs and improve quality. It may mean more hospitals outsourcing the reading of images to external networks of radiologists or other specialists. The turnaround time on reading images may be significantly shortened. And shipping costs and maintenance costs for local storage infrastructure could be reduced.

Increased efficiency may mean increased competition, fewer scans and fewer radiology jobs. A growing number of companies are entering this business and offering cloud-based radiology services to hospitals.

“If you went to the major radiology trade shows three years ago, you would hear, 'I'm not sure about this cloud stuff,' ” said Morris Panner, CEO of Phoenix-based startup DICOM Grid. But now, “market penetration is rapidly accelerating.” His firm claims 85 clients, including the Mayo Clinic, for its cloud infrastructure service.

Dr. David Hirschorn, director of radiology informatics at Staten Island (N.Y.) University Hospital and a member of the American College of Radiology's informatics committee, said the cloud may be the best way to create a central repository for images allowing doctors to look at the history of patients' exams, which is critical for enabling doctors to spot significant changes in their conditions. Otherwise, doctors have to query hospitals for past images one-by-one.

Hirschorn said that while cloud technology has been available for at least a decade, pressures such as rules requiring meaningful use of electronic health records have pushed providers to share more images, giving cloud-based radiology a boost.

Dr. Jonas Rydberg, a professor of clinical radiology at the Indiana University School of Medicine, wants to eliminate the compact disc as a mode of sharing images and replace it with cloud-based sharing. Since 2012, Rydberg has been developing a cloud radiology network across Indiana, called IU Health Radiology Cloud. Currently, there are 79 participating hospitals in Indiana, along with a few in Illinois, and he hopes to add 25 more. He envisions a system in which providers can perform full radiological evaluations within a couple of hours versus the days it previously took to retrieve old images from other hospitals.

In the past, Rydberg said, providers often used CDs in transmitting images. But CDs can be lost. In addition, he estimates that up to 5% of the images were unreadable because of corrupted discs, requiring retests. The cloud allows doctors to reach into the original picture archiving and communication system, or PACS, and access the exam, nearly eliminating the problems of lost or corrupted images, he said.

MH Takeaways Storing and sharing images through the cloud may enable providers to speed up the reading of images, reduce staffing and infrastructure costs, do fewer scans, and spare patients from duplicative tests.
A company called Imaging Advantage, based in Santa Monica, Calif., is using cloud technology to create a nationwide network of radiologists and claims 200 hospitals and health systems as clients. It partners with radiology groups. Naseer Hashim, the firm's CEO, said when a client hospital requests a read of a scan, his firm can direct the read through the cloud to the right doctor in its network, for instance a radiologist specializing in neurological scans.

Missing exams and problems in sharing images are common nationwide. A survey of 1,900 medical consumers recently released by the Office of the National Coordinator for Health Information Technology found that 18% of respondents had to hand-carry an X-ray, MRI or previous test to an appointment, and 6% had to redo a test because the previous results weren't available. Using cloud-based systems, doctors are better able to easily access scans instead of requiring another scan.

Rydberg said his cloud-based radiology project also improves quality of care. For example, waiting physicians can look at scans while a trauma patient is en route to the hospital, and the patient can be sent directly to the operating room. Doctors also can view images through the cloud and offer consultations remotely.

In one case he cited, a trauma surgeon averted a helicopter airlift of a patient because he could tell from images he read over the cloud that the patient's condition did not justify the airlift.

One challenge to expanding cloud-based radiology is resistance from some physicians and hospitals who see this as taking away their patients. “I regard this more as a psychological barrier than a rational barrier,” Rydberg said.

Hirschorn agreed that some providers worry that the greater efficiency of cloud-based image sharing means fewer scans and less business. He criticized institutional resistance to sharing images, saying that means more patients undergoing duplicative scans and being exposed to more radiation.

“It's insane, it's outrageous, and it's inexcusable,” he said.

Still, he said that while cloud technology makes it easier to share data among institutions that pool data, hurdles remain in sharing with other institutions.

30-minute turnaround

The advantage for client hospitals, he said, is that if their staff radiologists are busy, Imaging Advantage can direct the read off-site to a radiologist affiliated with another hospital who is free at that particular time. If a hospital wants a scan read by a subspecialist, the company can do that, too. The company's software tracks which radiologists have the appropriate credentials and state licensures.

Hashim said his company's system can help smaller hospitals that don't have board-certified specialists in every area.

By reorganizing the work and making radiologists more efficient, Hashim said, the company averages under 30 minutes for turnaround on reading a scan. And the ability for radiologists to do more reads means that productive doctors can get paid more. One obstacle to growth, he said, is that “people still hold on to this conception that we need to have radiologists physically located in hospitals,” he said.

Dr. Arthur Radow, a Phoenix-area radiologist and past president of the Arizona Radiological Society, said his radiology group joined Imaging Advantage in 2011. Under Imaging Advantage, the group has dropped from 18 doctors to about 12, and the remaining doctors are 60% to 80% more productive and are making more money, he said.

“We can recommend to the hospital exactly what the right test is the first time,” Hashim said. “And that tells us who the right radiologist is.”

Follow Darius Tahir on Twitter:@dariustahir



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