Clinical image courtesy of TeraRecon.

Christopher Herzog, MD, PhD, can pinpoint the precise moment he "got it" about cloud computing vis a vis advanced visualization for cardiovascular imaging. The Munich-based radiologist was preparing for an advanced visualization workstation face-off when his IT preparation partner suggested they try something a little different. The IT partner would log him into a thin-client workstation and, looking at the same images, guide him through the steps he'd need to perform at the face-off. Nothing unusual there—except that Herzog was at his company's satellite facility in Garmisch, Germany, while the IT partner was somewhere in Portugal.

The preparation went well and, at the actual face-off, Herzog met his PET/CT image analysis challenge (using TeraRecon technology) with more time left on the clock than any other participant.

"After that I realized that, 'I don't need access to my onsite workstation.' With this technology, we may not have to care about firewalls. Maybe this cloud thing is exactly what we need," he recalls.

Since then Herzog has embraced all things cloud, putting him on par with a growing number of progressive physicians using advanced visualization software.

According to the International Institute for Business Information and Growth, the federal government's incentives and mandates for healthcare IT "have made cloud migration inevitable. The cloud will have no less of an impact on healthcare than the internet has had on business and life." Meanwhile, a recent IDC survey predicts cloud computing in healthcare will see a compound annual growth rate of 23 percent through 2014. The forecast is quite optimistic.
 

Cloudy with a chance for cardiology

Cloud computing is many things to many people but, most simply and commonly, it's nothing more than running applications and storing data over the internet or an intranet rather than on an internal hard drive or local server. External providers of cloud services generally charge on a pay-as-you-go basis (qualifying the expense for the operating budget). They're experts in ensuring uptime and customizing servers for particular purposes, so cloud services tend to be faster, more reliable and more cost-effective than the in-house IT infrastructures they're quickly replacing.

Cloud computing turns individual ports into virtual computers and internet infrastructure, allowing it to expand by orders of magnitude on the thin-client concept that, a generation ago, gave rise to mainframes and LANs. Also, the apps and stored data are accessed by a familiar web browser.

"When you show a clinical viewer that runs on, say, Google Chrome, that's pretty compelling evidence" that the cloud is coming to stay for advanced visualization, says James Philbin, PhD, senior director of medical imaging and director of the Center for Biomedical and Imaging Informatics at Johns Hopkins Medical Center in Baltimore.

An outspoken cloud enthusiast, Philbin says the day is at hand when cloud computing will prove unbeatable when it comes to providing cardiology diagnosticians with download speed, image quality and reliable access to limitless image archives—and healthcare administrators with IT solutions that save money without sacrificing quality of care.

"Physicians are rightly concerned with the things that matter to patient care," says Philbin. "They don't care that we have, for example, copies of the data in multiple, dispersed data centers to guarantee reliability. Obviously, some like to know those kinds of things but, fundamentally, physicians just want not to be slowed down by a computer."

Philbin is quick to point out that Hopkins, with its six hospitals and numerous outpatient centers, is large enough to build its own private cloud, redeploying IT staff accordingly to build and maintain it.
 

Expansive access

That's fine with Johns Hopkins cardiologist David E. Bush, MD. As Philbin and team lead the institution into the Cloud Age, Bush is already enjoying the early benefits of remote connectivity. As long as one physician is onsite and logged into the reading workstation, he says, another can share the access from anywhere.  

"Over the years, we've seen a refinement of the technology to the point that there's really no noticeable difference between sitting down at a dedicated [advanced visualization] workstation or accessing the workstation remotely," explains Bush, who uses the Vitrea suite (Vital Images, under aquisition by Toshiba America medical Systems). "And that has been a game-changer, especially as the hospital has expanded and our practice has become more dispersed. Because I'm not tethered to one place waiting for data or images to come in, I can do other things and we can spread the work around among the physicians. It's just more efficient."

Philbin adds that the cloud is a boon for cardiology because of the specialty's need for speed. He says Hopkins' goal is to regularly render 5,000-slice CT studies in less than three seconds—and that saving imaging specialists from the waiting game is just one point where cost advantages enter.

"Of course, a lot of the savings will be [similarly] soft, like when you aggregate studies centrally and realize economies of scale, or make a study readily available to a referring physician." Still, the hard-to-measure cost reductions can add up. Says Philbin, "I would expect the total savings is probably 50 percent over current systems."
 

Safe, secure and scalable

Back in Germany, Herzog concedes that, because full, web-based cloud computing for advanced visualization is still in its nascent stages, it still has a few hurdles to jump. "You have to wait some minutes for uploading, for example. But that has a lot to do with bandwidth," not the cloud design itself, he says.

The cloud's benefits, he adds, easily outweigh its drawbacks. What about data security? Herzog answers that question by pointing out that healthcare-specific cloud vendors are "very, very keen" on encrypting data to comply with privacy regulations and HIPAA standards "because they always had this client-server technology and always had to deal with security concerns."

Philbin notes that using the cloud to fortify cardiovascular advanced visualization applications is a matter of when, not if. After all, people in general "worry more about the security of their bank records than their medical records"—and online banking is now ubiquitous.

Philbin also likes the seamless service the cloud enables the provider to offer. "You elim inate redundant imaging, as when the patient was imaged at an outpatient imaging center and then came downtown for treatment but the record didn't get transferred in time, so they end up re-imaging the patient," he says. And say goodbye to manually transporting CDs.
 

Back to the future

Herzog, something of an IT power user, puts the potential of the coming capabilities into perspective.

"There is a lot of hype going on about virtual medicine, virtual reality, online everything," he says. "At the end of the day, radiology and cardiology [services] have to be done onsite. You have the patient physically in your department, you perform the examination there, you most of the time have to read the cases there. Then, the physician concludes the process by speaking with the patient."

Cloud computing, he believes, will—by dint of its unobtrusive, offsite nature—succeed in subtracting some of the machinery that too often stands between doctor and patient.

Hopkins cardiologist Bush agrees. "This has been driven more by clinician interest" than by cost considerations, he says. "As long as you've got a decent connection, and a secure one, there is no downside to greater connectivity."