Radiology Cloud Standards
Over the past several years, cloud computing has made a positive impact on radiology. By expanding the means of storing, retrieving, archiving and accessing radiologic imagery, the Cloud has enabled better record keeping, faster diagnosis and treatment, easier second opinions, more widely available images throughout departments and facilities.
When chief information officers begin to consider using a radiologic cloud or expanding their existing cloud to include medical imagery, they should be aware of existing and developing standards that may impact their cloud launch. In point of fact, what they really need to consider are two sets of standards: (1) radiology standards; and, (2) cloud standards. More importantly they need to consider how these two sets of standards will be merged into a system that incorporates all requirements while being easy to use, cost effective and readily usable by the facility staff. Let’s look at both sets of standards.
Due to the critical use of medical imagery in diagnosis and treatment, the radiology industry has stringent performance standards that must be part of any care model. Any provider of a cloud used for radiology must be 100% committed to these standards. Diagnostic accuracy is vital, so any medical image accessed via the cloud must be able to be viewed and manipulated with the same degree of ease and visual acuity that a non-cloud system would provide, if not better. Importantly, there must be system-wide accountability to these standards.
Often radiologists and radiology providers are measured by their practice criteria and the standards to which they adhere on a daily basis. Maintaining required standards can elevate the cloud-driven radiology practice to a new level of value for referring physicians, hospitals at large, and the entire health system. Adding the speed and efficiency of the cloud to precise radiologic standards can ensure that radiologists are providing the best service to referring physicians and hospitals and, by extension, best service to patients.
The standards that are applied to the practice of radiology include the following:
- Accurate and consistent final reports, with standardized templates and diagnostic check lists that make it easy for physicians and hospitals to interpret the results.
- Communication of critical findings within 60 minutes of the tests being performed, with consultation as required.
- Provision of complete subspecialty coverage which ensures that all complex and high-risk imaging is read by the appropriate subspecialist
- Diagnostic accuracy requires the maintenance of less than two percent error rate with programs providing peer review of all studies and concurrence review of high risk studies
- Analyze how physicians use the data, with site of care and modality, maintaining greater than ten percent follow-up imaging rate
The Radiology Quality Institute has proposed these standards in order to hold the practice of radiology accountable for the quality of its services.
For cloud standards, we turn to the National Institute of Standards and Technology (NIST), which has been designated by the Federal Chief Information Officer (CIO) to accelerate the federal government’s secure adoption of cloud computing by leading efforts to identify existing standards and guidelines. Because NIST works closely with U.S. industry, standards developers, other government agencies, as well as leaders in the global standards community we believe that it can be looked to for standards that will support secure cloud computing across all applications, including radiology.
The NIST Cloud Computing Standards Roadmap Working Group has reviewed and recommended standards for interoperability, performance, portability, security, and accessibility relevant to cloud computing. By using this readily available information, cloud providers can ensure that their systems adhere to current standards and standardization priorities
The NIST Definition of Cloud Computing, Special Publication 800-145, “is a good starting place for understanding cloud computing, while the document identified as NIST_SP-500-291_Version 2_2013_June18_FINAL focuses on interoperability, performance, portability, security, and accessibility.
Both are informative documents that should be read, understood and adhered to by any cloud services provider.
NIST has also developed a Cloud Computing Reference Architecture and Taxonomy Working Group that provides a set of views and descriptions that are the basis for discussing the characteristics, uses, and standards for cloud computing.
- Cloud computing use cases describe the consumer requirements when using cloud computing service offerings. Through its working groups, the NIST Cloud Computing program has studied a range of U.S. federal government and general-purpose use cases to extract features that are amenable to standardization.
- Other standards have been developed or are now being developed to support specific cloud computing functions and requirements, such as virtualization, infrastructure management, service level agreements (SLAs), audits and cloud- specific data handling.
- Finally, the NIST Cloud Computing Standards Roadmap Working Group has compiled an Inventory of Standards Relevant to Cloud Computing. This inventory is being maintained and updated as necessary.
Any radiology cloud should actively embrace and coordinate both cloud computing standards and radiology standards in order to ensure the highest possible level of performance, security and diagnosis.
DICOM on the Web
What is DICOM?
DICOM (Digital and Communications in Medicine) is a standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. A DICOM image consists of a list of data elements (so-called attributes) which contain a multitude of image related information:
- patient information (name, sex, identification number),
- modality and imaging procedure information (device parameters, calibration, radiation dose, contrast media), and
- image information (resolution, windowing).
For each modality, DICOM precisely defines the data elements that are required, optional (i. e. may be omitted) or required under certain circumstances (i. e. only if contrast media was used). This powerful flexibility is at the same time, however, one crucial weakness of the DICOM standard because practical experience shows that image objects are frequently incomplete. In such objects, required fields are missing or contain incorrect values. These problems can lead to subsequent problems when exchanging data.
DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system (PACS). The different devices come with DICOM conformance statements which clearly state which DICOM classes they support. DICOM has been widely adopted by hospitals as well as in smaller applications like dentists' and doctors' offices.
Viewing and Exchanging DICOM Images
Traditionally, DICOM Images were viewed and exchanged via an in-house network – the PACS. However, the combination of modern internet technology and zero-footprint viewing via the web has simplified and broadened the ability to view and exchange DICOM data. This enables a wider reach for members of the medical field, with benefits to patients via speedy diagnosis and easier second opinions. Gone are the days when small-town and mobile medical facilities remained economically and technologically incapable of handling the exchange of medical images. With the introduction of the new DICOM viewing and exchange technology via the web, rural and mobile medical facilities can easily access high-quality medical imaging.
Sometime called Web PACS, or Web Picture Archiving and Communication Systems, are very easy to use. Since the Web PACS database may be accessed via a familiar browser interface, medical personnel can navigate the system with minimal training and, therefore, with minimal expense. In addition, images are not downloaded, but viewed with a zero-footprint viewer, so are accessible via nearly any mobile device, from anywhere. There is no need for installing costly software on multiple workstations. These features all make the viewing of DICOM images via the web quick, convenient and easy.
One such DICOM viewing and exchange system is Radiology Services Online. In addition to being easy to use, this Web PACS system provides easy security options. Since the system contains multiple encryption tiers, supervisors can assign passwords to personnel that authorize them to access isolated images, groups of images, or the entire digital imaging system, depending on their level of security clearance. The excellent encryption system also enables medical personnel to more easily comply with HIPPA regulations by more effectively limiting access to privileged information.
Not only does Radiology Services Online enhance security with its easy-to-use system, but it also makes data storage much simpler. For instance, unlike old PACS systems with multiple storage silos, usually segregated by departments, Web PACS maintains digital images in the “Cloud” minimizing the need for computer storage space. Any authorized user can view any image he or she is authorized to view, no matter which department “owns” the image. This makes it easier for multiple doctors treating a single patient to confer.
The digital images also back-up to multiple locations so that medical records remain recoverable in case of disaster. Because increased use of medical diagnostic imaging has created a greater demand for digital images, the need for sufficient storage remains at the forefront of Radiology Services Online technology. Once images have been uploaded to Radiology Services Online, users may not only view the images, but they may also manipulate the quality of images to enhance brightness, contrast, or zoom, aiding in patient diagnosis and treatment.
Medical Image Storage – How Do You Store Billions of Images?
While I wasn’t able to find any current, reliable statistics on the total number of medical imaging diagnostic tests performed in the U.S. each year, there is ample proof that for quite some time diagnostic imaging has been increasing, and the numbers of medical images being stored continues to expand.
Here are some statistics from the past decade:
- In 2003, Booz Allen Hamilton reported that the use of diagnostic imaging was projected to grow by 26% by 2008, when almost half a billion procedures would be done each year
- A report by John Iglehart in The New England Journal of Medicine (2009) indicated that, between 2000 and 2007, use of imaging studies grew faster than that of any other medical service in the Medicare population.
- A 2012 study published in The Journal of the American Medical Association by lead author Dr. Smith-Bindman, a radiologist and epidemiologist, looked at data on one million to two million patients a year from 1996 to 2010 in six health maintenance organizations across the United States, only some of whom had imaging. The number of CT scans tripled over the study period, to 149 per 1,000 patients in 2010, while the number of MRI’s quadrupled, to 65 per 1,000 patients in 2010.
- A 2013 Wall Street Journal article quote as many as 600 million imaging studies performed per year.
While there may be speculation concerning the many reasons for these increases, including advancing technology, patient requests for scans, “defensive medicine, and financial incentives, the focus of this article is not on the “why,” but rather on the “how, “ as in: How do we store, account for, and access all of these images?
So, the fact is that if you go to the doctor for any undiagnosed pain or problem it is likely that part of the diagnostic procedure will include some type of medical imaging – X-ray, MRI, CAT scan. Health care providers are generating high-resolution imaging data from tests such as these at an unprecedented rate. One of the reasons is that imaging modalities go a long way toward improving patient care through early, accurate diagnosis. However, the storage of medical imaging files can be a significant and costly challenge, with the need to manage, cool and expand data centers and hire additional IT personnel. Because of this, many health care organizations are turning to the Cloud for medical image storage.
Another reason for turning to the cloud for medical imaging is the Health Information Technology for Economic and Clinical Health (HITECH) Act within the American Recovery and Reinvestment Act. This Act set aside billions of dollars in federal funding for health IT, particularly Electronic Health Records (EHR) technology. This push toward EHR has been driving the availability of more cloud-based health IT options over the past five years.
Increasingly, health-care providers are embracing cloud services, the model of shared computing in which data is stored on remote servers that hospitals can access via desktop, tablet or smartphone. Instead of big capital investments in their own storage, they are paying a relatively modest upfront charge and monthly usage fees for cloud services.
Some statistics show that about cloud-based storage for images is growing rapidly with as many as half of the country's health systems using or planning to use cloud storage for medical imaging.
What Does All of this Mean?
One benefit for patients is the availability of personal health records (PHR) that can be accessed from their own mobile devices. Personal health records (PHR) can contain complete information regarding an individual’s medical history -- such things as vaccination history, laboratory test results, allergies, medications, surgeries, family history and medical images.
In the past, this information was normally kept as paper documents and film records on file at the doctor’s office. If you were traveling or had a medical emergency, the record might be inaccessible. With the advent of PHR services, however, these files are available electronically, for both doctors and patients themselves.
Benefits for healthcare organizations include savings on the capital investments of hardware and software upgrades, as well as helping doctors make diagnoses faster, reducing the need for duplicate images and protecting patients from the extra radiation exposure of having another CT scan because an original can't be found. Cloud-based storage systems also can let doctors call up historical images for comparison quickly and easily.
More Data – Bigger Files
Cloud medical image storage can address the rapidly growing need for a cost-effective way to maintain and access medical image archives. With hundreds of millions of new imaging procedures performed each year, and the legal requirements to keep the images for at least seven years, the availability of cost effective efficient medical image storage is a must! Additionally, as images become more complex, they take up more and more space. All this means that image archives are increasing by as much as 40% annually.
Cloud medical storage services help control medical costs while allowing health-care providers to store, view and share patient medical images expeditiously over a secure network. They can help doctors make diagnoses faster, reduce the need for duplicate images and protect patients from the extra radiation exposure of having another CT scan because an original can't be found. Cloud-based storage systems also can let doctors call up historical images for comparison quickly and easily.
Why You Must Add Diagnostic Images to Your HealthVault PHR
If you’re one of the many health-conscious consumers who is ensuring your ability to access your own health information anytime you need it, then you’ll be interested in knowing an easy way to add and maintain your own diagnostic medical images in your HealthVault PHR.
Why should you maintain your own X-ray images, CT Scans and other diagnostic images?
One key reason is simply the fact that imaging tests are far more frequently used in diagnosing illness today than ever before, and that sheer frequency implies that the images are important enough to be part of your personal healthcare records. As an example of the frequency of diagnostic imaging tests, it is reported that in one large health plan 377,048 patients underwent 4.9 million diagnostic tests from 1997 through 2006, and in the years since 2006, estimates indicate that diagnostic imaging tests continue to grow exponentially.
Because the use of imaging has skyrocketed in the past decade, you will want to maintain a record of all your medical images, both to ensure access to them when they are needed, and to prevent needless exposure to additional radiation through duplicate tests because the required images aren’t available.
Proactive patients make sure their complete medical records, with images, are available at their fingertips when needed.
Another key reason for maintaining your own health care records and medical images is the mitigation of errors. Some surveys show that as many 30% of respondents report that either they or a family member or friend have experienced a medical error and as many as 73% of respondents are concerned about medical errors, while 45% are “very concerned. What better for individuals to watch out for potential errors or mistakes in their medical information than by maintaining their own records and ensuring that all their medical images are available when needed?
Unfortunately, one of the main problems with many personal medical apps is their inability to serve up diagnositic quality images. Most make due with thumbnails, which cannot be used by your doctor for diagnosis. However, one company, Radiology Services Online (RSO), located in Celina, Texas has solved that problem. With their MediCle App for Microsoft HealthVault, they provide savvy consumers with an easy to use, HIPAA compliant service that enables any individual to store, access and share diagnostic-quality medical images, including X-ray, CT Scans, Ultrasounds, Mammograms and other diagnostic medical images as an add-on to their Microsoft HealthVault medical records. The MediCle app is a great reason to sign up for HealthVault.
Sean Nolan a Microsoft Distinguished Engineer had this to say about MediCle: “I am incredibly excited about the work that the team at Radiology Services Online has done with MediCle. “Not only have they delivered a great web-based image viewing experience, but their film-scanning service makes it even easier for individuals and families to create a comprehensive record of their care. We’re thrilled that ROS has made their work a
vailable for HealthVault users and (are pleased) to see real people taking full advantage of it.”
How Does MediCle Work with HealthVault?
RSO stores and hosts all MediCle app images within the same secure professional cloud system that is used and recommended by hospitals, mobile xray providers and physcisians. RSO provides backups and restores information; meets all HIPPA-required compliances; and, guarantees users’ privacy and security via the RSO/MediCle proprietary image-hosting Cloud.
HealthVault users are assured that no bulky images are saved in or running through their HealthVaullt account, their computer or mobile device. Everything is located in a secure remote cloud. The low cost MediCle app provides access to your personal X-rays, MRIs and other diagnostic images from any internet-enabled device, without slowing down your system or using up your storage with large files. These are full PACs diagnostic quality images for you and your physician to use.
Provisions for X-Ray Film
For HealthVault users who have x-ray film, rather than digital x-ray files, Radiology Services Online provides localized x-ray film scanning services through a network of regional scanning centers. This service, too sets this app apart from other medical imaging apps.
How the Cloud Aids Collaboration in Healthcare
The move from paper-based to electronic medical records (EMR) over the past few years has left many health care organizations in a state of flux. While updated systems in some departments have transformed how healthcare workers access and manage patient health data, other departments may still be struggling with paper-based systems. This is particularly true when patients move among various specialists seeking treatment for various illnesses. While each delivers excellent healthcare within his/her respective organization, the day-to-day collaboration with the other physicians who care for the same patient may be lacking.
Making a move to cloud solutions can make it much easier to manage the mix of old and new systems found within and among many different healthcare organizations. This move to the cloud can improve collaboration, help reduce medical errors, lessen the likelihood of duplicate tests and multiple treatments for the same illness; and, ultimately provide better patient outcomes.
The cloud can support a mixed medical environment that incorporates not only the newest applications and devices, but that also continues to make use of legacy systems. Unlike the traditional desktop approach that connects one monitor to one device, cloud technology is ubiquitous, allowing many different devices, many different users to connect to the data from many different locations, even at the same time. Thus, two physicians in different locations can view the same medical image at the same time in order to collaborate on the best treatment for the patient.
The Quickly Changing Face of Medicine
As the use of EMR has increased, so has the number of desk-top computers, laptops and mobile devises that health organizations need to manage and keep safe. If medical records are maintained on one server system, then each medical worker must have a way to physically access that server via a desktop or laptop. Another possibility is that they mas download medical files to their own devices, but then how can privacy regulations be ensured?
Managing these desktops is difficult and expensive, coordinating individual privacy concerns is virtually impossible, and true real-time collaboration is nearly non-existent unless all parties are located in the in close proximity. Most importantly there really is no way to ensure consistency of data and approach in this type of environment. In healthcare, more than any other field, where critical decisions are linked to a person’s well-being, there can be zero tolerance for error. Therefore, a device or application that can l help doctors do their jobs better should be considered.
Today, cloud applications are being looked at by clinicians and physicians themselves as excellent tools to further their reach, improve their service and help them provide better care for their patients. Especially in critical-care environments, such as cardiology, radiology and ER departments, having immediate access to a patient’s healthcare data via cloud application can mean the difference between life and death.
With a medical SaaS/Cloud clinicians can log in with their iPads, tablets or even smart phones and access patient records as well as patient care applications. With “zero-footprint technology,” which simply means that the clinicians access and see the full patient records and images “in the cloud,” rather than downloading any data to their individual device, the data remains private and safe. A file can’t even accidently be left behind, because it was never on the device to begin with…it was just an image of the file, although a very accurate image. In fact, even medical images can be viewed in full diagnostic quality with today’s mobile cloud technologies.
Because the changes are occurring so rapidly, the challenge at the organizational level is to balance the need for patient security, data availability and physician mobility with the budgetary needs of the organization. Often what at first glance appears to be additional expenditures for new equipment and services actually turns out to improve the bottom line with increased efficiencies and lessened errors.
Any healthcare organization that has begun the journey, can tell you that the place to start is with EMR. Scanning and removing paper files can go a long way toward increasing efficiency and improving patient security. EMR in the cloud goes a step further by providing physicians with the data they need when they need it.
Health in the Cloud Going Forward
Cloud based architecture can enable cost effective ways to exchange information, including: DICOM images; “written” records; scheduling; claims billing and insurance data; pps invoicing; reports and requisitions. In short, nearly any data or image required for patient care can be delivered faster and safer via the cloud.
Healthcare Collaboration in the Cloud
The health care environment is changing faster than ever before because of the demand to deliver higher quality medical services for less money. With increased competition between health care services providers, cloud collaboration is one way hospitals, clinics, private health care institutions and doctors can increase daily efficiency, decrease their spending and offer patients better care.
Just this past week, I got a letter from the healthcare organization that I use, in the small town that I live in, inviting me to sign up for their cloud communication. Granted…they didn’t call it “cloud communication” – they have their own unique moniker, but their letter tells me that by signing up I’ll be able to login via the web to:
- Communicate with your doctor
- View your medical records
- Manage your family’s health
- Request of schedule appointments
- Have online medical visits
This is medical cloud convenience that will save me time, and I’m all for it!
The Medical Cloud
Cloud computing technologies, if implemented and used appropriately, can improve services for patients, make it easy to share information, improve operational efficiency, and streamline costs.
Whether an organization is upgrading an existing, on premise PACS or EMR or going digital for the first time, consolidating systems into a vendor neutral Cloud is something to consider in order to improve your collaborative health care. Remember to include your medical images in your Cloud.
By transforming your medical imaging strategy to a cloud-based flexible, scalable, end-to-end solution that meets your EMR and Imaging requirements for performance, security, and ease of management you can enable authorized physicians to access patient records and images no matter where they’re located.
The sharing of medical records via the Cloud is also an efficient way to keep referring physicians in the loop after they’ve sent a patient to another doctor. On a more practice-based level, a doctor’s performance can actually be assessed by the quality of his or her communication with other physicians, and the Cloud can provide a tool for measurement.
The Cloud also has positive risk management implications. From a risk management perspective, the lack of a hand off when physicians are going on and off duty and the failure to document physician-to-physician communication can be a huge problem, which has patient safety implications. The Cloud can facilitate collaboration and teamwork, no matter where members of the team are located.
Benefits of Medical Imaging Solutions in the Cloud
The Cloud provides platform independent access to images, reports, and other documents, thus minimizing the limitations of a legacy based approach to radiology image and information sharing. In addition, medical imaging solutions that reside in the cloud:
- Reduce storage costs and information management burdens
- Allow viewing regardless of the modality that created the images
- Reduce the need to buy new storage systems and run them in house
- Eliminate upfront acquisition expenditures
- Reduce the need for IT staff and disaster recovery infrastructure
True collaboration and more is available when your health care facility looks to the Cloud. Other benefits include:
- Speed. Cloud-based tools can upgrade and improve their features faster, less expensively and with minimal or no service interruption. Plus, cloud services enables faster access to important information for health services providers and their patients.
- Mobility. Each mobile app is backed up by a cloud infrastructure. By storing data and computing power in the cloud, health care services providers enable their staff to have access to information anywhere and anytime.
- Security and privacy. Cloud services providers are required to comply with many privacy standards such as HIPAA (Health Insurance Portability and Accountability Act). In fact, some studies today show that the Cloud actually provides greater security and privacy than paper-based systems.
A medical cloud is a win-win for all parties, providing cost savings and efficiency for the medical practice; and convience and accessibility for the patients.
Best Practices for Cloud PACS
The standard for medical imaging archival in healthcare facilities has been PACS (picture archiving and communication system). Because these systems generally have proprietary storage and software, they are generally not scalable and not flexible. The arbitrary nature of PACS has resulted in isolated data silos, serving single departments. Thus, the cardiology department has no access to orthopedic images and the gastroenterology department images are isolated from general radiology. Because of this isolation, the different “ologies” are unable to communicate efficiently with each other, or with the organization’s EHR (electronic health records) systems.
With advances in Internet security and Cloud storage technologies, healthcare providers no longer need to be isolated by their “ology.” By subscribing to an appropriate medical imaging Cloud, images can be archived, integrated, accessed and shared, thereby enhancing interdepartmental communication, enabling communication with resources outside the medical system, and improving the security and sustainability of their data archives. This is possible while still using internal PACs as desired.
Vendor-neutral medical imaging Cloud technology has the additional benefits of enabling organizations to cost-effectively provide for the massive increase in medical image storage requirements, rapid developments in imaging technologies and the evolution of regulatory requirements regarding patient care. Because a properly established Medical cloud is scalable, constantly updated, and available 24/7 from any location, it can reduce the total cost of ownership for archiving; improve data management; improve healthcare delivery for patients; and give organizations the ability to make decisions based on need rather than vendor requirements.
Going From PACS to Cloud
“Best in Class” - Proprietary PACS image storage systems are outdated and in today’s healthcare climate can be considered a detriment to providing “best in class” healthcare while remaining competitive in an ever more cost-conscious environment. A cloud archive, retrieval and transfer system that is designed specifically for medical images provides a cost-effective way for any healthcare provider to maintain best practices of medical image management. Cloud solutions provide the scalability, flexibility, and ease-of-use that is required to keep up with today’s rapidly changing technological and regulatory landscape.
The cloud provides a better solution to the data storage dilemma by allowing the organization to treat their medical archive storage as infrastructure rather than as proprietary capital investments. A comprehensive, flexible, and scalable cloud medical archive solution (C-MAS) can even be integrated with existing PACS solutions to provide the most comprehensive solution and make use of existing equipment. This approach enables full use and depreciation of existing capital equipment.
Cost Benefits - Organizations with PACS that are reaching the end of their useful life can implement a Cloud Medical Archive Solution at less expense than replacing their PACS. Over time, the reduced expense of using SaaS/Cloud storage may save some facilities as much as 60% over the cost of upgrades, software provisioning, and data management via isolated silos and PACS.
Additionally, using a Cloud archive with sophisticated image management abilities and zero-footprint viewing makes it easier for organizations to integrate with their existing EHR.
Improved Communication - The communication capabilities of a Cloud Medical Archive Solutions extend far beyond the internal organization and the integration of different “ologies.”
Zero footprint cloud solutions can be accessed from anywhere, anytime, on any internet-enabled device. This facilitates communication and interaction between healthcare providers, inside and outside the system, as well as with insurance agencies, and other collaborative entities. Furthermore, Cloud systems are far better able to adapt to and be compatible with emerging technologies.
Cloud systems provide far better security and privacy than does handing off a CD to someone for delivery to another doctor. Yet, this casual approach remains commonplace with facilities that use traditional PACS storage. With an EHR-compliant, centralized C-MAS equipped with advanced file management and transfer capabilities, image files can be shared with other providers easily and securely.
Disaster Protection – With a healthcare organizations images all stored in a Cloud system, the challenges of data backup and redundancy are are dramatically reduced as compared to working with multiple, proprietary storage solutions.
Medical images are critical for delivering patient care, so protecting these images from disaster, loss, damage, or file corruption is crucial. Yet, organizations that utilize multiple stand-alone PACS units with proprietary storage are faced with the daunting task of coordinating separate data backup and redundancy plans for every unit. With cloud solution, the cloud vendor is responsible for data back up and replication in redundant sites to ensure the protection of both the hospital and the patient. Continuous data protection is assured by any responsible Cloud vendor.
By moving to a Zero-footprint Cloud for image storage, retrieval and transfer, healthcare organizations may reduce their costs for image archiving and capital investment in PACS by as much as 60%. Data aggregation, retrieval, exchange, and maintenance are all streamlined, both within the organization and with external entities. Integration with EHR is easier, making patient images available along with records.
Cloud systems offer optimal flexibility and scalability, while making security and privacy management more comprehensive with advanced security technologies that ensure appropriate permissions are enabled.
HIPAA Compliance and the Medical-Imaging Cloud
Today’s medical environment demands efficient and cost-effective workflow with access throughout the healthcare organization in order to make more informed patient care choices. These better-informed choices require electronic medical records, complete with access to each patient’s medical images and test results. A HIPAA Compliant Medical Imaging Cloud, such as Radiology Services Online is web-based technology that brings medical images into any electronic medical records system. This vendor-neutral solution unites healthcare facilities and medical professionals with globally-accessible diagnostic quality medical images.
With no capital equipment to purchase, no software to download and a zero footprint, even small medical centers can benefit from this Medical-Imaging Cloud with a full array of advanced visualization tools for digital images. Because it's in the cloud, or web-based, it's accessible anywhere, anytime as long as the authorized user has an internet connection.
Additionally, Radiology Services Online can help organizations meet HIPAA compliance requirements, particularly the HIPAA Security Rule. The HIPAA Security Rule establishes national standards to protect individuals’ electronic personal health information that is created, received, used, or maintained by a covered entity. The Security Rule requires appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.
What is a HIPAA Compliant Cloud?
Patient privacy is a huge area of concern as Cloud technology evolves into daily use in the healthcare community. Today, the majority of patient information is in digital format, and much of that is being accessed via the Cloud. Cloud access can expose healthcare organizations to certain risks, if they’re not careful. For instance, these hazards may include natural disasters that can cause physical damage to computers that store patient information, corruption by virus attacks, and even stolen data.
The Health Insurance Portability and Accountability Act (“HIPAA”), enacted by Congress in 1996, sets universal standards that healthcare providers must follow in order to properly secure patient information. HIPAA was designed to promote the confidentiality and portability of patient records, as well as to develop standards for consistency in the health care industry. Under HIPAA, organizations adhere to standards related to protecting their systems, and patients can feel confident that their personal medical information will remain private.
HIPAA requirements must be adhered to by any health care provider, health plan or clearinghouse (collectively “Covered Entities”) that electronically maintain or transmit health information pertaining to patients. If you are a Covered Entity, you must establish appropriate measures that address the physical, technical and administrative components of patient data privacy. The Security Rule requires health care providers to put in place certain administrative, physical and technical safeguards for electronic patient data. Among other things, Covered Entities are required to have a Data Backup Plan, a Disaster Recovery Plan, and an Emergency Mode Operation Plan.
Radiology Services Online (RSO) not only provides the ability to merge diagnostic medical images with any EMR system, but it also acts as a Cloud backup, archiving and recovery solution that automates the secure back-up and recovery of medical images. Created with healthcare providers in mind, RSO satisfies the need for a safe, reliable, and cost-effective way to access, share, restore and maintain medical imaging data at any time from any authorized location.
RSO-held data and images are electronically protected, backed up and stored with encrypted files in secure redundant locations, following HIPAA security standards. Furthermore, in the event of a natural disaster or system failure, the data is recoverable, thus, assuring the continuity of patient medical records.
RSO is a SaaS/Cloud solution that supports the display and maneuvering of medical images in full diagnostic resolution on any Internet-enabled PC or mobile digital device. This cloud solution hosts and manages data and images via the web providing primary, secondary and disaster recovery storage solutions that are scalable to any user's needs.
Find out more about HIPAA Compliance in the Cloud by downloading our whitepaper.
What You Should Know About Digitizing X-Ray Film
Did you know that one of the most important considerations for the successful digitization of X-Ray film is image quality? If you plan to purchase an X-Ray film digitizer and digitize the films yourself, then purchase the best X-Ray film scanner you can afford. You will want a digitizer that has clinically proven reliability, image quality, consistency, and overall productivity. The product should be cost effective, lightweight and require little space. Also ask about customer service and support. Vidar, Kodak and Microtek are some of the X-Ray scanner brands that are generally considered to meet the criteria.
If you plan to outsource your X-Ray film digitizing, then find an outsource firm that has the experience of scanning thousands of X-Rays of all types and sizes. They should be able to recognize spots as small as 44mm. They should support most PACS systems and offer direct support of DICOM in order to provide appropriate image compression to avoid bottle necks in imaging.
Disposal of X-Rays
Also, consider the disposal of the X-Rays after they’re digitized. When you send your X-Ray film to a service for scanning, make sure that they can also handle the recycling. The X-Rays should be separated from other accompanying documents, such as paper envelopes. To protect the patient’s privacy, these accompanying documents should be shredded, then recycled.
The process of recycling the X-Rays involves feeding them into a grinder where they are divided into smaller pieces, which renders the film unreadable. No one can put those small pieces back together, to view the X-Ray. The diced X-Ray film is then washed to recover the silver from the X-Ray and to protect the environment. The X-ray film is separated into silver and plastic, and the plastic components are sent to recycling. The silver is further extracted, purified, and finally sent to a silver vendor.
Ethical and Legal Considerations
Physicians have an obligation to retain patient records which may reasonably be of value to a patient. X-Rays are part of a patient’s medical records, so we recommend following the AMA’s Opinion 7.05-Retention of Medical Records, which is stated below:
(1) Medical considerations are the primary basis for deciding how long to retain medical records. For example, operative notes and chemotherapy records should always be part of the patient’s chart. In deciding whether to keep certain parts of the record, an appropriate criterion is whether a physician would want the information if he or she were seeing the patient for the first time.
(2) If a particular record no longer needs to be kept for medical reasons, the physician should check state laws to see if there is a requirement that records be kept for a minimum length of time. Most states will not have such a provision. If they do, it will be part of the statutory code or state licensing board.
(3) In all cases, medical records should be kept for at least as long as the length of time of the statute of limitations for medical malpractice claims. The statute of limitations may be three or more years, depending on the state law. State medical associations and insurance carriers are the best resources for this information.
(4) Whatever the statute of limitations, a physician should measure time from the last professional contact with the patient.
(5) If a patient is a minor, the statute of limitations for medical malpractice claims may not apply until the patient reaches the age of majority.
(6) Immunization records always must be kept.
(7) The records of any patient covered by Medicare or Medicaid must be kept at least five years.
(8) In order to preserve confidentiality when discarding old records, all documents should be destroyed.
(9) Before discarding old records, patients should be given an opportunity to claim the records or have them sent to another physician, if it is feasible to give them the opportunity. (IV, V)Electronic Medical Records
Remember that physicians have a legal obligation to conserve patient records, including X-Rays. Legal requirements for retention of medical records vary by state and depend on the type of records and their potential use, as well as on policies of associations and medical boards.
Healthcare Trends - 2014
Well into the second quarter of 2014, what are we seeing as the major trends in healthcare this year?
Cost containment remains high on the list, along with more consumer-driven medicine; IT developments and medical gadgets don’t lag far behind. We’ve come a long way since EMR seemed state of the art.
Healthcare Cost Containment
From Obama-care to cost-control accountability, the pressure is on to reign in medical spending. Some watchers predict that healthcare spending growth will actually slow in 2014. This may be due in part to lower growth rate projections in the large employer-insured market, which covers about 150 million Americans, as well as to increased use of private insurance exchanges. These private insurance exchanges may help control costs by providing patients with options so that they can choose coverage that best suits them, rather than forcing everyone in to a cookie-cutter insurance policy. We think this makes sense. Although some sources are concerned that insurance exchange could negatively impact non-profit hospitals. It appears that time will tell.
Interestingly, insurance exchanges leads us into the next segment…
The aforementioned health insurance exchanges are on the forefront of consumer driven medicine, by providing consumers with choices tailored to their needs.
Consumer-driven medicine also drives a whole gamut of digital trends including mobile apps and online tools. As healthcare adapts to the way the younger generations communicate, both providers and employers need to consider ways to adapt digital technology. Forbes magazine predicts that future healthcare "will be based on a model of seamless information gathering, collation, analytics and dissemination."
Interestingly, this consumer-driven digital health-care also contributes to cost containment as do some of the other medical IT advances and gadgets…
Medical IT Developments
Looking first at the consumer-centric IT developments and gadgets, we find a whole new realm of mobile heathcare apps for consumer’s smart phones. By one count there are more than 40,000 mobile health apps in the Apple Store alone, along with many additional apps available with MS HealthVault.
In fact there are now so many mobile healthcare apps that several firms have stepped up to help consumers distinguish among the apps. Several firms, including Happtique, HealthTap, Cigna, Partners Healthcare's Center for Connected Health and IMS Health offer critiques and rankings of various m-health apps.
For providers, the Cloud offers better integration of EHR/practice management systems. With the smaller initial investment required by a Cloud system, providers can more readily meet the Meaningful Use requirements for EHR, as well as outsourcing their revenue cycle management.
Following close on the heels of IT Developments comes the burgeoning field of medical gadgets…
Self-monitoring of health is becoming ever more popular – appreciated by consumers for the ease and safety they can provide and by providers for the comprehensive and convenient monitoring. Wearable monitors can be activated by patients to alert emergency health care workers of falls, heart attacks, or other critical conditions. Passive monitors can be used to manage chronic conditions, by alerting physicians or healthcare workers to real-time changes in a patient’s condition by monitoring blood pressure, heart rate and other measurable statistics.
While the medical field has been slow to adopt technologies that don’t directly relate to diagnosis and treatment, the twin pushes for cost containment and more patient involvement in healthcare seem destined to promote more IT development and medical gadgetry to provide lower cost, wider reaching care with 24/7 availability.
Commentary provided by Radiology Services Online, providing specialized zero-footprint solutions providing cloud-based storage, exchange and interpretation of diagnostic quality images.