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What You Need to Know About HIPAA and the Cloud


What You Need to Know About HIPAA and the CloudMedical Cloud

With the medical community looking more and more toward the cloud for hosting and accessing patient records, it’s really important to understand just what is necessary to have a “HIPAA compliant solution.”  This means that we have to sort through all of the jargon that’s out there about HIPAA, HITECH, BAA and the Cloud.  Let’s start with the acronyms first:

HIPAA stands for the Health Insurance Portability and Accountability Act, which sets standards for protecting individually identifiable information in health records.  In the fall of 2013, the HIPAA omnibus final rule, was enacted to strengthen patient privacy protections and provide patients with new rights to their protected health information.  Within this law, Title II specifically refers to electronic information.

HITECH is the Health Information Technology for Economic and Clinical Health Act, enacted in 2009, which stipulates financial incentives for healthcare providers that demonstrate meaningful use of electronic health records.  Because this meaningful use was required in stages, HITECH continues to impact the medical profession, just as HIPAA does. 

BAA revers to a Business Associate Agreement, which is a contract between the “HIPAA covered entity” and a business associate that protects personal health information.  In cloud computing, the cloud provider is considered a Business Associate, and therefore, subject to the requirements of HIPAA and HITECH. 

What’s It All Mean?

Do a Google search of any combination of the terms “Cloud” and “HIPAA” and you’ll find a wealth of companies who offer “HIPAA-compliant” cloud services of one kind or another.  The industry recognizes the need for HIPAA compliance, and you’ll have a choice when you’re looking for a HIPAA-compliant cloud.  But beware – you’re still the one that’s responsible, so you better do your due diligence and make sure that the cloud provider really is HIPAA compliant and that they really do provide the services you need for your medical team and patients. 

HIPAA Compliance is not a designation or recognition provided by any branch of the U.S. government.  Any firm can say that they are HIPAA-compliant.  You will need to understand what HIPAA compliance requires of you, and then make sure that the Cloud provider has the necessary controls and processes in place to ensure that these requirements are met.  There are no formal audit requirements for HIPAA compliance, but some Cloud providers to submit to voluntary third-party audits.  It’s always worthwhile to ask if the Cloud provider you’re considering has an outside audit report.  At the very least, the cloud provider must be willing to sign a BAA. 

The Health and Human Services website provides information about all aspects of HIPAA and is an excellent reference source to help you ensure that both your medical organization and anyone you partner with is HIPAA compliant.  With a Cloud partner, it’s particularly important to ensure that you and the Cloud provider are in compliance with the final HIPAA Omnibus rule, which clarifies that “a data storage company that has access to protected health information (whether digital or hard copy) qualifies as a business associate, even if the entity does not view the information or only does so on a random or infrequent basis.”

 Data Security best practices include encryption, however strictly speaking HIPAA does not require the use of encryption.  Or, in the round-about language of bureaucracy, encryption is not “mandatory” but “addressable.”  While HIPAA declares it to be not mandatory, it is wise to ensure that your data is encrypted.  It will help to protect you if your data is somehow breached.  Lost or breached data that has been properly encrypted will not be considered a breach of unsecured personal health records.  The wise medical facility and the wise Cloud provider will ensure that all personal health information is encrypted, both in storage and in transit. 

Of course, beyond the issues of HIPAA compliance, and security are the features and benefits on the individual cloud providers and the solutions the offer.   Once you’ve established a level playing field by ensuring HIPAA compliance and security, then you can begin to hone in on exactly what you want to be able to do in the cloud.  

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Small Hospital Medical Imaging Strategy


Small Hospital Medical Imaging Strategy

Most rural hospitals suffer from two problems – small size and limited budgets.  Add to these two problems the obvious “off the beaten path” location, and many rural hospitals find it difficult to keep pace with technological advancement.  This often means it’s necessary to transfer patients to specialists at other larger facilities, which means sharing data outside of its network.ruralhealthclinic jeua resized 600

This need to transport often means that patients will undergo expensive, duplicate tests in the larger facility, with needless additional cost and exposure to radiology.   Additionally, the rural hospital loses the revenue by transporting the patient to another facility. The challenge is to find a way to easily transfer patient data, including large diagnostic imaging files, for second opinions and better treatemtn. 

Digital technology aids significantly in the transfer of patient data, it being easer to transfer a CD than it is to transfer paper files and film.   But, while departmental PACS and a hospital-wide RIS are huge improvements over paper and film, small and rural hospitals who take advantage of today’s advances in cloud technology may find that they can optimize workflow and improve patient outcomes to an even greater extent, regardless of their geographic location. 

Because medical imaging is so ubiquitous in clinical practice today, the Radiology Department is one place where attention to technical improvements can return big dividends in patient outcomes as well as in cost savings.  Small, rural hospitals who venture into the cloud with their RIS  may enable big hospital benefits. 

What is a RIS?

Wikipedia defines RIS as “a computerized database used by radiology departments to store, manipulate, and distribute patient radiological data and imagery. The system generally consists of patient tracking and scheduling, result reporting and image tracking capabilities. RIS complements HIS (Hospital Information Systems), and is critical to efficient workflow to radiology practices.”

Add to this the concept of Cloud computing, and the rural hospital can have the benefit of consultations with physicians at major medical centers in larger cities without the need to move the patient and subject them to additional tests. 

These are basic RIS features:

·         Patient management, scheduling and tracking

·         Results reporting and delivery

·         Image tracking and delivery

·         Integration with PACs or WebPACS

·         Billing

·         Radiology Department workflow management

·         Modality management

The strategic goal in RIS is to bring order to the workflows in radiology, to manage medical images in a filmless environment, and to improve the referral base.  Small and rural hospitals who implement RIS for the first time are wise to prioritize the optimization of clinician workflow and productivity in order to be able to handle additional referrals and increase the initial ROI of the investment. 

Cloud RIS

The workflow and accessibility that a Cloud RIS offers enables the small, rural hospital to offer more imaging services, with the advantage of remote reads and diagnosis provided by the experts at the larger city hospitals.  The small hospital benefits by the increased patient base; the patients benefit by being able to have diagnosis and treatment performed locally, rather than traveling to a larger hospital.

The Cloud allows radiologists to store, share and connect more easily than ever before.  Since radiologists work with large images such as CT scans and X-Rays, the ability to store and share images on a cloud-based system can maximize efficiencies.   Newer medical devices often generate complex imagery with very large file sizes.  The Cloud provides a platform that is capable of supporting very large files.

Radiology Services Online is one HIPAA approved Cloud application that enables radiologists, hospitals, clinics, imaging centers and specialists to administer and distribute images and reports.  By providing consulting physicians will have better access to images and reports rural hospitals are able to make a faster diagnosis, potentially providing better patient care.

Some patients may still need to be transferred to a large hospital for care, if the rural hospital is not equipped to handle the diagnosed condition.  But Cloud RIS consultations can cut down on needless patient transfers when the diagnosed condition can be handled locally.  

Tips for Small HospitalsChoosing a Radiology Information System

DICOM – View for Free? Or Diagnose?


DICOM – View for Free?  Or Diagnose? 

Understanding DICOM

DICOM, the acronym for Digital Imaging and Communications in Medicine DICOM is a standard which specifies a nonproprietary data interchange protocol, digital image format, and file structure for biomedical images and image-related information.   The goals of DICOM are “to achieve compatibility and to improve workflow efficiency between imaging systems and other information systems in healthcare environments worldwide.”1describe the image

The DICOM standard is maintained the DICOM Committee, which exists “to create and maintain international standards for communication of bio-medical diagnostic and therapeutic information in disciplines that use digital images and associated data.”2  It is an independent, international standards development organization administered by NEMA’s Medical Imaging and Technology Alliance.  NEMA is the National Electrical Manufacturer’s Association, which is an association of Electrical Equipment and Medical Imaging Manufacturers. 

How Do DICOM Images Differ from Other Files?

Image files that conform to DICOM standards are commonly called DICOM-format images. The basic difference between a DICOM-format image and other image formats, like JPEG, TIFF, and GIF is that the DICOM image contains a ‘header’ with information (such as patient demographics, machine, scan parameters, and a host of other non-image data) in addition to the image data.   This header makes it possible to identify the origin of the image, the patient, the data acquisition parameters of the study and other similar data, even if a single image is analyzed in isolation. The adoption of DICOM standards by medical imaging equipment vendors has helped in effective cross-machine communications and made possible integration of imaging equipment from different manufacturers

While DICOM is the accepted standard for the storage and networking of medical images, unlike other accepted image files (JPEG, TIFF, and GIF) the DICOM format cannot readily be viewed on an average personal computer, tablet or smartphone.  This often means that viewing these images outside the radiology network requires printing of the images on hardcopy films or CDs, or using a specialized DIOM viewer.

Types of DICOM Viewers

There are a number of different DICOM viewers available on the market today…ranging in price from free to costly.  These DICOM viewers, or browsers, as they may be called, can be broadly separated into four different types: 

Free DICOM Viewers

These readily available, downloadable viewers are simple and intuitive.  Their purpose is to enable viewing of DICOM images that are not part of a radiology network.  Most equipment manufacturers offer the option of archiving imaging data on compact discs (CDs) which can be transported, stored, and reviewed easily. Though a proprietary DICOM viewer is written into the CD along with the image data, it is often limited in its functionality. Using a DICOM browser of one's own choice permits the use of a set of tools suited to one's needs, irrespective of the source of the imaging data.

It must be remembered that most freely downloadable software is intended for educational purposes and is not custom built for medical diagnosis or commercial purposes. Most of the freely downloadable viewers are easy to use and intended for use by the non-professional.  Free DICOM viewers are useful for radiology students, and may allow some medical image viewer aimed at no-professional users and radiology students.  These simplified viewers, often used for teaching,  usually convert the DICOM format to some other image format, such as JPEG, GIF, or TIFF prior to creation of the file. These formats are more compact than the original image and are recognized by most non-medical image management software that can be used to create teaching files and albums.

These free viewers usually have the ability to adjust image quality, size, and resolution, much as you can adjust the photos you take and store on your computer.  Often these viewers are simplified versions of commercial software.  But, what if you need professional, diagnostic viewing away from the radiology center?  Then free DICOM viewers will not do!

DICOM Viewers for Professional Use

A DICOM viewer that is intended for professional use must be able to serve up a diagnostic quality image on any PC, tablet or smartphone.  It should provide the ability to access, store and retrieve, transmit, display, and process images that were generated by DICOM-compatible equipment.

Viewers in this category range from simple solutions called mini-PACS or Web-PACS to extremely complex systems that interact with the hospital information system/radiology information system (HIS/RIS), electronic medical record systems, and web servers. In fact, they are far more than just DICOM viewers. 

Essential features of such solutions include the ability for hospitals, clinics, imaging centers and specialists to administer, distribute and view images anywhere, anytime, as long as they have an internet connection.  The images must be true DICOM images, from which a legal diagnosis can be made.  The viewing system must be zero-footprint, meaning that the image is never downloaded.  This protects patient privacy, and speeds the viewing process, since it is available for on-the-fly viewing.  Images must be stored securely and redundantly and available to be sent to any fully functioning PACS system.  Finally, it must be able to interface seamlessly with any workflow or electronic health record system. 


If you’re a non-professional or a student, a free downloadable DICOM viewer will serve you well.

But if you’re a professional, using the right DICOM viewing solution can enable better access to images and reports, allow faster diagnosis, no matter where you are, as long as you have an internet connection, and patients can obtain faster and more effective care.  Footnotes:   1. & 2.  DICOM Committee

How to View DICOM Images in your EMR


Is it Time to Upgrade Your EMR?


Is it Time to Upgrade Your EMR?

When your healthcare practice first switched to Electronic Medical Records (and once everyone had learned the new system), it seemed like your office had taken a technological leap forward.  No more paper files to maintain…faster access to patient files and easier updates; no more Dictaphones and transcription services, because every Doc had his or her own laptop or tablet for updating records on the go.

But now, several years later, and more technologically savvy, you’re beginning to notice a few things that could be better, faster, and easier; or, you’re wishfully thinking that you need some additional bells and whistles to make the system more responsive to your needs.  For instance, maybe you realize that having access to medical images right within your EMR would make diagnosis faster and easier.  Is it time for an upgrade? software resized 600    

Upgrade vs. Update

Don't confuse an upgrade with an update to your EMR.  In general, updates are changes to drug lists, ICD-9 codes, and fixes of minor bugs — updates don't change the day-to-day operation. EMR updates can be compared to the regular updates that you get to your Windows operating system or the Adobe reader on your home computer.  Upgrades, on the other hand, are bigger changes that address features of the product (much like changing from a Windows 7 to a Windows 8 operating system).

Advantages of upgrading

Being eligible for support.  In general, software manufacturers support only the most recent versions of the software.  Even when everything is working just fine, it’s best to upgrade to the current version of the software.  Staying with the old version will often leave you with no support and can also mean that you will be forced into an upgrade under duress rather than as a planned move forward. 

Keeping up with new technology.  Whether you upgrade or not, technology advances.  For instance, mobile technologies like smart phones and Ipads have inspired new features in EMR software that enable healthcare workers to stay updated on patients from anywhere, anytime. 

Evolving with the product.  As any product is put to use, manufacturers get feedback from the field, and that feedback is used to make the product better.  Whether is addressing product deficiencies, adding product features, or meeting government regulations, the EMR will evolve and change over time, and your practice should evolve and change with it.   

Upgrade Disruptions

Upgrades mean a certain amount of change in the status quo.  And change, no matter how beneficial, is always disruptive.  Practice workflow may need to be changed to take advantage of new features or to meet government requirements.  The simple learning process of using a new system will slow things down for a few days or a few weeks.  This is one reason for avoiding being forced into an upgrade under the duress of necessity because of system failure.  Upgrades need to be planned and systematically carried out, just like the initial implementation was.  You can’t avoid the disruption, but you can minimize it. 

Prior Planning Prevents Poor Performance

Working with your software vendor well ahead of the upgrade will ensure that the process goes as smoothly as possible.  This is the time to find out just what’s going to be different in the upgrade, and also a time to voice what additional features you may require.  For instance, many EMR packages still do not incorporate medical image viewing into the software itself, but there are very mature “plug-in” applications that serve very well to make diagnostic images available on a pull-down menu within the EMR software.  Implementing additional feature such as this at the same time as the upgrade can save time and money overall.   

Get your staff involved in the upgrade as well.  They will need a preview of how things will change for them as a result of the upgrade.  How big will the disruption be to the daily practice?  Which staff members will be affected?  Will overtime be required?  But don’t just focus on the negatives -- make sure that the staff understands the benefits that will come from the upgrade.  Motivate the staff who stands to gain the most from the upgrade as your in-house champions for change. 

Other Considerations

Once you’ve assessed the internal impact and have the staff working with you, you will also need to plan for any hardware upgrades that will be required.  Make sure that you know if the system will need to be down during the upgrade, and how long that will be.  Enlist the staff to help with contingency plans. 

Focus on advance training.  Well before the actual upgrade, give your staff an opportunity for some hands-on training on the new system.  Most vendors are more than happy to work with to ensure that this happens.  Remember, it’s in the vendor’s best interest to make sure the upgrade goes smoothly and that the system users are happy with it and understand how to use it. 

Finally, consider a lighter scheduling load during the upgrade.  Everything will probably take a bit longer during the transition time, so having fewer patients to care for during this time will help to keep  your practice running smoothly.  



Radiology Cloud Standards


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. Radiology Cloud

Radiology 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.

Cloud Standards

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.  

White Paper: Leverage the Cloud to Share Radiology Reports

DICOM on the Web


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).

radiology services onlineFor 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.

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Medical Image Storage – How Do You Store Billions of Images?


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. Medical Image

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?

Imaging Today

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? 

Doctors and patientOne 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.

  Learn How Cloud PACS Can Help

Why You Must Add Diagnostic Images to Your HealthVault

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?  Running health

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

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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.

There's An App for That!Manage Your Medical Images

How the Cloud Aids Collaboration in Healthcare


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 collabCollaboration in the Cloud resized 600oration 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.  describe the image

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.

Cloud Technology Revolution in Healthcare

Healthcare Collaboration in the Cloud


describe the imageHealthcare 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
  • See your lab results
  • Renew your prescriptions
  • 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.

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