As an early adopter of cloud-based electronic medical data-sharing, Virginia Commonwealth University Medical Center (VCU) in Richmond, Va., has some valuable information, based on its experience, to share with current and potential users of this data-sharing approach. VCU’s use of cloud-based file exchanges began in mid-2010, making it one of the pioneers with this new technology.

VCU now exchanges data in the cloud with six different facilities, five in Virginia and one in Rochester, N.Y. The exchanges mostly concern trauma or other patients being transferred from community hospitals to VCU, a leading academic medical center. The center's physicians have seen a clear benefit in the cloud’s ability to put vital patient files in their hands well before the patients arrive.

Cloud delivery of the files allows them to be reviewed, and an action plan developed by the time the patient arrives. That was more difficult to achieve when files were burned to CD and sent by courier or with the patient. Furthermore, dealing with lost CDs and files that wouldn't open correctly has been illuminated or significantly reduced.

The medical center has also found new applications for cloud-based file-sharing. VCU contracts with a company that searches for and retrieves external images and medical records on patients. When the company locates a patient file relevant to VCU, they transfer the file to VCU quickly and easily via the cloud.

In addition, VCU anticipates that there may be additional benefits in the area of organ and tissue transplants. More specifically, the potential capability to send images of organs to transplant physicians may improve the ability to identify the best specimens.

But while the cloud technology and approach appears to have performed very well, the changes it makes to workflow and other routines have required the need to re-engineer some processes and educate those involved in the care of patients.

As a Level I Trauma and referral center, imaging files sent via the cloud generally flow from other institutions to VCU. Referring facilities are having to adapt from a workflow centered on burning and sending CDs to one that requires simply uploading to a cloud server. While this approach is much more efficient, it is still a change that the hospitals have to integrate. It requires a different allocation of resources and can require different personnel.

As with many cloud-based services, there's no new software or hardware to purchase with the service VCU uses. Further, the skills required to use the web-based interface build upon most end-users’ existing computer skills. So while some small adjustments to workflow are required, VCU has had a positive experience so far as an early adopter.

A recent Association for the Advancement of Medical Instrumentation (AAMI) survey asked clinical engineers and biomedical engineering technicians to name the top challenges at their hospitals. As a measure of its multiple impacts on the way medical facilities currently operate, eMix – and in general, cloud-based sharing of medical information – addressed three of the challenges ranked in the top ten.

The top-ranked issue was interfacing between devices and information systems. This is hardly surprising, considering the vast array of IT devices and systems needed to run a state-of-the-art medical facility. With so many manufacturers selling proprietary technology, it takes a monumental effort just to get one hospital's IT components talking to each other. Then there's the added challenge of moving data between hospitals.

A lot of interfacing can be avoided just by using a system like eMix to leapfrog over the proprietary hurdles. As a vendor-neutral solution, eMix eliminates the need for costly interfaces in many circumstances. And now with its EMRconnect^TM option, eMix has moved beyond medical imaging and into the realm of HL7. Any document that can be sent via HL7 – imaging reports, lab reports, and so on – can be moved around via eMix without the capital expense of an HL7 interface.

The second-ranked challenge on the AAMI survey was “maintaining computerized IT systems.” eMix can significantly reduce a facility's IT maintenance budget or free up IT staff for other duties if the facility uses virtual private networks (VPNs). Many hospitals deploy VPNs as a workaround solution when they need to execute regular file transfers to other hospitals with IT systems that don't talk to theirs.

Earlier this year, we interviewed Amy Radonich, Assistant Director, Imaging Services at UC San Diego Medical Center (UCSD) about the problems with VPNs. She estimated that IT staff at her facility spent one to two days per month, per VPN, to maintain the hospitals six or seven VPNs. That's up to 14 working days per month by a $90,000/year employee, just for this one task. All of that can be avoided by using eMix, which UCSD now does.

Yes, the driving reason that UCSD flew to the cloud was clinical, because the hospital is a Level 1 trauma center that receives patients from throughout its region. eMix has made it possible to get transfer patients' files quickly to UCSD doctors so diagnosis and treatment planning can begin even before the patient arrives. But the time and labor savings from avoided maintenance haven't hurt.

The third item on the AAMI list that eMix addresses is “managing the radiation dose from CT.” eMix can't reduce the radiation from any single scan but it can certainly play a role in minimizing redundant scans, as we've emphasized many times, including here. To read an article about the survey in CMIO, click here.

Advances in medical informatics and cloud computing were headliners at  the recent Society for Imaging Informatics in Medicine (SIIM) annual meeting.

The opening talk covered the “top ten trends” in imaging informatics. Four of the trends were directly relevant to a cloud-based service for sharing medical images and reports. Speaker Katherine Andriole, Ph.D., director of imaging informatics at Brigham and Women’s Hospital in Boston, discussed ways that informatics could provide needed reforms for radiology.

As Andriole noted, the trends of cloud computing and image-sharing are related. With services like eMix, images and other medical information are increasingly being shared via the cloud.

This approach overcomes the longstanding problem of how to trade images between facilities whose IT systems don’t talk to each other. It improves upon such older workaround solutions as burning the files to CDs or sending them on virtual private networks (VPNs).

Another trend Andriole discussed was optimizing workflow. Using eMix is about as easy as emailing a cool Web link to your friend. It replaces the time- and labor-intensive process of burning files to CDs and sending them via courier or express mail, or uploading them to VPNs.

With VPNs, an IT staffer generally has to babysit the uploading process and will usually spend a significant portion of his/her work time just maintaining and troubleshooting the networks.

Finally, Andriole showed how cloud-based sharing of medical files is addressing public concerns about radiation overdoses. The general press has reported on overdose problems at hospitals around the country throughout the last year, including the overuse of high-dosage modalities like CT scans.

Sharing files by burning them to CDs is a significant reason for redundant CT scans and other redundant imaging. That’s because the files are sometimes lost in transit, don’t open if they do arrive, or arrive too late to be useful in emergency cases.

Transfers using the cloud take just a few minutes and open dependably. As Andriole also said, this kind of technology promises to keep repeat imaging to a minimum and thereby minimize the radiation overdoses. Reducing the risk of radiation overdose while optimizing trauma care, for example, is one reason UC San Diego is now using eMix.

Thank you, Katherine Andriole, for informing the SIIM audience about the multiple benefits of cloud-based file-sharing.

Cloud computing is known for its speed and convenience. Now it’s becoming known for another advantage: the color green.

Like email and electronically generated and stored documents, cloud-computing services save on hard-copy materials and fossil fuels used in mail and shipping.

When files are sent via eMix, they’re not being burned to CD or printed out and faxed. Added up one transmission at a time, this process reduces the materials that would have been used for the hard copy versions. It also saves the energy and other materials that are expended in the manufacture of hard copy media and paper. Looking even farther down the food chain, it reduces the fuel and materials needed to extract the raw commodities from which CD’s and paper are made.

Radiology files burned to CD are usually sent by express mail or courier. Transmitting files and reports that way requires a considerable expenditure of fossil fuel per file request. It’s true that fossil fuels are also involved in producing electricity to run the computers and networks that power eMix. But the energy used per file transfer is inconsequential.

This green advantage may well continue to grow – if, that is, more of our electric energy comes from renewable sources. Countries such as Germany (where eMix already has a presence through partner company DFC Systems) have already progressed well down that path.

Consider, too, the energy consumed when a patient is re-imaged because the burned CD with her radiology files was lost in transit or the files didn't open when the CD arrived. eMix also reduces that redundant imaging.

Green business is good business because being greener can reduce energy and material costs. There's also a marketing advantage to reducing an institution's environmental impact.

By their very nature, hospitals use vast amounts of materials and energy to provide state-of-the-art patient care. Anything they can do to “green” their operation can be turned into a selling point for their facility, to attract more patients who value the facility’s environmental commitment.