Cross-border radiology is becoming reality

In a private cloud scenario like the one established at “Sygehus Lillebaelt”, the hospital group takes advantage of cloud-based services but still remains in charge of the server infrastructure. Outsourcing the server infrastructure is the next step. It can further reduce workload for the hospital’s IT department, and it makes it easier to realize larger-scale collaboration scenarios and even cross-border collaboration. For Peder Jest, Chief Medical Officer at Odense University Hospital, Denmark, this trend can hardly be ignored these days: “A few years from now, we will have mostly big hospitals, and they will have to think globally. We recently visited the Eppendorf University Hospital in Hamburg, Germany, because we would really like to cooperate on certain issues internationally. Cloud computing could be helpful in this context. But providers will have to describe very precisely how the workflows look and how high privacy and security can be maintained.”

Privacy and data protection are two issues that are often mentioned by healthcare providers when it comes to the question why – despite obvious advantages – cloud-based solutions have not been implemented in a particular setting. “When we talk about cross-border scenarios, ensuring that the countries’ different ethical and legal demands are met is a big topic. If healthcare IT providers are able to tackle this issue, cloud-based computing could really be worth using in international cooperation scenarios”, says Peder Jest. Long-term accessibility of data is also an issue that many healthcare providers are still worried about when it comes to thinking about cloud-based solutions. Mathiesen: “We have to store patient data for a decade and some even longer, and this means we need some kind of guarantee that the data remains accessible, for example in case of bankruptcy. Even big providers can go bankrupt, and this fact needs to be addressed somehow.”

Google-ization of healthcare IT: more myth than reality

A pervasive concern is that healthcare providers might lose control over patient documents once cloud-based solutions are established that involve servers owned by commercial companies rather than the respective institutions. “We are simply not allowed to use, for example, a Google cloud to store patient documents, and I at least would not want to either”, says Mathiesen. Both Mathiesen and Jest are aware that using cloud technology in healthcare IT does not necessarily mean subscribing to Google, Amazon, Apple or the like. Healthcare IT companies like Carestream are running their own “private” clouds that have nothing to do with the internet giants.

However, issues remain: In many cases, the servers of cloud-based radiology providers will be in the country where the hospital is located, but this might not always be the case. At “Sygenus Lillebaelt”, Mathiesen is currently confronted with exactly this issue: “The region of South Denmark has decided to outsource servers and storage of its public hospitals. There is presently a tender out for the contract. If this tender is won by, for example, a South European company, it might well be that Southern Denmark’s hospital servers will no longer be in our region in the future.”

Ulf Andersson points out that both national and European legislators have realized that working with healthcare data on an international level requires proper legislation: “There is a big discussion running in Germany at the moment on how this will happen, and the European Union is also dealing with the issue.” These discussions are fueled by an increasing interest of hospitals and other medical care providers to use cloud-based solutions. This interest is not only driven by the demand for better accessibility of data and tools and for better infrastructures for cooperative care scenarios. It is also, and probably mainly, driven by financial considerations.

The business model perspective

Cloud-based healthcare IT services reduce or indeed eliminate investment costs and replace them with running costs. For a hospital, this can be attractive since the hospital administration does not have to knock at the door of local politicians every couple of years to get money for major IT investments. Instead, a hospital CEO can present the funders a yearly bill that shows what running a hospital IT infrastructure actually costs, and at the same time reduce the workload of his own IT department.

Andersson insists that this can be attractive not only for big hospitals but also for smaller facilities: “Even when we talk about small private clinics with four to five doctors, I see no compelling reason why it should be necessary to purchase an expensive IT solution instead of using a cloud-based service that enables the user to deploy whatever tool and whatever client wherever they want. And in addition, they don’t have to become IT gurus themselves to maintain the system.”

Peder Jest, too, is convinced that turning investment costs into running costs is a helpful concept: “If the providers succeed in offering us business solutions for cloud-based healthcare IT that work financially and that offer additional value to our patients at the same time, then the concept certainly will take off. At the moment, one of the problems is that many executives still know nothing about cloud computing. They stick to what they know and are not aware that there might be a technology can offer both patient benefit and a reasonable business model.”