In April, Burlington, Mass.-based Nuance Communications, thanks to its acquisition of Accelarad, launched its PowerShare Network, a platform to enable the sharing of medical images and reports; by August, PowerShare – used by giants such as Intermountain and Kaiser – had shared a whopping 3 billion medical images via the cloud.

"The cloud is there because hosptials are running out of physical space," says Hoyt. "And it's just too expensive to use good space in a hospital for disk drives. So get out of that business and move it to a rentable data center.

"There's some smarts about this," he adds. "The scheduling system says I know the patients who are coming in tomorrow let me go see their old records– oh, here are some over here in the data center 400 miles away. Bring it in.

"That type of technology is easy, it exists, and I presume it would be in use," says Hoyt. "If I was a CIO dishing images out to a cloud I would certain expect that to be happening: I queue up tomorrow's images into my data center from an archival storage center."

Stage 2 meaningful use is driving some of this activity, but only some. Its core imaging requirements – computerized provider order entry of at least 30 percent of radiology procedures; test results, including radiology reports, made available to patients within 24 hours – are doable, or at least should be, says Hoyt.

"They sound pretty easy when it comes to imaging. If you're going to have CPOE live, there's no reason you're not hitting 90 percent of images on your orders. That's a piece of cake. The issue is do you have CPOE live? 60 percent of our hospitals do, so I would think that should not be an issue at all."

Given that the DICOM standard is fairly mature, "I just don't get the impression that sharing images is that difficult," he says. "You just have to have a robust network – you might overwhelm the local rural carrier. But the standard and the ability to send and receive is, I don't think it's a big challenge.

"One of the great early advantages to PACS is getting the radiologist out of bed and looking at an exam at home," he adds. "We've been doing that for 20 years. They're in the network, admittedly, but they're at home. That saves radiologists from having to drive in. I don't think moving these DICOM images is much of a problem."

But non-DICOM images ("colonoscopy images, photographs of patients, all kinds of stuff") are a much different story. "Non-DICOM is really the bigger challenge – and so is 3D imaging because it occupies so much space," says Hoyt.

So, to sum up: "VNAs. Non-DICOM. That's the real future."

[See also: Is VNA the future of image delivery?]