Imaging in the Cloud 2021
Early Adoption Shows Promising Results

Fujifilm has one of the larger live cloud-based imaging customer bases in the market, and customers rate the vendor highest for helping them achieve desired outcomes. Fujifilm provides strong support to organizations making the transition to PACS production in the cloud. Respondents specifically highlight Fujifilm’s responsiveness, proactivity, and consistency. The support team ensures good uptime and minimal disruptions in the cloud, and they are quick to fix the rare outages that occur. Some small hospitals report initial issues with slow retrieval speeds and recommend that other organizations have enough bandwidth to support the solution. INFINITT was an early entrant in cloud-based imaging and has seen significant recent growth, particularly in organizations with small imaging volumes. INFINITT stands out for helping organizations seamlessly transition their PACS production environment to the cloud, thanks to thorough implementations and strong client partnerships. Most customers report they experienced no obstacles, disruptions, or system slowdowns during or after the transition.

Most organizations who have moved to cloud-based PACS production have small volumes (less than 100,000 studies per year). However, some large organizations have also transitioned their production environment. IBM Watson Health and Sectra stand out for supporting the largest production volumes in the cloud—both have validated clients with 300,000–499,999 studies per year. KLAS also interviewed organizations with volumes of 500,000+ studies per year who are planning to move production to the cloud; to date, organizations of this size have only been validated for cloud storage. Agfa HealthCare, Change Healthcare, and InsiteOne (NTT DATA) were validated for such large clients—Agfa and Change Healthcare for cloud-based VNAs (storing 600TB+) and InsiteOne for radiology disaster recovery.

Large organizations more often report a longer-than-anticipated migration process. Otherwise, there is little difference between the obstacles and disruptions organizations of various sizes reported when moving to the cloud.

Maintaining on-site servers and hardware requires IT resources, time, and money. The ability to pass that maintenance to a vendor is one major reason why organizations consider imaging in the cloud. Early adopters also report numerous other benefits from cloud-based imaging, specific to the type of environment in which they use their cloud-based solution.

“The things we do are critical for our patients and our community. We take our work very seriously, and moving to the cloud has helped us be more efficient and productive. We are now more available for our patients because we don’t have to try to manage servers and do all of the other work that comes from trying to do everything on-site. Moving to the cloud has been a big win for us.” —PACS administrator

While cost effectiveness is a driving reason behind moving to the cloud, only 18% of interviewed organizations mention they have seen hard savings after making the transition. Passing off the maintenance of hardware and servers does allow organizations to save time, repurpose IT personnel, decrease maintenance needs, and avoid the cost of hardware updates. Cost reductions related to these outcomes partially offset the cost of cloud-based imaging solutions but may not offset the full cost.

Many organizations funded the implementation as a capital expense and then transitioned to their operating budget for ongoing expenses. Multiple vendors offer a per-study or volume-based tiered pricing structure, which facilitates this budgeting approach. Multiple respondents cited an improved ability to plan and budget for imaging as a benefit of moving to the cloud.

Fears around the security of cloud-based data and systems can create some organizational hesitancy to move to imaging in the cloud. While results are early, so far this fear has not been realized for any interviewed organizations; none mention any security issues in the cloud. Rather, multiple organizations report improved security in the cloud thanks to having off-site disaster recovery and their vendor’s ability to better keep cloud-based systems up to date.

Bandwidth issues

Weak internet connection or insufficient bandwidth leads to outages or slow replication and retrieval of images

Implementation issues

Working with a vendor who is new to imaging in the cloud can lead to misaligned expectations, knowledge gaps, and a slower implementation as both the vendor and the customer learn the new environment

Decreased control

Moving to the cloud places maintenance of the system and the ability to personalize it in the vendor’s hands; customizations may be limited and have to be done via requests to the vendor

• Work with your vendor to ensure they know and understand your organization’s network, internet, and infrastructure so their cloud technology can be effectively deployed
• Test internet speed and bandwidth early in the process
• Have redundant ISPs as failovers

• Talk to similar organizations who went live with cloud-based imaging to understand compatibility and best practices
• Set your vision, strategy, and long-term plan going into the implementation
• Ask lots of questions up front to ensure that the vendor and your organization have completed needed preparation
• Take the time to ensure a controlled rollout of the imaging environment

• Choose a vendor partner you are confident can effectively maintain your system
• Understand the vendor’s service levels and the process for obtaining support for non-urgent requests like customizations