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Imaging in the Cloud 2021 Imaging in the Cloud 2021
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Imaging in the Cloud 2021
Early Adoption Shows Promising Results

author - Monique Rasband
Monique Rasband
author - Jonathan Christensen
Jonathan Christensen
author - Sidney Tate
Sidney Tate
November 9, 2021 | Read Time: 8  minutes

Cloud-based technology is quickly gaining momentum among provider organizations, particularly for imaging solutions. To get an early look at the reality of cloud-based imaging and the vendors best positioned to help organizations transition to the cloud, KLAS interviewed 37 organizations that have adopted imaging technology hosted by their vendor in the cloud (i.e., the organizations are leveraging the public or private cloud to operate or store imaging solutions and/or data); of this group, 20 are doing primary PACS production in the cloud. These organizations almost unanimously report positive experiences. Most have successfully transitioned to the cloud and are seeing beneficial outcomes—e.g., decreased IT burden and improved security. Because of the early nature of this market, all vendor performance data is limited (see the About This Report section). This research is also specific to the United States.

Fujifilm and INFINITT Lead in Successfully Moving Organizations (Small to Midsize) to Cloud-Based Production Environment

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.

vendor contribution to achieving desired outcomes in the cloud
estimated customer base and validated environments in the cloud

Philips and IBM Watson Health Make Strides in Cloud Imaging Adoption, with Some Bumps along the Way 

Philips and IBM Watson Health each have an estimated 11–20 customers live in the cloud; both have helped cloud customers achieve success, though with some challenges along the way. Interviewed Philips customers (using cloud-based versions of Vue PACS or Vue Archive, formerly under Carestream) primarily have small imaging volumes. Most say Philips is accessible and supportive, enabling them to be successful in the cloud with limited obstacles or disruptions. The few reported bumps in the road occurred during the transition from Carestream to Philips, as some customers felt the support and responsiveness slowed. IBM Watson Health is the only rated vendor in this report validated for supporting a primary PACS production environment of 300,000+ studies per year in the cloud. Responsive and consistent support has helped most respondents eventually achieve desired outcomes in the cloud after overcoming some challenges, ranging from implementation planning gaps to system slowness in replicating and retrieving images.

Cloud PACS Production Primarily Done by Smaller Organizations; IBM Watson Health, Sectra Validated for Larger Volumes

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.

validated imaging volume

Making the Transition to Imaging in the Cloud

Why consider imaging in 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.

reasons for moving to the cloud by type of cloud environment

Have early adopters of cloud-based imaging been successful?

of 37 interviewed organizations say they have achieved their initial goals with cloud based imaging

“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

Does cloud-based imaging save money?

of 37 interviewed organizations mention seeing hard savings

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.

“Cost isn’t easy to figure out by just looking at initial numbers. . . . We don’t have to manage the IT infrastructure or pay to update the hardware because those things are rolled into our overall costs. On paper, it looks like we are paying more, but at the end of the day, we are paying less because we have to factor in time and personnel costs, which are not part of the vendor’s contract costs.” —PACS administrator

How do organizations budget for imaging in the cloud?

of 20 respondents use only their operating budget for ongoing expenses related to cloud based imaging

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.

What about security concerns with cloud-based imaging?

of the 37 interviewed organizations mention security issues with cloud based imaging

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.

“We still think about security . . . but it is nice to know that there are teams of people thinking about security and looking at it every day. It really takes the burden off of us.”  —IT manager

What are the biggest obstacles organizations have had to overcome when moving to cloud-based imaging?


Bandwidth issues

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

of interviewed organizations report bandwidth issues

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

of interviewed organizations report implementation issues

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

of interviewed organizations report decreased control

Suggested solutions

  • 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

About This Report

Each year, KLAS interviews thousands of healthcare professionals about the IT solutions and services their organizations use. Typically, interviews are conducted using KLAS’ standard quantitative evaluation. Additionally, KLAS creates supplemental evaluations to delve deeper into a given market segment. The data in this report comes from a supplemental evaluation only. Interviews were conducted over the last 12 months.

Sample Sizes

Sample sizes displayed throughout this report (e.g., n=16) represent the total number of unique customer organizations interviewed for a given vendor or solution. However, it should be noted that to allow for the representation of differing perspectives within any one customer organization, samples may include surveys from different individuals at the same organization. Ratings from these individuals are aggregated in order to prevent any one organization’s feedback from disproportionately impacting a solution’s score. The table below shows the total number of unique organizations interviewed for each vendor or solution as well as the total number of individual respondents.

Some respondents choose not to answer particular questions, meaning the sample size for any given vendor or solution can change from question to question. When the number of unique organization responses for a particular question is less than 15, the score for that question is marked with an asterisk (*) or otherwise designated as “limited data.” If the sample size is less than 6, no score is shown. Note that when a vendor has a low number of reporting sites, the possibility exists for KLAS scores to change significantly as new surveys are collected.

about this report
author - Amanda Wind Smith
Amanda Wind Smith
author - Madison Moniz
Madison Moniz
author - Jill Wilcock
Project Manager
Jill Wilcock
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.

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