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Moving to the Cloud
Evaluating PACS/EIS vendors today requires a lot more than just evaluating who has what feature, how it best meets your needs and at what price point as it was in the past. Many PACS/EIS today are hosting Cloud-based SaaS (Software as a Service) solutions. With over 150 PACS implementations under my belt over the years and working with over 350 facilities never have I experienced an engagement as complex as moving from an on-premise to Cloud-based PACS. Its so much more than just a simple change of venue. Evaluating network requirements are significant including how select the right Cloud Service Provider, data migration huge both from a time and cost perspective, making a clean cut-over from your existing PACS provider to the new one far from an easy task,….and then there are the little things like developing new hanging protocols that are time consuming (several months to years) andthe list is endless
Doing a Cloud evaluation correctly also requires an internal (facility-provided) project manager who knows the entire facilitys need not just radiologys. It involves a team approach that includes not just radiology, radiologists, admins and techs but everyone from executive leadership to IT to purchasing on down. Interestingly it does not require an RFP either. Working with all of these individuals requires a knowledge of what each entity needs so they can feel comfortable with the decisions that they need to make. The Cloud engagement I am just finishing had close to 40 people involved although a core team of six performed most of the background work so that others could review it and provide their input.
Interested to learn more before you take the leap into the Cloud? Drop me an email at [[email protected]][email protected][/email] and lets set up a time to chat
Mike Cannavo PACSMan
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16 Replies
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Sounds like a great deal more to consider than just a shift of where folks store their stuff. Good awareness!
Do you recommend that facilities ever do a hybrid solution with some functionality/local storage remaining on premises?
What happens if external internet is lost? Downtime scenarios?-
A well designed Cloud based system is always a hybrid one where the system can function in the event of a network disruption. This obvioulsy requires some on site hardware but a minimal amount. Advanced workstation functionality might take a hit but many workstations can function in a stand alone mode where connectivity to the cloud isn’t required, just desirable from a feature and performance standpoint,
Full system downtime is rare in a cloud scenario as redundency is typically built in, The biggest hit comes from a loss of network connection but even there you can have redundency albeit at a price., Given the robust performance of most Cloud systems the cost of this almost always exceeds the value.
Please LMK if you have any other questions.
Mike Cannavo “PACSMan”-
Thats awesome and much needed. Thanks, you seem ahead in the game.
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Interesting. I set up a new private practice 3 years ago, albeit a lot less complex than a hospital, and it couldn’t have been simpler (either that or my IT providers are geniuses, though the opposite is probably the case)
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With all due respect setting up a private practice is like childs play compared to correctly settng up a hospital Cloud-based PACS especaily in the relatively high volume (500K studies/year) multi-facility envirpnment like I worked with the team on
Most PP solutions are software that run on a relatively low cost server and a few workstations. Even non-genius IT folks can set this up although admittedly there is a level of techiocal experise required to do it right. Done wrong or even done right where it doesnt meet the requirements you initially hoped it would will cause you to spend hundreds on Tums trying to get it right..or at least marginally acceptable for the investments made.
PACSMan-
Do you have any tips for telerads to achieve best performance? Too bad our system is on intranet. I use a work router hardwired to fiber at home and was checking intranet speeds. I see router and VPN are both providing about 60 mbs up and down. Are those limited by server or software? I can bump up my home speeds from 400/400 if that would do anything.
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My experience has been that the hospital vpn is a fixed tunnel. Once your internet speeds match it, further high end speed adds little. Also, many modern pacs can do well at 60.
I tested it by going to 1 gig, figuring more is better, it wasnt.
You need to work with IT to max performance. Just opening up the faucet wont necessarily help.-
Quote from boomer
My experience has been that the hospital vpn is a fixed tunnel. Once your internet speeds match it, further high end speed adds little. Also, many modern pacs can do well at 60.
I tested it by going to 1 gig, figuring more is better, it wasnt.
You need to work with IT to max performance. Just opening up the faucet wont necessarily help.Makes sense. I tested it over weekend and peak hours, looks like fixed tunnel.
Strangely, I get things slow when I am checking resident’s work and open multiple xrays nearly simultaneously, possibly due to thermal throttling on the old workstation. Otherwise I can open multiple cross sectionals including CTA’s with good performance. IT said to wait for new workstations that will be rolled along with new PACS. Will see how that will work.-
We had an upgrade in PACS in the midst of Covid, the newer version was much more efficient. Hope the same for you.
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Quote from boomer
My experience has been that the hospital vpn is a fixed tunnel. Once your internet speeds match it, further high end speed adds little. Also, many modern pacs can do well at 60.
I tested it by going to 1 gig, figuring more is better, it wasnt.
You need to work with IT to max performance. Just opening up the faucet wont necessarily help.
The hospital or whatever pays for an ISP. That bandwidth is split between VPN, P2P VPN etc.. you’ll always be limited as there’s a need to maintain quality of service for the X amount of people and things using that bandwidth. Something like 50-60mbps is probably a pretty decent speed.
Sectra One Cloud is an option for people who are looking at cloud or hybrid. I suspect that’d be on our radar at some point but right now we’re all internally hosted.-
I was thinking I can utilize one tunnel for PACs and fire up a laptop for everything else including charts, chat, VOIP, emails if needed. VoIP alone can probably chew up big chunk of the tunnel when I am using it actively
My side gig is web based and that indeed makes things simple.
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VoIP isn’t much. We deploy a Cisco Meraki which is hardware VPN. It can power a VoIP phone and can have a voice VLAN extended to it. Works pretty well. All that other stuff like email, chats is a tiny chunk of data compared to something like pulling a TOMO with 10 comparisons.
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Quote from DICOM_Dan
VoIP isn’t much. We deploy a Cisco Meraki which is hardware VPN. It can power a VoIP phone and can have a voice VLAN extended to it. Works pretty well. All that other stuff like email, chats is a tiny chunk of data compared to something like pulling a TOMO with 10 comparisons.
We use Cisco VAVO routers which are probably the same. It has IP phone connector which probably needs to be configured within the router?
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Quote from boomer
My experience has been that the hospital vpn is a fixed tunnel. Once your internet speeds match it, further high end speed adds little. Also, many modern pacs can do well at 60.
With a true cloud deployment, you become independent of the hospital IT and it’s idiosyncrasies. You are not connecting to the hospitals network but some data center where your PACS vendor has leased server and network capacity.
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It’s interesting how the conversation shifted from deploying PACS in the Coud to network issues. The network is a big part of the Cloud but done right shouldn’t be a major issue. You always have (or should have) redundency on site but this shouldn’t impact the systems performance unless deployed because the Cloud connection went down for whatever reason and even then have minimal if any impact on the system operation. Of course latency and a whole host of other issues can impact the system but you need to work through that.
Circling back deplaying a PACS/EIS in the Cloud is no easy task and takes a lot of preparation and knowledge not just from one or two people but from everyone on the team.
PACSMan-
If you’re sitting at home the service might as well be the cloud weather it’s from Azure, or a hospital hosting it’s own infrastructure.
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