welcome everyone to today's Webinar died
cloud migration and enterprise
imaging. Evolution's not revolutions
on behalf of Becker's healthcare. Thank you for joining
us. Before we begin. I'm
going to walk through a few quick housekeeping instructions.
We'll begin today's webinar with the presentation,
and we'll have time at the end of the hour. For a question
and answer session.
You can submit any questions you have throughout the Webinar
by tapping them into the Q and a box you see on your
screen. Today's session
is being recorded and will be available after
the event. You can use the same link
used to lock into today's webinar to access
the recording.
If at any time you don't see your slides moving
or have trouble with the audio, try refreshing your
browser.
You can also submit any technical questions into
the Q and a box. We're here to help
with that. I am pleased to turn the floor over
to Tracy buyers,
senior vice president and general manager of
Enterprise Imaging at Change Healthcare.
To introduce our presenter Tracy. I'll
turn the floor to you.
Thanks, Brian.
Well, I'm really excited and pleased
to introduce Dr Elliot Siegel.
My simple intro is that he's
a unique combination of a teacher,
a clinician,
a tech geek and a disrupter.
He's the professor and vice chair
at the University of Maryland School of Medicine
and the Department of Diagnostic Radiology,
as well as the chief of radiology and
nuclear medicine for the Veterans Affair Maryland
Health Care System.
He's the director of the Maryland
Imaging Research Technologies Laboratory
and has adjunct appointments
as professor of bioengineering
at the University of Maryland College Park
and as a professor of computer science
at the University of Maryland, Baltimore County.
Dr Siegel was responsible
for the NCS National Cancer
Image Archive and served as the workspace
lead
of the National Cancer Institute. See
a big in vivo imaging
workspace.
He's been named as radiology researcher
and radiology educator of the year
by his peers, as well as one of the top
10 radiologists.
Under his leadership,
the Villa Maryland Health Care System
became the first film Bliss
Healthcare Enterprise in the World.
He has written over 200 articles
and book chapters about packs, picture
archiving and communication systems and
digital imaging, and he's edited
six books on the topic, including
the film Lys, Radiology and secure
issues in the digital medical enterprise.
He's made more than 1000 presentations
throughout the world on a broad range of topics
involved in computer applications and imaging
and medicine.
Dr. Siegel served as symposium
chairman for the Society of Photo, Optical
and Industrial Engineers Medical Imaging
meeting for three years
and is served on the board of directors of
the Society for Imaging Informatics in
Medicine, or Sin.
He is a fellow of the American College
of Radiology and the Society
of Imaging, Informatics and Medicine.
Oh, as a leader in Clinician,
you serve two very important health
care organizations.
Tell us first about the University of Maryland
Academic Medical Center and the Veterans Affairs
Maryland health care system.
Sure happy to do that. And thanks
for the nice introduction. I appreciate
that. Um, so the University
of Maryland Medical Center is located
in Baltimore
and the it's comprised of two
hospitals. One is sort of the main
flagship institution
in 800 bed teaching hospital,
and then we have a 200 bed
community hospital. The midtown
campus, and were a major
referral center, were probably the largest
trauma center
in the country and were a major referral
center for Cancer care, neuro
care, cardiac, diabetes, endocrinology,
women and Children's health. And we
have one of the oldest and longest
running transplant programs
in the country. All the faculty
on staff, such as myself, are
also faculty physicians of the
University of Maryland School of Medicine,
and we essentially have 10
affiliated hospitals that are part
of the University of Maryland Medical
System.
I also, um,
and so in that capacity
vice chair of research
on information systems.
And then I also have a second role
in charge of radiology and nuclear
medicine for the V, a Maryland
health care system.
And in that role, I
have responsibility for radiology
nuclear medicine for the V
A hospitals in Maryland and also
in Washington, D. C and all the V
A hospitals in West Virginia,
Virginia, Maryland Health Care System
essentially is
comprised of the Baltimore V
A medical center, Loch Raven and Perry 0.5
community based outpatient clinics,
and we serve all of Maryland, including
Maryland's Eastern Shore.
We have over 1100
residents, interns and students
that rotate from the University of Maryland,
and we're physically connected by a bridge
that spans between University of Maryland
and the Baltimore
V A medical center.
And so it's interesting
for me, sort of
being at both of these institutions
for decades to sort
of see and compare and contrast
the federal facility
with the University of Maryland and academic
facility. I think the to work together, hand
in hand, synergistically, and
it's given me some combined experiences
at multiple facilities because
of all the affiliated hospitals.
Okay, well, certainly seems like it's keeping
you very busy.
Um, so you have a
proven track record? Dr. Siegel
is success. And as a thought leader,
how have you been able to bring together
all of your passions? The teacher,
the clinician, the leader And if I may say,
the technical geek side
to be on the leading edge of medicine?
Yeah, well, thanks for that. And
I think my very
favorite thing
is actually being sort of a teacher and
a mentor.
And what's been wonderful for me over
so many years is being
able to have had
so many of my students,
in turn, become teachers and mentors
for others,
and I think
that's probably the most satisfying
part of my career, and I really have had
the opportunity, I guess, partly
because health care and radiology
and specific is a relatively small community
of being able to keep up with. And I'm
really so proud of hundreds
of my former
students who
gone on to do some really amazing things.
But the next and second theme of
my career beyond
teaching and sort of being a mentor
has been as sort of a positive
disruptor,
and I know that the title of today's
discussion is Guide to Cloud
Migration and Enterprise Imaging.
Evolution's not Revolution,
but actually what's been fun for me is to
foment revolution
and that level of disruption.
And so during my career,
I've had multiple opportunities
to do that.
So, you know, one of the first opportunities
to be sort of disruptive is
one that I think is an interesting example
for our discussion.
And that is, I had the opportunity
coming right out of radiology
residency at the University of Maryland
to create the world's first film,
this radiology department.
And so it was just an incredible
paradigm shift.
And, you know, here I am just coming out of residency
and, you know, asking the question
Well, I had a background
in computer science as an undergrad
and work my way through medical school,
and it just seemed as though film was
so constraining. I mean, films
got lost, films got damaged,
films could only be in one place at a time.
And it was one of the biggest
challenges in radiology. And
that infrastructure question you
know about managing films was
something that created a lot of issues. The
other thing that I was really excited about
as a computer science geek
or computer science major
was the idea of being able to have the computer
help us out with image
diagnosis and image
interpretation and to make us better
radiologist by combining our
efforts with computers.
And, you know, this was back in the
late 19 eighties when we actually first
started shopping
for a brand new way to operate
radiology in a brand new
radiology department. So I simultaneously
came out of residency, became the head
of the department, which is sort of a strange
transition,
and then had the opportunity
to design a whole new radiology
department and to design it as
being the first department that was filmed
Liss. And so some of the disruptions associated
with that, you know, And
it was No one had done that in the world at
that point was to have images
anywhere at any time to review
all images on computer monitors
to use this standard Dycom for
all modalities, which hadn't been
really implemented
to essentially perform all studies
using digital X rays or CR,
because those were originally acquired on
film.
And, you know, we even had to work
with the lawyers who essentially told
us that one of the challenges was that
the letter of the law was that we have to save,
um, five years worth of film.
But since we weren't making film, the lawyers
couldn't figure out how we could
actually save five years worth
of film if we weren't printing it. And so
all sorts of expected and
unexpected things went associated
with this huge paradigm shift.
One of the challenges that we had was
that there was no Ethernet
at that point,
and so there was no hospital network,
and so we had to essentially set
up a completely proprietary
radiology network throughout
the hospital. And I think this is going to become
important as we talk about cloud computing
because in many ways, you know, sort
of the first tier of my experience
was I had to, within the radiology
department itself and then outside through
the rest of the hospital, do my own
wiring for the network
essentially create my own storage, my
own backup and
all the things that we take for granted.
We had to essentially all do
in the imaging department.
And so we ended up managing
to do that, managing to interface with
multiple different vendor solutions
using sort of emerging standards.
And that worked really, really well.
And then after some period of time,
essentially we were told, Well,
g, you
guys in radiology aren't really
the experts in networking.
We've got great news. The hospital has
networking people. You can join our
network. You guys in radiology are
not really the experts. And it shouldn't
be your core expertise
to store
imaging studies. And we have challenges
in radiology. Whereas the
media changed as we went from a Kodak
optical jukebox holding
a terabyte of data.
Um, and we went from these really
large platters to smaller platters
to spinning disk. You
know, the idea of us managing
all of our own migration in the radiology department,
you know, was a challenge. And we ended
up having major issues as
we ended up having to keep up
with the latest in storage technologies
and hardware and software. And
I can tell you I had probably more meetings
as the head of the radiology department in
infrastructure than I did
in issues related to radiology percent.
And so you know, somewhat ironically
today, given today's topic,
you know, the hospital. If people
made a really strong and convincing and compelling
argument that I should just be
in the role of radiology and that
I should not have to worry about
backups and archives and couldn't
I just do sort of what my own core
expertise was, and so
again we'll kind of get back to that. But I think
it's ironic that we're seeing now
this kind of next successive
discussion about the hospital now
being told that its core
is taking care of patients and medical
expertise and health care issues,
and maybe
the hospital itself, just as I
as a radiologist,
the hospital itself should not necessarily
be in the business of
archiving and backups
and networking, et cetera and
So I think you know, we can talk
about that a little bit more detail.
And so, um, I think
you know this whole question of as we
end up seeing a migration
from within the radiology department
within the hospital, to the Enterprise, to
the cloud, it's been interesting for
me to see how this
is changed progressively
during my career.
Um,
we also had some issues in disruption
between connecting the electronic
medical record, which was just emerging
for us in the media.
In around 1993 when we started,
our real hospital opened and we started
our packs operations.
And then we had an image enabled electronic
medical record
and so other things that I've had fun disrupting
in my career. Sort of, you know, since
that 27 years ago has been creating
the world's first enterprise wide
three D advanced visualization
pack system. Being
on the IBM Jeopardy came when
we play Jennings and Roger and essentially
kind of disrupting the whole idea
of what machine learning might be
able to do, you know, in
health care. And we actually did some projects
together with IBM synthesizing
the electronic medical record to summarize
the important points of it using AI
and natural language processing.
We also essentially were major
disruptors in artificial intelligence
applications and diagnostic imaging
and, more recently,
looking at augmented reality and virtual
reality technologies and
implementing them
being able to look at C T
as a substitute for conventional X rays.
And so we're now using a CT scanner,
essentially to be able to scan
with the quality of CT but
using the similar dose
with CT that we would for playing
film studies and implications of that.
And so in all of these different types of sort
of revolutions or disruptions,
it's been really fun in my career
to be involved in trying
it first and then seeing colleagues,
you know, in the hospital, other facilities,
and then having that go throughout the world and,
you know, certainly is the world's first film, this department.
We experienced tremendous amount
of media attention associated with it
and visits from all around the world
looking at sort of this new paradigm. And so
for me, I'm kind of excited at the
idea of the cloud now
essentially becoming the next example
of a really cool, disruptive technology,
and I would have to say a revolution,
you know, in addition to being a revolutionary
approach to
So it's so interesting to hear,
uh, hear your perspective and
makes me kind of laugh to think about your
favorite role as a mentor and trying to educate
your new radiology students
what it was like to operate in a world
of film. But, um,
it's, uh, it's certainly
interesting how history is continuing
to repeat itself.
It's how many
current amazing how many of my current
students have never really seen an X
ray on fame. And
when you tell them that you know,
the one of the things that was sort
of historic at the hospital was
making the transition from film to digital.
They can't really wrap their heads around
images not being digital and on
the computer. So it's kind of
fascinating to see that perspective. I
guess every once in a while, you see still see a
film on E. R. Or Grey's Anatomy
or something. But it's been
fun seeing your,
uh well. Speaking
of disruptors, one of the greatest disruptors
of late is the pandemic.
It has certainly influenced the practice of medicine
and imaging greatly. Can
you tell me a little bit about how
the pandemic has influenced the
shift to the cloud.
Yeah, well, so that pandemic has had
many different
direct areas of
impact on the practice of diagnostic
radiology.
The first thing that we saw was that the hospital
actually ended up mandating
us to significantly
curtail
our radiology operations
in some areas, for example, screening.
We stop doing screening studies.
We also stopped
doing, um, having
patients walk in that made all
of our appointments
all of our imaging studies
by appointment.
We also significantly
decreased the number of studies that were
being done in the department, especially
during the greatest peaks of
the pandemic. And the other
thing that the hospital did is it encouraged,
strongly encouraged. It's workers, including
radiologists and anyone who could
to be able to work remotely.
And this idea of working remotely
was in many ways, ironically,
something that we had wanted to do for a while.
But particularly at the
Department of Veterans Affairs, there
was a fair amount of reluctance to
have radiologists work remotely
because of
concerns about security
and privacy and and,
you know, even performance
of the systems with limited bandwidth
and So you know, the advent
of the pandemic
essentially made us
accelerate our efforts.
And so we were able to have
policies changed and get permission
to be able to do image interpretation.
We had work stations set up
when we were never able to
get them to be set up to connect
into the pack system.
Previously, and I've personally
been working at home,
you know, more days that I'm in at the hospital
over the past year and so
this transition to working remotely
has certainly opened up everyone's
eyes, not only for interpreting
radiology studies but doing tele video
conferences,
for example. And so most of the hospital
meetings that we still have
are done. Probably 99%
of the meetings I have are done remotely.
And so this created additional
strain on a limited
network,
particularly as practitioners were
making the transition to seeing their patients in
the cloud. And so the Department of Veterans
Affairs needed to sort of beef up its network.
Its capabilities modify its
policies, and all of these things
essentially encouraged cloud
solutions.
And so the idea of being able
to do interpretation and collaboration
in the cloud was really important.
I think it also demonstrated for the
data that one can
successfully stay secure
and maintain patient privacy,
you know, still, while using the
general Internet and still while utilizing
the cloud, I think of a had been
very reticent to do that.
And we've demonstrated because of these
emergency situations
that indeed we can. We're
even seeing
applications directly in patient care
where we've been able to take iPads,
put them in the intensive care so that patients
are able to interact with their families,
as in patients.
For the first time, the V A has allowed,
you know, being able to utilize programs
that can allow a patient
to be able to directly communicate
with loved ones.
And the other thing that has happened
is that we've seen an incredible amount
of variability in our volume
of studies. You know, the studies
have decreased dramatically and
then popped back up and then gone down
as different waves of the transition have occurred.
And so the potential for
the elasticity provided by
the cloud to allow us to
be able to have other people essentially
called in to help out with image interpretation
or for us to essentially provide
assistance to other hospitals
within the system. Over
the cloud has been really exciting. So
really bottom line has been that
the pandemic has certainly
been a major, major
challenge to so many of
us. But when you look at adoption
of technology and when you look at ability
to be able to utilize cloud resources,
it's really been, you know,
extraordinarily,
um, powerful accelerator
of our move to the cloud, which
I think is a good thing. I've been a major
proponent for Cloud
Technologies for quite a while,
and some of the constraints,
you know have been lifted. And I'm hoping
and expecting that many of
those will continue or well past the
pandemic so that this
acceleration towards the
cloud will not decrease.
Nor will the enthusiasm as the pandemic
starts waning over time.
Yeah, I think, Yeah, I think you're so right about
that. I know you've seen
so much change in health care and, you
know, specifically in in enterprise imaging
and such a short amount of time, from from
film lys to cloud platforms
with a i technology.
When colleagues and peers are thinking about
a cloud strategy and their vetting,
the solutions What are some key
elements that they should consider?
You know, maybe in terms of
influence on patient care, security,
scalability, efficiencies.
Yeah. So
one of the points that I'd like to emphasize
is the fact that
we think of the cloud
as being essentially a
surrogate for the way
that we handle image information.
Currently, in other words, could we do what
we're doing today? But do it,
um,
more efficiently, more cost effectively,
for example, potentially more securely.
And I think the answer to all those is yes.
But to me, I think that the cloud
offers us an opportunity to kind of think
outside the box or maybe open the box up
a little bit
and to do things that maybe we weren't before.
For example, when we made the transition
from film to digital imaging,
one of the things that we found
was that instead of looking at the images
in a static format, for example, a CT
scan of the chest,
we were able to take all the images
and stack them on top of each other.
And so, rather than moving our eyes across
the successful successive frames
of an image you can create sort of
this movie view in this movie view
allowed us to be able to see changes
because our eyes can detect change when
there's a nodule or lesion that sort
of pops in and pops out.
We also found that when we could
stack the images up, we could essentially
read more images per time because
we could read more images per time.
CT NMR were able to essentially
create thinner sections and
more complex images. And so we
saw this feedback, whereas
the switch to
imaging digitally wasn't just
that we had film, but it
was portrayed or depicted
or shown on a monitor. But we had
new capabilities with digital that we didn't
have before. Certainly, ai
types of applications are a great example of
that. And so you know, what
I would encourage colleagues to do
is to think not only of the cloud
is being infrastructure outside of the
hospital,
but also maybe provides
new possibilities for us that we don't
have locally one of the first things that
occurs to me there in radiology,
our ai types of applications,
where many of them are only available
over the cloud, the potential to be able
to do speech recognition
over the cloud, the potential to
be able to do more sharing
of data and to be able to
allow peer review, for
example, of cases or
super sub specialist consultations
to occur in the cloud. Those are all things
that are enablers that allow
us to do new things in the cloud,
not just essentially create more
efficient ways
of doing the previous things that
we had done. The idea potentially
of looking at storing genomic data,
proteomics data, other things that we don't
really potentially have storage for,
or have the expertise for the ability
to be able to work with. Third parties
that could potentially help us do analytics
and things where they could access things
safely and securely in the cloud rather
than reaching into our networks
are all really cool applications.
Um,
and so I think that we do need to
think, rethink how we're using
the cloud. And I personally
think that the same way
that we in radiology,
we're told that image
storage and image computer networking
is not our core expertise
and essentially those things moved
to the hospital level. I personally
think that hospitals should be concentrating
on health care and that hospital
it folks who are incredibly
valuable and incredibly important
should essentially be spending more of their time,
you know, with essentially hospital
applications and and doing
things that allow us to be able to be
better at analytics at safety,
etcetera.
So I think, and one of the other
examples I think is security.
And I know that there have been a lot of concerns
about security of data outside
hospitals that so many of us know,
particularly with the recent ransomware
hacks that hospitals themselves
maybe less,
um
secure than maybe
some of the most secure third
party vendors. And so it may
be that hospitals are actually easier
to access
to get in and access data
in hospital systems than in, say,
an Amazon cloud or
or Microsoft or Google Cloud,
for example. And so, you know, I
think that as, um, hackers
and ransom, where folks get more and more
sophisticated, it's going to require an
even higher level
of expertise and security.
I think it's time goes on. It just doesn't
make sense for each hospital in each
health care system
have to try to maintain that
the data has made the decision, for example,
that it's getting out of the
electronic medical record software
business. And essentially, it's going
to Cerner famously after
the data has sort of done its own
development of software.
And I think it's a great idea
to essentially go private just
because it doesn't make sense
for healthcare system to maintain
software development. And I think similarly
with regard to security, it makes sense
to essentially outsource that
scalability. The idea of efficiencies
that are, you know, gained as we
scale up and scale down. And we've seen that during
the pandemic with nature volume
chefs.
And, you know, I think of the
idea, you know, having access
to new systems, new artificial intelligence
software, all sorts of different third
party software, you know, really makes
sense also getting space
back.
I know one of the things that happened with us
is we first had our film room,
and then that film room essentially
gave us back space to be able to expand
with an MRI scanner and put some
radiology equipment. And I know
our hospitals the ones I work at,
spaces in an incredible premium,
and the potential to be able to give
back some of the incredible amount of space
that's required just for image storage.
You know, I think, is a tremendous,
um, key thing that I think we
can do with regard to
the cloud strategy.
All great points, you know. And I think about
security. I also think about
how quickly can you deploy
a fix and knowing what
the cloud really enables. You know,
thinking about how fast hackers
move and being able to instantaneously
deploy a fix rather
than having to patch all kinds of systems
across the globe, is, uh,
it's really amazing when you think about the efficiencies.
So you've obviously had experience
moving and organizations and new technologies.
So now let's talk about key stakeholders.
What are some of the features you suggest
showing stakeholders?
Yeah, so I think
some of the ones are sort of the obvious ones,
and that would be savings and, you
know, decrease in total cost of ownership.
I certainly think that from the administration's
perspective that you can really make
a compelling argument. The cost of storage
has gone down so tremendously.
I mean, if you just look at Amazon
storage, for example, it's something in the order
of magnitude of two cents a gigabyte
for standard storage. But it's about
4/10 of a penny
per gigabyte
for their glacial storage
and about a quarter
No. 1/10 of a penny per
gigabyte for their
longer term glacial archive.
And so, you know, I think it's time
has gone on, you know, whether it's Amazon
or so many other services that essentially
are offering, you know, storage.
I truly believe that when you look
at all of the different costs
that it's actually less expensive
to essentially migrate data
out to the cloud and do storage
there, particularly given the fact
that such a large percentage of hospital
information does not need
instantaneous retrieval.
But so much of it is essentially being archived.
And I think rethinking some of their strategies
can do that. You know the cost of
the space, the cost of the hardware,
the cost of keeping up with
software. One thing that nobody
seems to keep um to take
into account is the cost of the
energy and the power
related to so many
of these hardware devices. And as
we're increasingly thinking
green and being encouraged,
you know, for these energy savings.
I think that this could
be a huge way to decrease
our carbon footprint, which I think
so many of us are being more
aware of. The idea of being able to get
cutting edge applications is really important.
And I think being able to redeploy expertise
is going to be critical. So if
you ask me specifically some of the key
stakeholders and what I would talk about,
I mean for the CEO, I would just
remind her or him that data
storage is not their core business
and that I think computers,
not their store business. And I think outsourcing
those to the cloud allows hospitals
and CEOs to focus more
on what our core business actually
is. Um, staying, you know, in
the business of caring for patients, I would
tell the CEO
that from a cyber security and hospital
infrastructure perspective
that essentially it would make us
less vulnerable to attacks and less
vulnerable to all the legal
and medical implications associated
with those. I think for a c m i o.
I would tell r c m I O
that essentially the potential
to be able to utilize AI
applications Analytics, third party
applications that can essentially
extract insights from the data
is really where we should be going. And, you
know, I think a C M I o
should be spending less time worrying about
infrastructure, and you should be able
to concentrate more and have a flexible
A system as possible. And I think going
to the cloud gives us access to
so many more providers. It
also gives us access to being able to pick
and choose best of breed applications.
It used to be if I heard a really cool song
on the radio and I wanted to have
it. I'd have to go out and buy the record
or the CD.
Um, and I get maybe
my favorite song to songs that I kind
of liked a little bit and a bunch of songs that
I really didn't care that much about. Wouldn't it
be amazing to be able to go into a marketplace
where we could essentially consume on the
cloud a variety of different decision
support analytics packages,
And so that's what I tell the C m I o.
As far as the C I O. I mean, I
would speak to the C i o. Again
about essentially concentrating
their expertise and experience
and decision making on
you know, what are the best ways
that we can make our healthcare information
systems better and safer?
What are ways that are C I o can
make really good decisions about what's out
there and have the cloud as part of
our seat IOS armamentarium
to be able to deploy
all sorts of different applications the CIA
might want to have.
And to essentially reassure the c i
o that I think the future of cybersecurity
is going to be increasing
reliance on the cloud
for better security.
Yeah, I think you are. So right
now we know many people listening
today are
getting ready to take that incremental
step to get to the cloud.
So looking ahead and helping others
with their migration to the cloud, what advice
do you offer them to take one
or two steps to start that journey?
Yeah, I think the first steps
would essentially asking
these facilities to define
their own expertise. I mean, what
are the core goals of your hospital?
What are the issues? You
know, that might benefit from
the switch to the cloud. I mean, do that sort of a swat
analysis and take a look
at where you are today. And
then I think it would, you know, I would
strongly recommend that they consider
a migration strategy. I think in
this case for most facilities,
it will be in evolution. I'm
sure most facilities are already
doing so many things in the cloud already.
I mean, certainly, you know, Internet
access. Google searching,
you know, resources.
Um, for information are already,
you know, on the Internet the
idea of, um, you know,
programs such as office 3 65
that they may already be using that
essentially, I think are phenomenal examples
of the success of being able
to have hybrid systems
that allow you to be able to operate
both in the cloud but also be able
to operate when the cloud is not
available, or
in times when you
know you need to have things done
locally. I think you know, finding
another facility like yours
that has already made the transition to the cloud
is really important. And to hear
you know, what were the challenges that they
had as they ended up making
the migration and looking
at doing it incrementally deciding
whether you want to do storage in the cloud computing
in the cloud, Decide whether you want to
consume some of your applications. Microsoft
Office is one example of many many
that allow you to consume either locally
or in the cloud or a combination of two,
and then look to others who have implemented
and garner lessons from
that as well.
And so you know, I think
one thing that we tend to
do in hospital systems because we're also
busy and were also involved
in a critical mission of the hospital,
is to think, Sit down and
ask yourself the question If you were setting
all these things up from scratch
and didn't have legacy systems,
but we're pretty much starting a new
how would you set it up? And
if you know how you would set it up,
is there a pathway to being
able to get to what you
would do if you could just start today
without those legacy systems?
And I think thinking about all of those things
and then you know, finding some
really outstanding examples
of facilities who have gone to the cloud
and who have seen really tangible
gains and have done essentially
measurements of performance. There are lots of studies
that are out there that delineate,
you know, specific cost savings, performance
savings and others. I'm having
gone to the cloud, and I think paying attention to that
can be really important.
So great, thank you. This has been
really insightful, so
I'm gonna turn it over to Brian.
He's gonna offer some further instructions
because we've got some time for some Q and
A. Cool,
Yes, absolutely thank you,
Dr Siegel and Tracy for that
engaging and really informative exchange,
we will now begin today's question and answer session
as a reminder. You can submit any questions you have
by typing them into the Q and A chat
in the box on your webinar council there.
So let's go ahead and get started here. The first question
I'm going to throw out, the attendee asked.
We have struggled to handle outside films
coming from multiple areas and having multiple
PCs, systems packed systems.
Have you any experience in a similar situation,
and if so, what efforts have you
implemented to address this type of issue?
Since many of our physicians do not want to go
to multiple systems, to find their images.
Thank you.
Yeah, that's a terrific question.
And I think that this
is something that many of us have struggled
with and there are multiple
ways to be able to deal with that. But
I think the best way is to
essentially look at the ability
to be able to harmonize these
various systems
and to create a single
system that allows you to be able to
intake and input images from
multiple different packs and
to be able to integrate them into
a single system. This was a challenge
for us at the University of Maryland, where
we essentially as we ended up incorporating
additional facilities in the Baltimore
and Maryland area
into our system, we ended
up essentially finding ways
to ingest new studies that
were done interface with the pack
system and then be able to
essentially consume all of them
in one place and then send the reports
back through varying reporting systems.
And so I think this is, you know, one
area where there could be the potential
again of cloud based systems.
And so, um, rather
than just telling the radiologist
to learn how to read
from five different tax systems per se
and to sign into those systems.
Um, I think that our
experience has been consolidating
all of that into one not suggesting that these
other facilities essentially abandoned
their packs. They can continue
to have those systems,
but there are a variety of different ways
to be able to combine those.
For example, in Maryland, we have
health information exchange called Crisp
C R E S P,
and it allows.
It essentially ingests studies
from all of the different
hospital systems in Maryland
and keeps all those studies. And so
it's possible to be able to
be at anyone facilities,
a University of Maryland. And we have the capability
looking not only at reports but imaging
studies using that crisp system
obtained at Hopkins or all sorts
of other systems. And so in a similar
manner. You know, I think it's possible
to be able to do that consolidation not necessarily
at the h i t level, but even
within your own enterprise. And so
what I found is that an increasing number
of systems are doing that.
We're seeing lots of colleagues
in radiology farming, really large
groups and the tele radiology groups
increasingly paying attention to
efficiency and productivity.
And what we're finding is that the really
by far the best way to do that is
to consolidate those into a single system
and reading system.
I know that it's not easy to do that.
It's easier to say than to do.
But I think that there are a number
of entities, including entities
that provide Vienna's
vendor neutral archive solutions
that could allow you to be able to do that.
And that might not mean keeping all the data
redundantly forever. But just new studies
could be shown on your packs, and then one
could go back and retrieve their studies again. The
standards are all there to support that HL
seven and I calm.
And so I do believe
that ultimately, the best way to do that
is to combine into one system.
There's one practice that I know of in Chicago
that's incredibly efficient,
and what it does is
they have multiple different scribes
assigned for each radiologist,
and those scribes call up studies
from, say, the five hospitals
in my hypothetical case and those
imaging studies are already called up and the radiologist
just bounces from one scribe to another
and the studies are all pre arranged. But
you know that that seems like a fairly elaborate
system to get around the multiple
tax issues. But in general,
I think that the solution
moving forward is to consolidate.
And I do think there are providers that are
available to assist you
in a multi system
to be able to set that up.
So thanks for the question. It's a really good one.
Yeah. Yeah, definitely was. Thank you, Dr
Siegel. And there's been a ton of great questions. We've
really got a lot of great engagement here.
So I really appreciated
this, uh, this level of engagement from all the attendees.
So we'll dive right into the next question.
The attendee ads with more image storage
moving to the cloud. Do you see a time when
a workstation will become a single pane
of glass working from a single work list
in multiple packs. Environments using
one VR system?
Yeah, I was
keeping up with the question until it
was V r system. And so
are you talking about virtual reality system? I'm
not sure exactly what VR refers to, but
let me try and answer the question.
Um, a little bit differently.
And that is to say that, um,
I think the answer is going to be
that we will have many
different personalized
solutions for interpreting
different types of studies moving forward. So
if your question is getting at, how will
radiologists interface with
imaging studies?
I think what we're seeing already are
all sorts of different advanced visualization
companies ai companies etcetera,
coming up with their own applications. And so
if I'm doing a cardiac CT,
I may want a sub specialist
applications specifically for
that. There may be five out there, and maybe my favorite
is number three.
Um, but maybe someone else's favorite is Number
two. If I'm reading a ultrasound,
um, study that I may want
something different if I'm reading a CT study
looking at lung nodule, something different.
So what I think the future is going to
be is going to be
a work a applications
orchestrator. So I will have that piece
of glass in front of me,
and I will essentially have
the ability to program for
whatever type of radiology
study it is. I'll have an application
or maybe more than one application
that will essentially be used to
visualize and interact with that
is going to operate a lot like a
smartphone, where different people
have different favorite programs,
for whether it's email
or whether it's looking at images or
doing all sorts of different things. And
you'll be able to pick and choose what
your favorite is, um,
from many different types. And so
I think what we'll all have in common is a workflow
orchestrator. And I think there are a number of platforms
that now are emerging from some of the big
vendors, like Siemens and GE and Philips
and Cannon et cetera. But also,
other vendors are coming up with platforms,
and I think we'll all be consuming
using these types of
application orchestrators.
Um, your question
about VR. I'm assuming that
you may be talking about virtual reality
or augmented reality. It's
an area of my particular interest,
and I think at some point,
rather than having glass monitors
in front of ourselves as the resolution
for I've mentioned reality
and virtual reality increases, we've
done studies already at the University of Maryland,
where we've shown that a Microsoft
hololens, we just use the number
one version of it. There's a whole
lens to that's out now could essentially
allow you to create virtual workstations
anywhere. Stay in your office, and
you could literally move around in your office
as though they were real workstations.
And yet be able to essentially
interact with have as many monitors
that you want kind of in your virtual space.
So if we're going well into the future,
a lot of the applications that are being applied
in military applications,
for example, for a jet cockpit
are now becoming less and less expensive.
And so give it 10 or 15 years.
And I think VR or augmented
reality a r will be the way that
we interface. But it's not going to be
one size fits all. It's going to be personalized
to you, and you'll have your favorites.
And those favorites may change over time. So
really cool question. Thanks.
Yeah. Thank you, Dr Siegel. And
I think that, uh,
part of the VR could have also stand for
your voice recognition. Right. Uh, and
that would sort of feed
into that. That broader sort of augmented
reality sort of you're talking about, right? We
giving them to add to that
question based on the idea of voice recognition
being a piece of that. Yeah, thanks. I didn't think
I guess I'm sitting in future mode and didn't
even think of
a voice recognition or speech
recognition. So
thanks. And I think different
speech recognition systems will
also emerge as time goes on.
And, you know, we may be able to
essentially drive our applications
with things that are integrated in
speech recognition. I know some of the PACs
vendors are already looking at integrating
speech recognition of their own so
that you could have the images and voice
combined to create multimedia
types of reports and applications, which
is really powerful. So
I do think in the future
that will have much more flexibility.
Rather than being constrained with only one
voice recognition or one display
set of software, I think we'll have
a window into a variety
of all sorts of different types of applications.
And one thing we've done some research in is something
called gesture based reporting.
So rather than as
I'm looking at a chest X ray, you
know, dictating what I'm
seeing with a speech recognition system
to be able to have a stylist
and a tablet sort
of interface and then I could just draw little
symbols like we used to with a red wax
pencil on film.
And then those symbols themselves would
end up creating the report. We've documented
that that could be significantly faster
in a graphical way to be able
to issue a variety of reports. So
I think that, you know, we're
dealing with really all sorts of
different exciting possibilities, particularly
as we move to the cloud. So I think
both we are in visualization.
Applications are going to expand,
and we'll have lots to choose from
so that
thank you so much, Doctor Siegel. Let's
roll right into the next question here.
So the attendee asked, How long
does migration to the cloud take? What
is the resource to show to hospitals?
That cloud is the solution for future.
Yeah. I mean, I think we could probably spend the next couple of hours
on answering, Um,
some of those questions. And
I think, really, the bottom line is, is that
the benefit to the cloud
is going to depend on,
you know, your own situation, your own hospital
and your own needs. As far as rolling
things out, I think some facilities
will want to move it at slower rates
and some at faster rates. It's going to depend
on the resources that you
have the type of applications that you have.
It turns out that our
the tax system that we're using at the
Baltimore V A medical center,
um, is, uh,
change healthcare system and our vendor
change Healthcare is indeed moving,
you know, to the cloud, and it's offering
us the capability. The
tax system that we have. A University of Maryland is
currently not offering that moving forward.
And so I think to some extent it really depends
on your own information systems
and a pack systems, and
you know what their offerings are and how
they're going to be in the cloud. I would
predict in the next relatively short number
of years everyone is going to be talking about
cloud, and whether those are DNA
is whether those are packs providers. I think
even our friends epic concern
er and some of the really big E. M. R
s are going to increasingly provide
offerings that we can consume over the cloud.
So how quickly to move it over? I think really
depends on who your vendors are
what you have currently,
and I think moving over
judiciously but guided
by the experience of other facilities
is really the best way to go. As
far as documenting the benefits of the cloud.
Those cost studies are really tricky
to do because you have to take so many
things into effect. I mentioned, for example,
power savings,
Um, you know, with energy and one of
the biggest consumers of energy actually
turns out to be like. And so
there's so many subtle things that are difficult
to put into a return on investment.
Um, I just think it's going to become community
standard to be in the cloud moving
forward. And I'm applauding,
You know, some of the early pioneers who have done
that who have tried to do really good,
scientific, well thought out logical.
Um, you know, studies
to try and document
on what their savings are. I'm absolutely
convinced, based on the data that we
have, that there will be savings,
and I think that we're going to have
more efficient ways to store data
than just throwing up the dycom
repository. I think that Dycom itself
is going to be essentially changing
to a form that's still interoperable
with the legacy systems, but
that will have new mechanisms of
storing images, interacting with images
for machine learning and also
for, you know, rapid retrieval
and storage. And so I think the cloud
allows us the capability to be a lot more creative,
and I think you're going to start
seeing more and more cost
saving studies over time. When
we first had our pack system,
we were asked to do cost effectiveness
studies because no one had
one. But now nobody really
justifies attacks with a
cost effectiveness study per se,
because it's so much
taken for granted that that really is the only
way to go. And I think in 10 years
that we're all going to be moving to the cloud
without necessarily needing those, because it will
be self evident.
Great, great points there, Dr
Siegel. And with just a few minutes left,
Tracy, I want to get your take on this question,
too. So just to restate,
how long does migration to the cloud
take? And what is the resource? You
can show the hospitals that the cloud is the solution
for the future?
Yeah, that's a great question. And It's
actually one of the places in some of
our early beta site
work where we've seen huge advancements
where we're able to
make major migrations
in days instead of months.
And so historically,
when hospitals
were looking at different vendors, they were
really looking at months and sometimes years
to transition all of their data
to a new system. Uh, and
that's really a game changer now with the
cloud based on the advanced
technology. So it's very exciting. Uh,
you know, as a different
hospital systems think about making this transition.
Absolutely. Thanks for for
tackling that one, Tracy as well. Uh,
we've got just a few minutes left. We might have
time for one or two more questions
the next one
that I can be my
inbox if I can interrupt from
Stephen Link. That says, How can we best
deal with turnaround time issues for
stroke type cases when transmission times
for the new case in each prior
one, maybe 3 to 4 minutes each?
It's okay with you. I'd be happy to tackle that
one because I think it's an interesting question to
Yeah, yeah, for sure. Go ahead.
Thanks. So one of the
technologies that is,
I think will be emerging with dot
com is going to be image
compression, and I know we've had it around
for lots of years, but I
think it's very much underutilized.
And, you know, there have been lots of studies that have suggested
at compression ratios of,
you know, 8 to 1, maybe 15
to 1
for C T and M R studies.
You really can't even discern a difference
using some of the more advanced
lossy compression technologies. So
from my perspective, I think
we could probably get
transmission rates in
the cloud that were comparable
to transmission rates that were getting
locally. The other thing is that I wouldn't
advocate necessarily keeping
all new studies only in the cloud
I would advocate for a hybrid. So if
someone has just done a new study at your
facility, then rather
than having to go up to the cloud and then back
again, I think that
the hybrid approach allows you to cash
a relatively unlimited number
of hours or days of studies or some
subset, and to keep it so that
a brand new study shouldn't necessarily
in any way be dealt seriously
affected by the fact that it will eventually be
stored on the cloud. And I think that's really
the strategy for some of these hybrid
approaches. So you can store 99% of
your studies in the cloud
and still be able to have super fast turnaround
times by cashing studies
within a certain number of days or
weeks from when they're done.
So important question. Because I
think performance over the cloud
is a major issue
that we need to be really cognizant of as
we move forward. I think we can definitely
achieve similar or even improved
performance by utilizing the cloud.
But I think we just need to be judicious,
absolutely some
important distinctions there. I appreciate you
you grabbing that one for us. And
you know, we are just about out of time.
Dr. Siegel and Tracy, thank you so much
for an excellent presentation. Truly appreciate it.
Yeah, Thank you very much, Doctor Siegel.
This was excellent. And so many really positive
comments. So I appreciate you
taking the time and helping
us guide through what I think is the next
inflection point of innovation
in the enterprise imaging. So thank you.
Yeah, My pleasure. Thanks for a great job moderating.
It really made it fun. And thank you
so much for those questions
that you ask. The questions
were really perceptive and help
me underscore points that I thought were important.
So I really appreciate the
questions from the audience, too.
So thanks so much.
Yeah, we had we truly had some great
engagement on behalf of Becker's
Healthcare. I want to thank Change healthcare
for sponsoring today's webinar
to learn more about the content presented
today, please check out the resources section
on your webinar console and fill out the
post Webinar survey.
Thank you for joining us. We hope you have a wonderful
afternoon.