Health IT Summit DC 2015 - Cloud Storage and Medical Image Management: Responding to the filesize increases of advanced imaging technologies Todd Thomas CIO Austin Radiological Association iHT2 case studies and presentations illustrate challenges, successes, and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

1. Cloud Storage and Medical
Image Management
RESPONDING TO THE INCREASING FILESIZES OF ADVANCED
IMAGING TECHNOLOGIES

2. Speaker Bio
20+ years healthcare IT
Software development, network design, management, storage network design
Computerworld Honors Laureate for Visionary Use of Information Technology
in Medicine - 2002
Network World Enterprise All-Star Award for use of free space optics - 2005
Computerworld Best Practices in Storage - Finalist, Data Lifecycle Management
– 2006
ITIL Foundation Certified

3. ARA Diagnostic Imaging
17 outpatient imaging centers
20+ area hospitals
90+ radiologists
 1.3 million exams read or performed annually
900,000 exams digitally stored annually

4. ARA – Department of Information Technology
Chief Information
Officer
Director, Service
Delivery
Manager, Service
Delivery
Service Delivery Group
Server/Network
Administration
Director, Imaging
Informatics
Application Managers
Software Engineering
Manager
Development Group
Security Administrator
ICT Group
Administrative
Assistant

5. ARA Image Management Through The Years
2001
ARA – Department of Information Technology
• 6 TB usable
• Growth rate was 3 TB annually

6. ARA Image Management Through The Years
2003
ARA – Department of Information Technology
• 24 TB usable
• Secondary datacenter for replication

7. ARA Image Management Through The Years
2004 – content addressable storage
ARA – Department of Information Technology
• 2006: 58 TB of usable space

8. ARA Image Management Through The Years
2010– clustered storage
ARA – Department of Information Technology
• 2011: 235 TB of usable space

9. ARA – Department of Information Technology
Image Management Today

10. As Image Quality Goes Up, So Do Filesizes
16 slice CT: 18MB
64 slice CT: 23MB
1.5T MRI: 29MB
3T MRI: 71MB
US: cine loops, color flow

11. Digital Mammography By The Numbers
Average file size for a standard mammography image: 19MB
Average file size for a 3D tomography image: 392MB
Average ingest rate: 25G/day

12. 6.60
13.40
27.20
55.21
112.08
227.52
461.87
937.60
1,903.32
3,863.74
7,843.40
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2014 2016 2018 2020 2022 2024 2026
TERABYTESCONSUMED
EXAM YEAR
Projected Storage Consumption of Digital
Mammography: 2D, 3D
Sum
The Challenge
Migration Migration

13. Image Management At Scale
Image retention requirements
Increasing file sizes
Hardware refreshes
Maintenance costs
Data migrations
10 months to migrate 150Tb off CAS

14. Alternatives to the “Classic” Storage Arrays
Managed vendor neutral archive (VNA)
Software-defined storage
Storage-as-a-service/cloud

15. Managed VNA
Hardware, software, off-site replication
Possible to have no capital outlay
Dell, Deepwell

16. Software-defined Storage
Your hardware, their software
Multi-protocol support
SAN + NAS = Unified
Act as basis for scale-out storage architectures
Atlantis, SwiftStack, Elastifile, Datacore

17. Cloud Storage
Attractive
Let someone else worry about capacity planning
True pay-as-you-grow
Considerations
Data protection
Privacy laws
Compliance with Health Insurance Portability and Accountability Act of 1996
Pricing models
Performance
“The future for PACS is in the cloud,” - Steven Tolle, chief product officer for Merge
Healthcare, at the 2013 annual meeting of the Radiological Society of North
America (RSNA).

18. Nasuni – Storage-as-a-Service
Onsite cache married with cloud storage
 Your hardware appliance or theirs.
Encryption in flight, encryption on disk
Business-associate under HIPAA
Simplified pricing: one vendor, one price, one check.

19. Performance Testing
Old-school: stopwatch
Time to first image <= 3 seconds
3 trials for each study, per modality, using different settings
 Over 3,000 time trials
Compared to baseline established by incumbent

20. Performance Findings - On premise
Time to first image from the cache – on average – performed 21% faster.
For a complete study coming from the cache – on average – 7% faster than the
incumbent.

21. Performance Findings – Cloud Retrieval
80MB Internet link
No bandwidth restrictions
Time to first image from the cloud – on average – was 49% slower than the
3-second baseline
A complete study from the cloud downloaded 8.5% slower than local
storage

22. Nasuni Today
Upon implementation, all new mammography studies were written directly to
Nasuni.
Have migrated 98% of all historical mammography studies (2d,3d) to the cloud
Performance has not been a concern due to the radiologists’ workflow for
mammography images

23. We’re Not Done Yet
Deployment of a VNA bring some compelling image lifecycle tools to the
environment
 Multi-protocol support and storage-agnostic
Reduces the need for high-speed links to cloud

24. DATACENTER 2
Imaging Storage Architecture v4.1
1
2
1. Images ingested into VNA
2. VNA writes two concurrent copies
3. Nasuni writes images to out to the
cloud
3

25. Cost Considerations
1. Primary array acquisition and maintenance
2. StAAS appliance
3. Cloud costs
4. Telecom
5. Port speed connection charge for a direct connection
6. VNA acquisition and maintenance

26. In Summary
Filesizes are continuing to increase as modalities provide higher resolutions.
Storage-as-a-service is a viable model for long-term study retention.
 Hybrid deployments even more so
Choose your cloud partner carefully.
Ensure compliance with HIPAA/HITECH/Omnibus from your partner vendor

27. THANK YOU
R Todd Thomas
Chief Information Officer
Austin Radiological Association
Email: thomast@ausrad.com
LinkedIn: www.LinkedIn.com/in/rtoddthomas
www.ausrad.com