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In a world where we instantly send and receive information by texts, tweets, and emails, patients expect immediate answers to their important medical questions. When Arizona Breastnet, a full-service breast diagnostic center, opened its doors 13 years ago, our commitment was to give patients their test results at the time of their appointment, to answer all their questions, and to be available as an ongoing resource. This alleviates the wondering, worrying, and waiting after an exam. An empathetic staff of specially trained clinicians with outstanding knowledge and experience is at the core of what we do. They allow us to focus on the needs of our patients in comfortable, home-like surroundings. Our technology, business practices, and personal interaction support these goals for the nearly 6,000 patients we see annually.

In 2010, about 74 million women over 40 were expected to have mammograms; that number should reach 78 million by 2015, according to the Government Accountability Office. We're also seeing increasing use of other breast imaging modalities such as ultrasound and MRIs. With demands surging, we needed a system that would allow us to be at the forefront of medical  imaging with anywhere/anytime access to patient data. We also needed to replace our existing storage with a platform that could handle current needs while meeting future requirements designed to encourage the health care delivery system to move toward collaborative care, coordinated case management, and community-wide access to patient information.

Rather than automatically replacing our storage system, we chose to explore other options that would allow us improve communication and data exchange with our patients, physicians, and other authorized parties. Some of the questions we considered were: 

• What would our medical imaging system need to accomplish now, in the next five years, over the next decade, and beyond?
• What future exchange, storage, access, and archiving needs did we anticipate?
• Will a medical image management solution be configurable, scalable, and flexible enough to handle evolving market forces, ongoing regulatory changes and new technology?
• Is the system affordable and user friendly?
• Can we implement without downtime or a productivity drop?

Shahram (Shez) Partovi, MD, CM, CMIO and neuroradiologist at Barrows Neurological Institute in Phoenix first introduced me to the idea of a cloud-based solution for radiology as a way to efficiently store and instantly share images and data with physicians and patients. We found that selecting a cloud-based medical imaging management system would allow us to access, store, annotate, and share current and prior medical images. Once we decided to pursue this course, we identified the following 10 priorities: 

• Affordable pricing that provides a quick return-on-investment (ROI) and long-term cost savings
• Easy implementation without a loss of productivity
• Proven, state-of-the art security that incorporates encryption and de-identification that meets or exceeds HIPAA and other privacy, security, and retention regulations
• Plug-and-play vendor neutral archive (VNA) technology that promotes interoperability as well as seamless data access and sharing regardless of where the image was created or what equipment was used
• Instant, 24/7 access from any Internet browser, including Google, Firefox and Safari
• The ability to block unauthorized users and record when and who attempted to access information
• Eliminates expensive infrastructure costs for disaster recovery, business continuity, and archival storage
• The option to view and compare multiple images on a single screen
• No limitations on storing or transporting even the largest images
• Scalability that satisfies an organization's current and future medical imaging management needs

Two years ago, we began the transition to DICOM Grid's cloud-based platform for medical imaging management. For months, it ran parallel to our existing storage system to ensure accuracy. When we determined that it performed slightly better than our system and provided expanded functionality for far less than we would spend on a new PACS, we decided that we would transition to the cloud-based platform that could incorporate pertinent data into an electronic health record (EHR) and boost collaboration. Before the transition, we relied on CDs, snail mail, and couriers to receive patient priors and for patients to share the info with referring physicians.

We estimated that a PACS migration would have been a costly, time-consuming, and aggravating process. Our move to the cloud-based platform was completed in about two weeks with very little drop in productivity. Everything returned to normal and the streamlined workflow has added to our productivity; we've never lost an image or had difficulty accessing data. The ability to instantly access and exchange images has enhanced our ability to collaborate with other hospitals and physicians in near real time. On the business end, we are ensured business continuity and disaster recovery.

Switching from a system can be stressful, but the outcome for medical imaging management is worthwhile. It helps us improve the quality and timeliness of care and can provide an easy method to integrate imaging data into EHRs, which will likely be required soon. It also provides the infrastructure to enable quick and painless adjustments needed to comply with other changes that soon will be mandated by the rapidly evolving health care delivery network.

Belinda Barclay-White, MD, is a board-certified radiologist and breast imaging specialist. She is owner and medical director of Arizona Breastnet in Scottsdale and co-founder of the non-profit Arizona Institute of Breast Health, a consortium of volunteer medical professionals who provide second opinions at no charge for women diagnosed with breast cancer.