Medical Information on the Go

Oliver Klaffke
Article from the customer magazine Medical Solutions, December 2010

www.siemens.com/healthcare-magazine

Highlight Topic Efciency: Cloud Computing

28 Medical Solutions December 2010 www.siemens.com/healthcare-magazine

Highlight Topic Efciency: Cloud Computing

Access to medical data from everywhere is the promise of cloud

computing. It will help increase efciency and reduce costs to make
the life of radiologists easier.
By Oliver Klaffke

Medical Information on the Go

Elliot Fishman, MD, is Professor of Radiology and Oncology at Johns Hopkins
University School of Medicine in Baltimore, Maryland, USA, and an e-gadget
aficionado. His enthusiasm for using
multipurpose devices is strictly professional: He wants to make medical images
available to physicians everywhere. Just
a day before I spoke to him on the promises of cloud computing for medical professionals, he presented a novel radiology
iPad application to Apple.
The days when a radiologist had to dash
to his or her computer to access images
are coming to an end. It is cloud computing that is going to change the way radiologists, as well as a number of other
professionals, will work with data. Stored
in a so-called cloud, which can be a distant hospital server or somewhere in the
Internet, data can be worked with from
everywhere provided there is access to
the Internet.
Fishmans application1 is destined to
make life easier for radiologists and those
involved in using medical information.
Nowadays, everybody is used to accessing information 24 hours a day, every
day of the week, and wherever they are,
Fishman says. The way we expect information to be available has changed much
in recent times. We are used to checking
our mails on the go or surfing the Internet on a mobile device while commuting
to or back from work or sitting in a caf.

Technological breakthroughs such as the

iPhone and the iPad helped the mobile
Internet to really take off during the past
three or four years, Fishman says. Information is no longer available only on the
hard disk of a computer, on a laptop tapping via wireless access to the Internet
today a cellular phone or an iPad is sufficient. When sitting in a caf, I could
easily access my cases on my iPad, he
says.
While out of his office, Fishman could still
react to inquiries by surgeons, cardiologists, referring physicians, or anybody
who needs his advice. Having access to
the data in the cloud will make the life
and work of radiologists more efficient,
he says. There is even a benefit for the
patient: As it will be easier and more convenient to access data2, physicians will
spend more time actually having a closer
look at the computed tomography or
magnetic resonance images.

Soarian Integrated Care

What Fishman described as a major
change to the way radiologists work has
been on Siemens agenda for the past
couple of years. The company has used
the cloud computing approach to design
novel services. They enable hospitals
to give their different medical facilities
access to a patient file. In the Aachen

The information about the described application is

preliminary. The software is under development and
not commercially available in the U.S. and its future
availability cannot be ensured. The application is not
intended for diagnostic use.

Prerequisites to data access include: Internet connection to clinical network, DICOM compliance, meeting
of minimum hardware requirements, and adherence
to local data privacy and security regulations. Use of
images for diagnostic purposes on mobile products
varies by country. Check your local regulations for
usage of mobile products. Not for diagnostic use in
the U.S.

region in Germany, just at the border to

Belgium, Silke Haferkamp, MD, started
an ambitious networking project back in
2008. Its aim is to connect all facilities
of Aachen University Hospital to make
patient data readily available at all sites.
Aachen University Hospital has 32 clinics
where almost 45,000 patients are treated
every year. Haferkamp is the head of IT
services and responsible for designing
and implementing the network that will
consolidate a number of different patient
record systems to just one. Siemens
Soarian Integrated Care plays an important role in our strategy, she says. We
want to offer the other hospitals in the
area a hosted platform that makes the
complete patient file available. Soarian
Integrated Care supports communication
between various healthcare facilities.
This is enabled through the exchange
of diagnostic reports and images and
through the administration of a common
patient file. Experts consider this to be
a key to boost efficiency and to reduce
cost. As a result, those involved in caring
for a patient have easy access to all relevant information entered in the treatment
network and provided in the patient file.
Before implementing Soarian Integrated
Care, we used TelePACS, Haferkamp
says. Our radiologists sent their images
using DICOM from the PACS [picture
archiving and communication system]
directly to their colleagues involved in
the case. Unfortunately some emergency
rooms werent connected to the system,
and in cases where time was precious
the imaging data would have been copied
on a CD and sent in a cab to the hospital
where the patient was waiting for urgent

Medical Solutions December 2010 www.siemens.com/healthcare-magazine

29

Highlight Topic Efciency: Cloud Computing

Summary
Challenge:
How to make medical information
available 24/7 from anywhere,
raise efficiency, and save money
Solution:
Cloud computing provides access
to data from virtually anywhere,
provided Internet or a data line are
available
Result:
Medical files can be accessed from
every computer in the clinic fulfilling corresponding prerequisites
and only one patient file will exist
Data will no longer be stored in the
hospitals IT department but will
be taken care of by third-party data
storage providers

treatment. Since the staff working in

the emergency rooms wanted to have
access to the TelePACS as well, we decided
we wanted a solution that included not
only images but the patient file as well.
It was time for a leap forward and a network solution that offered all the benefits cloud computing can provide: one
file stored on one server that can be

accessed from every hospital in the network. Three weeks after implementation
was started in Aachen, Soarian Integrated
Care was running. It took three further
months to train the users to run the
system and introduce them to the new
workflow.
The classic hospital information systems
from Siemens, such as medico, i.s.h.med,
and the innovative workflow management system Soarian Clinicals, are compatible with Soarian Integrated Care.

home in a fraction of the time without

wasting fuel and polluting the environment and with less damage to his family
life.
In Nuremberg, a town in southern
Germany, Reinhard Loose, MD, PhD, has
been trying to benefit from cloud computing for the past couple of years. He is
Head of Radiology at Nuremberg hospital. With cloud computing, we are pursuing a number of different approaches,
he tells me. The aim is to make our work
more efficient, to reduce complexity,
and finally bring costs down.
In January 2010, Loose started a collaboration project with Siemens for a
cloud-based approach to computer-aided
detection (CAD) of lung nodules in digital chest X-rays.3 This is an extremely
difficult task that needs very sophisticated algorithms and a lot of computing
capacities, he says. A cloud-based
approach is very promising, as it is possible to combine three key success factors:
large amounts of data, expert radiologist
feedback, and cutting-edge CAD technologies.
In this collaboration project, digital
chest X-ray data is de-identified so that
no personalized data leaves the hospital,
and then sent over to an offsite server
managed by Siemens using a secure
Internet connection. The data is processed

Taking Cloud Computing

Further
Siemens is taking the cloud approach
further and has developed solutions which
help to access data through the Internet.
With syngo WebSpace, radiologists can
work from nearly wherever they wish and
benefit from all the features they know
from the imaging software syngo.via. In
daily clinical practice, this is greatly welcomed. Think of a senior radiologist offduty and spending an evening with his
family, and his assistant calls because he
needs his opinion. Until a few years ago,
he would have hopped into his car and
dashed to the clinic in order to have a
look at the images, which would have
taken a couple of minutes at least. If he
was lucky he would have been back
within an hour but the evening would
have been lost. With Siemens syngo
WebSpace, he checks the images from

Not available for sales in the U.S.

Cloud Computing
Advanced clinical applications and image management
solutions impose high demand on the underlying IT infrastructure regarding performance, security, and dependability. The challenge is to deliver these requirements in
the most economic way, optimized to the healthcare providers IT environment and business needs.
Cloud computing offers a set of technologies enabling very
efficient means to provide IT resources such as storage
and computation on-demand and with very high scalability.
For this, the local hospital systems are linked to remote
data centers via a secure connection to protect sensitive
patient information. Applications are delivered from the
data center or by smartly combining data-center and on-

premise resources. Leveraging central maintainability and

on-demand scalability of cloud computing, software and
infrastructure can be delivered as a service, economically
scaling along with customer needs.
Being intrinsically connected to the Web, cloud computing offers efficient means to enable cooperation between
users within and outside of the hospital. Images and
patient information will be available on-demand, anywhere and on any device.
Siemens is continuously developing syngo products and
solutions that employ cloud computing technologies to
offer fast and secure access to clinical data, flexible licensing, zero maintenance, and a low on-premise IT footprint.

30 Medical Solutions December 2010 www.siemens.com/healthcare-magazine

Highlight Topic Efciency: Cloud Computing

The aim is to make

our work more
efcient, to reduce
complexity, and
nally bring costs
down.
Reinhard Loose, MD, PhD,
Professor of Radiology, Department of
Diagnostic and Interventional Radiology,
Nuremberg North Hospital, Germany

using the latest available chest X-ray CAD

algorithm, the nodules are marked, and
the data is sent back to the hospital. With
the cloud-based approach to CAD, we
can collaborate in a very effective way in
order to continuously improve the algorithm performance of the chest X-ray CAD
system, Loose says. We have processed
several hundred cases by now. The system runs very smoothly, and the turnaround time is only a few minutes.
Patient confidentiality is a top priority,
and since no personal data is sent out
of the hospital, the risk of inadvertent
patient data disclosure is drastically
reduced.
Cloud computing also offers some advantages when it comes to archive data.
Medical data needs to be stored in Germany for a period of ten years or, in the
case of children and adolescents, until
they are 28. In daily clinical practice, 90

We want to offer
the other hospitals in the area a
hosted platform
that makes the
complete patient
le available.
Silke Haferkamp, MD, Head,
IT Services, Aachen University Hospital,
Germany

percent of the data is retrieved from the

archive when the patient is still in hospital until a few days afterwards. Archive
retrieval falls exponentially thereafter,
Loose explains. The big question is how
to store data and organize access. In the
Nuremberg hospital, an in-house system
uses local storage capacities and allows
fast retrieval of up to seven-year-old
data in the radiology department and up
to five-year-old data all over the clinic.
Simultaneously, the data is constantly
uploaded to an external data-hosting
provider. The reasons for outsourcing
data storage are price and practicability,
Loose says.
Teleradiology is a good example for
the benefits of cloud computing, he
says. Smaller hospitals in particular
tend to have an understaffed radiology
department, which needs to be closed
when the radiologist is on vacation or

Having access
to the data in the
cloud will make
the life and work
of radiologists
more efcient.
Elliot Fishman, MD,
Professor of Radiology and Oncology,
Johns Hopkins University School of
Medicine, Baltimore, Maryland, USA

ill. We have a contract with a nearby

hospital which needs an additional radiologist when the regular one isnt around,
Loose says. One of his staff members
takes over, accessing the images in the
cloud. Perhaps one day he can work
with a complete set of advanced reading
applications on mobile devices.

Oliver Klaffke is a science and business writer

based in Switzerland. He has worked for New
Scientist and Nature, among other publications.

Further Information
www.siemens.com/SIC
www.siemens.com/
CAD-subscription
www.siemens.com/WebSpace

Medical Solutions December 2010 www.siemens.com/healthcare-magazine

31

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