? Cloud imaging is the storage of medical imaging data (CT, MR, DR, ultrasound, etc.) in the cloud, so that it is convenient for the patient to access, and for the patient to transfer to the hospital or other hospital doctors to access the consultation. At present, many companies provide a thing called "cloud film", each image uploaded to the cloud, radiology and MR is about 20 ~ 30 yuan, ultrasound category is about 2 ~ 3 yuan. It also encourages hospitals to put all the image data into the cloud to save. It looks wonderful, but requires careful consideration of risk avoidance.
Second? The benefits of cloud imaging: 1. Convenient for patients, without having to wait in line to get the film, the film itself is not easy to carry, not easy to save. When the patient is transferred to the hospital for consultation, it is convenient for the other doctor to access.
2, the benefits of the hospital is to reduce the amount of film purchased, after all, now to push the zero-percentage increase in supplies. Reduce the amount of self-service filming machine configuration, which means space, electricity, maintenance fee savings. If the patient does not hit the film, more able to save a lot of cost for the hospital.
Third, there are hidden dangers
? "Electronic Medical Record Management Specification" Chapter 1, Article 3 Electronic medical record refers to medical personnel in the process of medical activities, the use of information systems generated by the text, symbols, charts, graphs, figures, images and other digital information, and can realize the storage, management, transmission and reproduction of the medical record is a form of medical record records, including the outpatient (emergency) clinic and hospitalization medical records. Chapter III Article 19 Outpatient (emergency) electronic medical records kept by the medical institution, the preservation time from the date of the patient's last visit not less than 15 years; hospitalization electronic medical records preservation time from the date of the patient's last discharge not less than 30 years. This specification determines that we must be careful in choosing cloud imaging.
? I've seen contracts offered by certain companies that don't specify storage years at all. Even if there is a storage life, with 30 years being so long, the risk of the company going out of business is raised to a very dangerous level. Many companies have extracted the image storage cost in one go through the charging method mentioned above, the short-term gain is much bigger than the long-term gain, the short-term cost is much smaller than the later cost, and the risk of subsequent default is getting higher and higher. Moreover, hospitals sign contracts with cloud film providers, and they have no control over where the cloud space for images is located. For example, if a company promises to save images with our hospital for 30 years, and then they only sign a 5-year contract with the cloud space provider, what will the hospital do then?
Fourth, the hospital's response
The many advantages of cloud imaging make it imperative that we apply it, but the safety and reliability of imaging data is always higher than anything else. How to avoid the risk, I think we can consider from two aspects, the image data all on the cloud and part of the cloud. The judgment standard is cost (economic cost, management cost), everything is based on cost. A hospital is unconditional to expand the machine room, personnel maintenance costs are high, then you can consider all on the cloud.
1, all on the cloud, choose the most secure cloud space provider, directly with the space provider to sign a contract, the size of the cloud space according to the actual situation of the purchase is the most economical, the three major communications carriers are recommended (choose the state-owned enterprises of the least political pressure). The cloud film provider is to provide services, including the provision of systems, functional modification, promotion and operation of human resources.
2, part of the cloud, which requires the transformation of the PACS system, the image is divided into hot images and cold images. The hot image is the image produced in the recent period (6 months up to 1 year). For hot images to go to the cloud, the cloud space can be rented in a relatively small space, which is relatively inexpensive and does not affect the use. Hot images in the hospital can be set up in a higher-end server (e.g., all-flash) for fast distribution and smooth in-hospital use. Cold images can be stored in lower-end storage to save costs, and can be compressed using compression technology to further save space. Five months of uncompressed images in a hospital is roughly 8.6 TB, compressed to only 2.6 TB. how much does a low-end storage cost? How much is the monthly electricity bill? And full can also be external hard disk cabinet, hard disk capacity is increasing, the price is decreasing. Interested in their own can do a cost analysis.
V. An example
A cloud film company to a hospital quoted radiological cloud film 23 yuan / copy, ultrasound endoscopy 2 yuan / copy. A hospital in 2018 CT, MR, DR, DSA new images 139,150 copies, if each copy needs to pay 23 yuan to the imaging cloud, then it will need to pay 3.2 million yuan. 131,699 ultrasound, endoscopy, pathology images, each copy needs to pay 2 yuan to the imaging cloud. Then $264,000 is needed. A total of 3.464 million dollars.
A hospital's six-month image increment is about 10TB, then if only these hot images on the cloud, a communications carrier quoted 594 yuan / TB / month, the total **** is less than 6000 yuan / month. Other system setup, functional modifications and other service fee costs have a reference offer is about 20,000 / month.
Six, summary
Cloud imaging is essentially a service, cloud film is to take it as a general commodity to price, it will bring a lot of problems. Hospitals need cloud imaging, reject cloud film.
VII. Postscript
A company came to me to say, their cloud film is a medical device registration certificate, if the hospital to provide similar services to patients must be medical device registration or will be reported. Also cited so-and-so hospital to engage in their own, and then was how how 。。。。。
I listened to the anger, rhetorical question: 1, cloud film registration certificate how to come I do not go to examine whether the relevant licensing unit did not consider clearly. Simply on medical devices, hospitals to buy any medical device, must be qualified manufacturers to produce and provide a complete product. Where does the cloud film data come from? It is generated by the hospital, how does it become your product?
2. The image data is generated from the medical devices in the imaging department, which themselves have registration certificates, and the PACS system software for image storage and reading, which itself has a medical device registration certificate. Our hospitals provide this imaging data to patients, and not a single byte of the data changes, so where is the non-compliance?
The ownership of the image data was originally the hospital's, so why are you so arrogant?