Benefits of a Cloud-native Environment in Enterprise Imaging

Whitepaper | Todd Doherty
Product Manager and Director of Product Management in Data Services, Change Healthcare

Mr. Doherty has 20+ years of IT experience, including delivery of scalable cloud solutions in global markets. His team manages the cloudnative Change Healthcare Enterprise Imaging solution as a service.

In today’s world of value-based care, better outcomes and lower costs are imperative. Recognizing the need for innovative solutions is critical to achieving those objectives. To thrive in a crowded market, healthcare providers must also distinguish themselves from their competition.

Artificial intelligence (AI) and cloud-native solutions are making dramatic improvements in clinical outcomes possible. Their continued use will be vital as healthcare heads into the future of greater automation, sharing, and collaboration. By leveraging technology innovation, the world of enterprise imaging is embracing a new normal that will eventually shape the entire healthcare industry: cloud-native architecture.

Cloud-based Versus Cloud-native Technology

Before continuing, let’s distinguish between “cloud-based” and “cloud-native.” These terms sound similar, but the differences are important.

Cloud-hosted applications are defined as those that are stored, managed, and processed on a network of remote and leased servers hosted on the internet, rather than on local servers or personal computers.

Described another way, cloud-hosted solutions are traditional on-premises applications that have been “lifted and shifted” to an independent and leased data center location. This process achieves some economies of scale, as such solutions can share some network, platform, and storage components. However, the cloud-hosted solutions are limited by the need to manage each instance separately; the operation of potentially older technologies; and traditionally lengthy and manual upgrade processes.

In contrast, a full cloud-native solution is designed specifically for the cloud. According to a May 2019 article in Forbes, “cloud-native is about how applications are created and deployed, not where. Something can’t just be in the cloud to be cloud-native; it must be of the cloud—designed, optimized, and operated for the cloud.”¹

A cloud-native solution typically uses many automation features in its application to operate, support, and upgrade many customer accounts from a single instance, which uses far fewer resources than traditional IT solutions. As the Forbes article explains, cloud-native solutions help to enable flexibility, interoperability, efficiency, and resiliency—advantages that are not achieved by simply lifting legacy applications to the cloud.²

The differences between cloud hosting options are very important when deciding on a new vendor for an enterprise imaging solution.

Healthcare Leaders Weigh in on Cloud Technology

To better understand how the healthcare industry feels about cloud technology, Change Healthcare surveyed healthcare executives, finance leaders, VPs, and IT directors in late 2018. Our survey results indicate that 90% of respondents with a cloudhosted EHR believe that “cloud is where the industry is headed.”³

Along with other important questions, the survey asked whether the healthcare leaders currently had any IT systems in the cloud. Respondents cited EHRs (41%) and analytics solutions (32%) as the top two cloud-based systems currently being used.⁴

Clearly, cloud-based and cloud-native solutions are not a novelty. The movement to the cloud is already in progress, and expectations for measurable success are helping to guide the transition.

Artificial Intelligence in Healthcare

We all know that healthcare produces volumes and volumes of data, which can be instrumental in helping healthcare organizations manage costs and improve treatment outcomes.

But with mountains of data, the need to uncover actionable insights becomes an imperative. AI helps to guide clinical decision-making at the point of care by enabling fast analysis of huge quantities of data.

A recently published article in FierceHealthcare on the importance of AI in healthcare claims that AI clinical decision-support tools have given physicians “the ability to understand, access and analyze a wealth of real-world data…to produce trusted best practices that can be rapidly applied to their clinical practice.”⁵

The article also cites a report by Dell EMC and the research firm IDC, which found that “health data volumes increase by a staggering 48% annually.”⁶ This creates a great opportunity to use AI to mine this wealth of data for trends and medical analysis for improved clinical outcomes.

When used in conjunction with patient diagnosis, AI also helps to improve the efficiency of analysis and clinical results. For example, the use of integrated AI capabilities in radiology tools is replacing the need for tissue samples in certain tests, such as biopsies—minimizing the need for invasive procedures and reducing the patient’s risk of infection.⁷

Benefits of Cloud-native Solutions

Now that we have a bit of a framework around the terminology and the uses of AI in healthcare, let’s talk about the specific benefits of cloud-native solutions for healthcare.

The primary benefit lies in superior accessibility. When data is properly organized and hosted in the cloud, caregivers can access the information they need more easily, resulting in more effective collaboration.

Some providers choose to adapt their legacy, onpremise architectures to the cloud. Unfortunately, this “lift-and-shift” approach does not take full advantage of cloud computing’s scale across multiple tenants, which results in beneficial services automation, ease of interoperability, and most importantly, security controls. In addition, cloudnative solutions are easier to deploy, operate, monitor, and upgrade.

When migrating to a cloud-native service, there is no need to design project- or department-specific requirements for hardware, software, or loadbalancing resources. The migration and onboarding process can be accomplished rapidly—within days or weeks, not years—with no need to plan for future hardware or storage. In addition, moving to the cloud is generally associated with low switching costs from legacy solutions.

A cloud-native architecture can request system resources for performance demands and expansion as needed, and reduce systems resources when not. Resource efficiency is optimized through automatic system monitoring that recognizes peak and nonpeak times. The system is therefore able to provide millisecond access response for all storage tiers, without delays, regardless of file age.

In a multi-tenant environment, upgrades are issued to all customers at once, allowing the entire customer community to benefit from product enhancements at the same time. Changes can also be isolated to specific groups of users, allowing customers to reduce risks or enable testing and training to be completed before full accessibility of new features.

Traditional maintenance events for large-scale upgrades require lengthy planning and downtime. With cloud-native architecture, these events are no longer necessary. Application versioning is no longer relevant, as product changes are released frequently, as needed.

Alternatively, lift-and-shift cloud-hosted solutions require each customer to be individually upgraded. This greatly increases costs, as system and personnel resources are needed to manage the updates, risks, and testing. Due to these limitations, cloud-hosted solutions are generally not upgraded as frequently as cloud-native solutions.

To summarize, cloud-native architecture can help providers reduce cost burdens, build a connected healthcare ecosystem, and enable caregiver focus on improving outcomes.

Technology to Enable Better Outcomes

The evolution toward cloud-native, AI-enhanced enterprise imaging is currently in progress. At Change Healthcare, we are committed to developing cutting-edge solutions that connect the healthcare ecosystem and help our customers reduce their cost burdens and improve the quality of care they deliver. We strive to be the vendor of choice for our customers as they focus on outcomes.

The zero-footprint Change Healthcare Enterprise Viewer easily integrates with existing EHRs, providing a holistic view across all imaging specialties—a critical component in building a more comprehensive health record. The platform can help unlock valuable data and improve imaging outcomes, providing healthcare organizations with financial predictability and limitless scaling.

Change Healthcare’s cloud-native enterprise imaging platform is the only solution designed for the era of big data and AI. Its cutting-edge capabilities are helping healthcare organizations reduce IT costs and simplify enterprise imaging to ultimately improve care delivery and outcomes.

Internal Resources and the Cybersecurity Concern

As our survey indicates, most healthcare leaders already recognize the cost benefits of cloud-native architecture. The majority (64%) cite cloud-based systems as superior to traditional IT solutions in that they use fewer internal resources,⁸ which is a concern for those with insufficient resource talent and training—particularly around cybersecurity— within their IT employee pool.

In fact, most healthcare CIOs report that they do not want to be in the IT infrastructure business on a long-term basis. Most surveyed healthcare leaders (51%) believe that cloud solutions are easier to deploy and maintain.⁹

When asked how cloud-native architecture compared to traditional IT, almost half (48%) appreciated the opportunity to move from a capital expense to an operating expense, while 43% cited easier upgrades as a key factor in making the transition to the cloud.¹⁰

Despite these benefits, many leaders still believe that a well-managed on-premise imaging solution is more secure and controlled than cloud-native solutions. Perhaps this is due to a misconception about the degree to which cloud-native systems excel in security practices. When executives were asked what key factors they would consider before moving IT systems to the cloud, more than 80% cited data privacy and security, with performance (80%) and financial benefits (70%) coming in strong as top concerns.¹¹

In fact, a large, centrally administered, multi-tenant system allows cloud service providers to standardize security practices across an entire customer base. This increases a vendor’s capacity to respond more quickly to threats and adhere to cloud security frameworks. It is imperative that cloud solutions adhere to the latest cybersecurity guidelines and certifications, and that they are fully compliant with HIPAA, FDA, and HITRUST standards.

Healthcare vendors with a vision for the current benefits and future potential of cloud-native applications can guide hospital and health system CIOs to select the most appropriate nextgeneration solutions for improving outcomes and managing costs.

Key Features of Well-structured Enterprise Imaging Solutions

We believe that there are three important questions healthcare executives should be asking when considering their next generation of EI solutions.

1. Is the platform comprehensive and fully integrated across all modules? 
2. Is the platform vendor-neutral, and does it follow industry-standard data practices? 
3. Is the solution designed as cloud-native to scale for the future? 
4. A comprehensive and fully integrated enterprise imaging platform ought to cover the full imaging spectrum: radiology, cardiology, radiation treatment, orthopedic surgical planning, surgery, wound care, dermatology, point-of-care ultrasound, and emergency ultrasound, as well as other care settings.

Vendor-neutral EI solutions are ideal, as they offer ease of integration. CIOs should feel confident that they have the right solutions to improve image data sharing across multiple vendor platforms—helping their clinicians provide more efficient patient care.

Technology to Enable Better Outcomes

The evolution toward cloud-native, AI-enhanced enterprise imaging is currently in progress. At Change Healthcare, we are committed to developing cutting-edge solutions that connect the healthcare ecosystem and help our customers reduce their cost burdens and improve the quality of care they deliver. We strive to be the vendor of choice for our customers as they focus on outcomes.

The zero-footprint Change Healthcare Enterprise Viewer easily integrates with existing EHRs, providing a holistic view across all imaging specialties—a critical component in building a more comprehensive health record. The platform can help unlock valuable data and improve imaging outcomes, providing healthcare organizations with financial predictability and limitless scaling.

Change Healthcare’s cloud-native enterprise imaging platform is the only solution designed for the era of big data and AI. Its cutting-edge capabilities are helping healthcare organizations reduce IT costs and simplify enterprise imaging to ultimately improve care delivery.

_{^{1 Karthik Ramasamy, “What Does It Mean To Be Cloud-Native?” Forbes Technology Council, May 21, 2019.
2 Ibid.
3 Change Healthcare, C-Suite Cloud Adoption Survey. October, 2018.
4 Ibid.
5 Richard Loomis, M.D., “Industry Voices: How AI Technology Can Improve Patient Care Outcomes,” FierceHealthcare. May 10, 2019.
6 EMC Digital Universe and IDC, “The Digital Universe Driving Data Growth in Healthcare: Challenges and Opportunities for IT.”
7 CIO Review, “How Adopting Artificial Intelligence Is Going to Benefit the Healthcare Industry,” June 4, 2019.
8 Change Healthcare, C-Suite Cloud Adoption Survey. October, 2018.
9 Ibid.
10 Ibid.
11 Ibid.}}