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ARA’s swift and decisive move to Azure. Why and how they did it.
Last month my curiosity was piqued when I heard about Austin Radiological Association’s (ARA) decisive and swift move of their 3D tomography data storage and compute services to the cloud. Especially at a time when so many of the health system executives I meet still cite security and compliance concerns keeping them out of the cloud. To better understand why and how they pulled off such a feat, I picked up the phone to arrange an interview with their CIO, Todd Thomas. Below is the transcript of my interview with Todd.
Schmuland: To provide readers with some context, could you tell me a bit about the business of Austin Radiological Association and your service area footprint?
Thomas: Sure. ARA is the largest outpatient imaging services provider in central Texas. We operate 17 outpatient imaging centers–offering everything from mammography to MRI–and serve 21 area hospitals throughout Austin and Central Texas with quality imaging services. We have roughly 750 employees and 100 radiologists and our commitment is to ensure access to high quality imaging technologies while delivering excellent patient satisfaction to our community.
Schmuland: In a few sentences, how would you describe your unique customer value proposition in the fee for service and fee for value payment models?
Thomas: Our value proposition is the same, regardless of the payment model. We go out of our way to make the exam experience for the patient as easy, smooth and positive as possible. Our outpatient clinics in the suburbs provide better access and convenience for patients that don’t live near a major hospital. This means we’re frequently able to schedule imaging tests where it’s most convenient for the patient. We also expedite the registration process to enable patients to get back to doing the things they’d rather be doing. And we hire top radiologists to make sure our read quality is the highest and we maintain high service level agreements with our health system customers.
Schmuland: ARA appears to be an outlier in that your move to the cloud was swift and decisive at a time that many health organizations are still reluctantly inching their way to the cloud. What were the factors that compelled your leadership to leap rather than dither your way to the cloud?
Thomas: We saw three sharply rising trends that made it clear to us that moving to the cloud sooner rather than later was an absolute necessity, not an option: image size, quantity, and storage costs.
First was the explosive growth in image size. As image quality gets better and better for modalities like CT, ultrasound, tomography, and MRI, the image size on the disc also gets larger and larger. For example, when you move from 2D mammography to 3D the size of each image increases exponentially, by about 20-fold for 3D mammography.
Second, the quantity of images per study is increasing exponentially. CT slices are getting thinner and thinner. So, the number of images per exam on disc is growing exponentially. There is also 3D reconstruction of these images, which is not a part of our normal radiologist workflow today, but with the increase in workstation compute power, will become more common. Storing those 3D reconstruction models will take an immense amount of storage space.
Now couple these two trends with spiraling growth in the cost of on premise storage and cooling. This was the writing on the wall that made it clear to our leadership team that moving to the cloud wasn’t optional for us. It just made complete business sense.
But it wasn’t just our never-ending capacity headache that made our decision to move to Azure easy. Moving to the cloud also enabled us to focus our limited time and resources on growing, running, and transforming our business, rather than running an ever-expanding datacenter.
We first came to fully appreciate this two years ago when we launched 3D tomography to our community and realized we’d have to go to the board to get approval for another 150 terabytes of in house storage space. By now this had become a recurring event –every 6-18 months we’d have to get board approval for the new capital needed to expand our storage capacity. The problem was that we knew we didn’t have another 6 months of storage capacity because demand was going through the roof—by 2020 we were projecting to be at 1.5 petabytes of mammography image storage. So this time we turned to Nasuni, a virtual and on-premise storage service built on Microsoft Azure, and asked them how quickly they could add 150 terabytes. When they said, “How about tomorrow?” and then went on to prove their performance to be better than their competitors through performance benchmarking, we knew we had our answer.
Since then, Nasuni has greatly simplified our storage provisioning and made storage management much easier. Moving our 3D tomography images to the cloud has protected our capital budget from large and lengthy storage procurement requests every two to three years. Now, rather than focusing time and labor on these refresh cycles we can focus our resources on growing our business and improving the quality and end user service excellence for our patients. In the first year alone, we estimate we saved approximately $1.2 -1.3M in storage costs with the Nasuni/Azure solution.
Schmuland: Were there any other reasons you chose Nasuni as your go-to cloud partner over other alternatives?
Thomas: As I mentioned earlier provisioning additional storage with Nasuni was easy and on-demand. We also liked how Nasuni’s pricing model is both competitive and predictable. Plus, they also offer integrated backup and disaster protection for patient files and they let us hold our own encryption keys–which means that neither Microsoft nor Nasuni can access patient data. The other major reason we chose Nasuni is that they built their solution on top of Microsoft Azure, which gives us the level of security, geo-redundancy, and disaster recovery, as well as compliance documentation to be confident that our data is secure.
When it comes to retrieval, we are able to ensure clinicians have rapid access to images without cloud latency using Nasuni edge appliances, which intelligently cache files locally. We are also able to pre-load large, historical file sets if they are needed for a patient visit the next day into the Nasuni edge appliances. Overall, Nasuni/Azure provides a very comprehensive cloud solution.
Schmuland: Many health organizations, like ARA, understand the business justification for moving to the cloud, but unlike ARA, many of these same health organizations are delaying their move to the cloud because of security and compliance concerns. Did your leadership team have concerns around security and compliance and, if so, how did you address them?
Thomas: Sure, there were concerns at first, until we understood that the Nasuni/Azure solution we were looking at was completely HIPAA compliant. Along with the business case, I shared several analyst reports like a recent one from Gartner stating that cloud service providers in the health industry are in most cases more secure than healthcare providers’ internal IT services. Knowing that Nasuni’s Azure-based solution was secure and compliant by design gave our leadership team confidence to move to the cloud. At the same time we knew that, for our clients that weren’t yet ready to move to the cloud, we could keep their storage on-premise until the time came when they were ready to make the move.
Learn more in our Cybersecurity in Health e-book.
