Keystone Technologies works with Merge Imaging to deliver AWS cloud-based solutions to Radiologists


Keystone has been in the business of supporting the on-premise infrastructure for PACS (Picture Archive and Communications System) solutions for over a decade. When recently working with a client in Paducah, KY on a hardware upgrade and cloud migration strategy to improve the performance of the EMR platform, it became apparent that moving PACS to the AWS cloud was a winning strategy. This was a surprising revelation.

PACS is somewhat unique – it works with very large image files that dwarf most other common systems’ files found in healthcare IT applications. This presents special challenges for the Radiologists tasked with viewing and interpreting these files. Even with high speed internet, 1Gbps networks, it can take several seconds to load a complex study onto their screens. Because of this, on-premise, local hardware has traditionally been the go-to strategy for PACS even in the current “cloud first” evolutions for other systems. While a cloud architecture can work against the performance requirements for PACS, other factors all favor being in the cloud such as: lower capital costs, a tighter “pay as you go” op-ex, better disaster recovery and business continuity at a reasonable cost, enhanced security, and improved remote access.

We initially approached the client with a hybrid strategy: local storage for performance, and the rest of the solution in AWS to gain the aforementioned benefits. Local storage was kept small and simple to minimize the downside associated with maintaining on-premise hardware. No local backups were required as the complete system was fully backed up in the cloud. Local storage was simply treated as a local “cache” of the last 12-18 months’ worth of studies which account for approximately 95% of all prior study requests. Client Radiology workstations were configured to “look local first” and automatically escalate the request to the AWS cloud infrastructure only when needed. Reliable and performant study retrieval, along with a world class application workflow, are the key success factors in every PACS implementation.

To address performance and reliability of the Wide Area Network (WAN), an SD-WAN infrastructure was put in place as-is best practice in all mission critical cloud architectures. With 40-50 concurrent users on the EMR and PACS systems, with testing we determined 200Mbps of symmetrical bandwidth (up and down) would be sufficient. Indeed, their average utilization during busy times is under 50Mbps.

During a downtime of the local storage, the pleasant surprise was that the Radiologists experienced nearly the same performance when hitting their studies on AWS as when they were hitting local storage. With this, the decision was made to simplify the overall architecture by eliminating the local server entirely. This also supports the Radiologist’s access from any location. This consistency of user experience was another huge win!

With Keystone’s PACS AWS Migration-Hosting solution our client reduced and eliminated performance issues with dynamic computing, gained real-time direct database access to all PACS images from any location, reduced costs for PACS management, eased integration with foreign systems, and provided faster patient diagnoses due to increased ease of collaboration between platforms.

This hosted solution, powered by AWS, provides a highly available and reliable infrastructure to address our clients medical image management needs and allows their staff to focus on patient care, not IT.

Share this: