Keystone Technologies has been in the business of supporting on-premise infrastructure for PACS (Picture Archive and Communications System) solutions for over 25 years. Our experience spans numerous healthcare facilities, helping them optimize their PACS performance while navigating the challenges of managing enormous image files. Recently, while working with the Orthapaedic Institute of Western Kentucky (OIWK) on a hardware upgrade and cloud migration strategy to improve their EMR platform, we uncovered a surprising revelation: moving PACS to the AWS cloud was a winning strategy.
The Challenges of PACS in Healthcare IT
But let’s level-set before we dive into the OIWK story. Each year, over 3.6 billion medical imaging procedures are conducted worldwide, producing vast amounts of data measured in exabytes. That’s an enormous amount of data to store, secure, and make accessible. Would it surprise you to know that the average number of daily imaging procedures assigned to radiologists in the U.S. has grown from 58 to 100 since 2008? On top of that, due to improved imaging technologies, the average size of an imaging study has also doubled, reaching nearly 150 MB.
PACS stands out in healthcare IT because it handles massive image files, far larger than the text-based data found in Electronic Health Records (EHR). These complex imaging studies require rapid access and seamless integration, making performance critical. Traditionally, on-premise storage has been the preferred solution to avoid delays in loading images—even as other systems have moved to the cloud. The last situation a CIO wants to face is hearing from a radiologist who couldn’t pull up essential scans or experienced lag during a procedure.
With high-speed networks, it can still take several seconds to load a detailed study on a radiologist’s screen. This has historically been a major reason healthcare providers were hesitant to adopt cloud solutions for PACS. However, other factors such as capital cost reduction, lower operating expenses, improved disaster recovery, enhanced security, and better remote access all favored cloud migration.
Why Keystone’s AWS-Powered PACS Hosting Stands Out
During the project with our client in Kentucky, we initially proposed a hybrid strategy—local storage to handle immediate performance needs, and AWS for enhanced scalability, cost-efficiency, and data security. This approach enabled the client to benefit from the best of both worlds. Local storage was minimized, acting as a cache for recent studies, while the bulk of the data was securely stored and managed in the AWS cloud. Radiologists’ workstations were configured to check local storage first, and if necessary, escalate the request to AWS. The results exceeded expectations.
Here’s where Keystone Technologies’ AWS-based PACS hosting sets itself apart from traditional providers solutions:
- Dynamic Performance
Keystone’s solution offered a seamless experience, even when relying on cloud-hosted data. When the local storage experienced downtime, radiologists were able to access their studies from AWS with nearly the same performance as from local servers. This success led to a bold decision: eliminating the local server altogether. - Cost-Efficiency and Simplified Infrastructure
While some healthcare solutions typically offer PACS hosting through on-premise or hybrid models, Keystone leverages AWS to provide a fully cloud-native solution. This eliminates the need for expensive hardware refreshes and reduces operational costs significantly. With Keystone, healthcare providers benefit from pay-as-you-go pricing models that scale dynamically, based on their needs. - Improved Security and Compliance
Keystone Technologies’ PACS hosting solution on AWS ensures HIPAA compliance through a robust framework of industry-leading security protocols. Leveraging AWS’s advanced security features, Keystone enforces strict role-based access controls (RBAC) to ensure that only authorized users can access protected health information (PHI). Data is safeguarded at every stage through encryption, threat monitoring, and multi-factor authentication (MFA), both in transit and at rest. Regular audits uphold compliance and maintain the highest standards of PHI protection. - High Availability and Disaster Recovery
By tapping into AWS’s global infrastructure, Keystone offers multi-region redundancy and disaster recovery options. In contrast, traditional PACS providers rely on localized hardware and backup strategies, which can be more prone to downtime and slower recovery in the event of an outage. Keystone’s AWS-powered hosting ensures continuous availability and performance. - Scalability and Remote Access
With Keystone’s AWS-hosted solution, radiologists and medical professionals can access PACS data from any location. The consistent performance provided by the cloud environment ensures that remote staff, as well as on-site teams, have fast, reliable access to critical imaging studies. Keystone’s migration eliminated local server dependencies, giving radiologists the flexibility to work efficiently from any location—a major advantage over traditional solutions.
Real-World Success: A Client’s Journey to Simplified PACS Hosting
The OIWK PACS project moved from initial assignment to full execution with Keystone focusing on setting up the AWS instance and a behind-the-scenes data sync to migrate data across the internet to the cloud. Meanwhile, the Keystone team worked hand-in-hand with OIWK to manage additional complexities, such as data discovery, re-linking in AWS, application installations, and database configurations.
Keystone’s client in Kentucky, with around 40-50 concurrent users on their EMR and PACS systems, witnessed firsthand the transformative power of our AWS-hosted solution. By implementing an SD-WAN infrastructure for optimized Wide Area Network (WAN) performance, we ensured reliable access and quick study retrieval even in cloud-hosted environments. After testing, we confirmed that 200Mbps of symmetrical bandwidth was more than sufficient, with peak usage rarely exceeding 50Mbps.
This efficient use of bandwidth, combined with AWS’s robust cloud capabilities, demonstrated to the client that they no longer needed local storage for high-performance imaging workflows. The result? Simplified architecture, reduced IT overhead, and a consistent user experience for radiologists—whether accessing PACS from the office or remotely.
Figure 1. Simplified PACS Hosting Architecture
Utilizing AWS, Keystone ramped up performance throughout the migration, achieving cost savings along the way. By combining strategic resource management with AWS’s flexible pricing and storage options, IT team maximized performance and availability without inflating costs. This approach included:
- Right-sizing – Regularly assess and adjust resources to align with actual usage. This includes selecting appropriate instance types and sizes that match workload requirements, thereby avoiding over-provisioning and reducing unnecessary costs
- Reserved Instances – This option offers significant discounts compared to on-demand pricing, leading to substantial cost savings over time by paying upfront and/or committing to a specified term length.
- Storage Optimization – Choose storage options that align with data access patterns. For PACS, this meant dividing hi-resolution images onto faster storage, while moving infrequent access or lower-resolution images onto cheaper storage tiers. This is reflected not only in production, but also backup and Disaster Recovery storage.
The Keystone Advantage: Redefining PACS Hosting with AWS
With Keystone’s AWS Migration-Hosting solution, our client reduced and eliminated performance issues through dynamic cloud computing, gained real-time direct access to all PACS images from any location, and cut down on the costs and complexities of managing local storage. Radiologists experienced faster study retrieval, which led to quicker patient diagnoses, improved collaboration between platforms, and an overall streamlined process.
Keystone’s approach allows healthcare organizations to take full advantage of the cloud’s flexibility, scalability, and cost-efficiency. By partnering with AWS, Keystone delivers a hosted PACS solution that addresses healthcare organizations’ unique imaging needs—letting them focus on what matters most: patient care, not IT management.
