DIGITAL PATHOLOGY


Storage Deletion


Description


Digital image is deleted (typically after 6-9 months) and physical slide is stored long term. If required, slide re-scanned.


Pros • No need to revise storage budget


• No extra concerns for security introduced • Access short-term benefits of digitisation


Cons


• Does not retain medium of diagnosis • Physical slide deteriorates in time


• Lack of ability to contribute/conduct large studies requiring digital images quickly • Slowest recall – slide transport/rescan


Hard Drive or


Data directly saved to a physical, transportable hard drive for local access.


Removable Could be a CD, USB memory stick etc. Drive


On-Premise Data directly uploaded, stored and (LAN)


• Easily transportable • Desktop agnostic • Inexpensive


• Storage limited to size of individual drives


accessed via the health providers own local network and data centre.


• Instantaneous sharing of images in-network • Quick image retrieval


• Ability to create databases for contribution to studies/training own AI


• Larger volumes accrued than on hard drives


Public Cloud


Delivery of IT through the internet, data is ‘hosted’ on servers at a remote data centre to the healthcare provider.


• Unlimited scalability


• Ease of in and out of network image sharing • Built-in data redundancy options


Deployment is public when outsourced to • Benefit of outside security budgets public cloud IT companies (eg AWS) or central government public IT networks.


Hosted Private Cloud


IT through the internet, data is ‘hosted’ on servers at a remote data centre. Private deployments refers to cloud deployments fully outsourced to a software vendor (e.g. Philips) and includes deployments at


vendor maintains ownership of IT hardware (renting space from third party).


Hybrid A hybrid architecture involves both


on-premise and cloud architectures. Most common use of hybrid cloud is focused on long-term storage/back-up of data (ie one copy remains on-premise, a further copy/copies are stored remotely with the third-party).


• ‘Best of both clouds’ • Long-term storage of data can results • Fast data access short-term, whilst benefiting in latency issues


from cloud collaboration, transferability of data • Costs and TOC is poorly understood/ • Easy to collaborate both locally and globally • Design enables single hardware component (physical or virtual) on local network that does not have to expand with need


proven in the market. Table 1: Storage options open to laboratory providers. Each has advantages and disadvantages.


clinical IT. These actions have created a positive shift in attitudes towards cloud with many Chief Information Officers, with an increasing number of recent deals around pathology utilising cloud technology. However, despite these drivers for cloud, barriers do remain which are expected to inhibit provider uptake. A lack of standardisation in the DP industry for image formatting has created heterogeneity in image sizes which can quickly scale storage requirements to higher levels than necessary. Price sensitivity is also expected to remain especially high in pathology departments, and unless a hospital- or trust-wide budget is allocated, individual laboratories may not be able to justify expenditure.


Because of these challenges, the market has begun to bifurcate into smaller sites, which retain a preference for on-premise image storage, versus larger organisations which are more likely to have larger budgets and consider full cloud adoption.


Hybrid architecture However, there is a third, newer option. The hybrid model, where digital pathology images are retained on-premise for a set period before being moved to the cloud for longer-term storage, incorporates the best of both worlds to help mitigate costs whilst also facilitating scalability and cost effectiveness in long-term image storage. Hybrid deals in the market today typically are contracted for around a petabyte of data, with contracts running between one and five-year periods. However, as many of the adopters of hybrid models are concurrently scaling their scanning volumes, one of the true questions in the market today which needs to be resolved involves retention policy: how long should digital images be kept? No legislation exists that requires pathology laboratories to retain digital images globally. However, recommendations are in place which encourage retention of digital images used for diagnosis for at least the same length of time that physical slides are stored. This arguably involves a


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duplication of storage budgets amongst two redundant mediums. As a result, there is a considerable need for clarity in future legislation to avoid additional cost to departments. Unfortunately, due to the quick rate adoption of in markets, there are also many concurrent issues which require attention, and such the issue is not expected to be fully addressed for some time.


Using the cloud Another aspect that is rarely clear to providers and will add some confusion also relates to how cloud technology for DP software products is batched together under ‘cloud’ terminology but can be very different from a technical perspective. One of the common issues for customers relates to ‘cloud enabled’ versus ‘cloud native’ IT products. Cloud-enabled products are software applications that have traditionally been designed for on-premise use but have been adapted to allow use within a cloud architecture (private or public).


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• Predictable operating expenses (often lower pricing than private models)


• Offers more control and customisation over resources


• Easy to collaborate globally


• TOC may be lower than public (some evidence required)


third-party multi-tenant data centres where • Can comply with data retention policies


• Easy to lose loose hardware – not traceable • Lack of inherent security


• Drives easily corrupted and no auto backup


• Expansion can create physical storage requirements and additional complexity


• Difficult to share data outside organisation • Must build own databases


• Expansion can be expensive and take time to scale


• Requires IT department to maintain


• Data access is reliant on internet access • Lack of data isolation


• Requires knowledge of cloud security


• Long upload/download times for large images • Shared infastructure (non-compliance data retention/security policies)


• Data access is reliant on internet access • Speed of access is reliant on internet • Site requires knowledge of appropriate cloud security measures


• Long upload and download times for large images


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