Once you have decided to make the switch from a traditional onsite picture archiving and communications systems (PACS) to a cloud-based PACS solution, there are a number of items you should be sure you are thinking through. Planning out your transition to the cloud can look like a daunting task without the proper guidance.

Clear communication with your cloud PACS vendor is essential to executing an effective migration. Here are four topics that you need to bring up with your vendor, in order to make your transition successful.

No. 1: Understanding Your Workflow

Your vendor will need to have an intimate understanding of your practice's workflow in order to implement the right solution for you. Your transition to the cloud will look very different depending on variables in your workflow, such as the type of care your practice provides, the modalities you work with, if you need to share images with referring physicians or patients, and if you do your own reads versus leveraging a teleradiologist.

This means that you should look for a provider who puts considerable effort into understanding your practice, rather than simply trying to put you into a box with a boilerplate solution that might not be optimal for you. If your vendor isn't taking the time to learn about your workflow, and is instead just trying to push the next great feature onto you, you'll soon find out that great features are meaningless if you can't use them. Your information isn't where you need it, when you need it.

No. 2: Setting Expectations

Hand in hand with understanding workflow is setting proper expectations for what will be possible with the cloud based on your practice's unique variables.

For instance, if you need your imaging studies to be available for reads immediately but you have a prohibitively slow internet connection, then you may be setting yourself up for disappointment if you expect to read your most recent studies from the cloud without delay. A situation like this, however, can be easily rectified by creating a thoughtful architecture that allows you to read immediately from a local cache prior to the studies being available in the cloud.

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A good vendor will understand your workflow and any network limitations you may be working under prior to prescribing which cloud architecture is right for you. This will allow you to set realistic expectations for how your facility will leverage the cloud. Your vendor also might suggest running a speed test at your facility prior to implementation — ideally conducting a data transfer in the size of one of your actual studies to best simulate real-world behavior.

If there are latency issues, these will need to be taken into account when setting your expectation for how quickly images will be available in the cloud. If you do not require immediate access to the imaging data, then latency issues may not be a concern.

If you require immediate access, then you might need a slightly different approach, such as relying on a local cache for your current studies and the cloud for priors as you won't need to worry about upload times. That's because the comparison studies will already historically be in your cloud PACS.

No. 3: Migrating Legacy Data

Almost every medical facility has legacy data stored somewhere, but if you transition to a cloud PACS do you need this data available in the cloud as well?

More than likely, your answer is yes. Having it accessible in the cloud will help you get the most out of your new platform. Many cloud based diagnostic viewers today allow you to run comparisons of prior studies side-by-side, but you will only be able to do this if you have the previous studies stored in your cloud PACS.

The next question to ask yourself regarding legacy data is whether your data is stored in a standard DICOM format that will be easy to send to your new vendor. If the data is not in DICOM format, you should be sure to alert your vendor as the process will become more challenging, especially if it is in a proprietary format.If your data is in DICOM format, you should understand how you will get this data to your vendor — can you transfer it over the internet, or will you have to export it to an external hard drive and send it to them physically?

You should also understand both how long the data migration process will take and what the cost will be. Many vendors set their prices for legacy data migration on a per-terabyte basis. This is generally preferable to pricing on a per-study basis, which could become cost-prohibitive depending on the number of historical studies you have to import.

Finally, understand that if your data is in a nonstandard file format, you run the risk that some or all of your files may not be able to be moved into the new cloud environment. Talk with your vendor and make sure that they have a plan for how to transfer these nonstandard files, or be comfortable with the idea that you may have to maintain some of these files within your legacy system.

No. 4: Providing Support

Working in the medical industry means you need access to technical support at a moment's notice in case something goes wrong, as lives could be at risk. The last thing you want is to have to cancel a surgery or delay a diagnosis because you experience a technical issue but can't get the level of support you need from your vendor to rectify the problem in a timely manner.

Be comfortable with the level of support your cloud vendor is willing and able to provide. You should be sure to have some sort of a service level agreement (SLA) in place with your vendor that clearly outlines their obligations for support and maintenance, as well as how quickly they will respond.

You should also be sure your vendor is willing to provide ongoing training for your personnel who will be using your new cloud PACS. This is especially important for winning over slow adopters at your facility who may be reluctant to change to a modern technology.

Moving to the cloud means that you give up some control over your system in exchange for benefits like data security and accessibility. So, make sure your vendor is taking the time to listen to you and understands what you are trying to accomplish with a transition to the cloud.

Both parties need to be on the same page in terms of support and services to avoid frustrations later down the road.