Managing security risks and ensuring optimal performance for remote radiology reading

COVID-19 has put enormous pressure on organizations to expand digitalization initiatives and embrace cloud computing. Even before the pandemic, Radiologists have been reading imaging studies at home or at off-site locations. The ability to read images from any location outside the hospital has become even more beneficial with the current situation.??

Remote reading has emerged as a keyway to support social distancing, protect vulnerable radiologists and others in the hospital while delivering patient care. In addition, remote reading ensures seamless interpretation capabilities in emergency scenarios, according to an open-access article published ahead-of-print by the American Journal of Roentgenology (AJR)1.??

The impact on healthcare IT departments?

Healthcare IT departments face a host of challenges today – from providing radiologists with the right tools at home, to providing a secure environment to work in. According to research and analysis experts at Gartner2, the most significant security challenges are the scarcity of technical security staff, legal and regulatory compliance requirements, and the steady onslaught of new threats.??

A common approach for remote reading is to provide radiologists with a virtual private network (VPN) connection either; on their personal PC or laptop, via a corporate-owned and managed workstation, or in combination with virtual desktop solutions.??

Here are some of the risks that are related to VPN connections.??

VPN connection on personal PC or laptop?

While this option is easy to set up, it introduces several security risk. These are the primary concerns, outlined by Morey Haber3.?

1.????? Multiple users amplify the risks?

2.???? Inability to secure hose and lack of authority?

3.???? Lower malware defense?

4.??? No protective resources?

Corporate-owned and managed workstations?

A corporate-owned and managed workstation would minimize the risks mentioned above and it operates as a regular PACS workstation for the radiologist. It does mean that, from a distance, the workstations need to be managed, updated and supported to ensure secure access to patient images and data.??

Performance can still be an issue as most of the time VPNs are running over a shared internet connection with the organization, meaning the necessary performance cannot be guaranteed due to lack of upload bandwidth of the healthcare organization.??

VPN in combination with virtual desktop solutions?

With solutions like Citrix or VirtualBox, healthcare organizations create a virtual desktop on the home computer of the radiologist to provide access to the applications of the healthcare organization. From a security standpoint, this is a strong choice and relatively easy to implement. However, they are not suited to read studies in PACS given the large datasets, nor can they support window leveling, 3D, or speech recognition tools.??

The evolution of the web-based cloud platform in healthcare?

While using a VPN, installing local software and providing radiologists with a dedicated PC can address some of the security and performance issues related to remote reading, this approach remains open to risk and requires significant support from IT departments.??

With the security challenges, the need for multiple medical imaging software applications, and significant bandwidth for radiologists, the adoption of cloud-based technologies is beginning to gain ground.??

There are several reasons for this:??

·????? Legacy?

·????? The technology bar is high to implement every feature in a web-environment?

·????? Multitenant cloud?

·????? Performance?

Web-based cloud PACS?

A web-based, cloud PACS solution can eliminate the security risks of using VPN, does not require the installation of any software to view high-quality DICOM lossless images remotely, and is available via any web browser on any device* connected to the internet. With a true cloud PACS radiologists can:??

1.????? Prepare (preliminary) reports outside of hospital walls, from home or another office?

2.???? Easily collaborate with other reading groups and radiologists?

3.???? Access full PACS functionality without requiring a VPN, or any complex IT infrastructure?

The advantages of this technology for healthcare will help organizations to keep and simplify their current infrastructure, lower the management tasks and overall costs, and provide a solution for remote work without compromising security or patient care.??

References?

1.?????? Srini Tridandapani, Greg Holl, and Cheri L. Canon, ‘Rapid Deployment of Home PACS Workstations to Enable Social Distancing in the Coronavirus Disease (COVID-19) Era,’ American Journal of Roentgenology 2020 215:6, 1351-1353. Retrieved from: https://www.ajronline.org/doi/ full/10.2214/AJR.20.23495??

2.????? Christy Pettey, ‘Gartner Top 9 Security and Risk Trends for 2020,’ September 17/20. Retrieved from: https://www.gartner.com/smarterwithgartner/gartner-top-9-security-and-risk-trends-for-2020/??

3.????? Morey Haber, ‘The Dangers Of Using A VPN On Home Computers For Work And What To Do Instead,’ Forbes, Forbes Technology Council, July 17/20, retrieved from: https://www.forbes.com/sites/forbestechcouncil/2020/01/17/the-dangers-of-using-vpn-on-home-computers-for-work-and-what-to-do-instead/?sh=5041735d6349??

4.????? AV-TEST Security Report 2019/2020, from the AV-TEST independent research institute for IT security in Germany, retrieved from: https:// www.av-test.org/fileadmin/pdf/security_report/AV-TEST_Security_Report_2019-2020.pdf??

5.????? Sophie Anderson, ‘Antivirus and Cybersecurity Statistics, Trends & Facts 2021,’ SafetyDetectives, January 24/20, retrieved from: https:// www.safetydetectives.com/blog/antivirus-statistics/#:~:text=The%20 Threats%20Against%20Regular%20Users&text=However%2C%20 an%20estimated%20one%2Dfourth,PUPs%20(potentially%20unwanted%20programs)?

?

*diagnostic use requires a suitable device?

?

?