Choose Wisely for Your Surgical Data Management: Security & Scalability in the Cloud vs. On-Premise Limitations

It's one thing to record your surgeries, but what happens to the recorded data after you leave the Operating Room (OR)? In this article, we talk to Gus Svab, Proximie's Principal Cloud Engineer, about why the cloud offers scalability, flexibility and, most importantly, security that on-premise servers cannot.

Proximie is now home to over 80,000 individual surgical views, an archive of global surgical expertise which is not only the biggest of its kind in the world but also a considerable resource to help shape and improve best practice. This database embodies the power of Proximie’s cloud-based capacity and highlights why the team made a conscious decision during the design of Proximie to choose the cloud over other data management storage options, such as those stored on-premise.

Cloud-based or on-premise data storage

Before investing in any new technology in your OR, one of the most important factors to consider is how this new platform or device will manage the safety and security of your data. If you are committing to recording multiple surgical views of procedures and with it the capacity to unlock a world of insights into what is happening in your OR, significant storage space is needed upfront. Those storage needs will only expand as recording surgery becomes more ubiquitous around the world, whilst the storage demands on your OR will continue to increase as you look to layer on more technology to your patient pathways.

The two most popular healthcare deployment options currently are on-premise and cloud data management.

The cloud-based data management represents a decentralised network of servers housing software and infrastructure, accessible via the Internet. These servers are spread across data centres around the world.

On-premise deployment involves hosting surgical data on in-house or on-site servers, which are maintained and implemented by the organisation’s implementation or IT team.

Some medical devices and other surgical software companies around the world utilise on-premise servers to manage their data. If you are choosing to use on-premise storage, any data that your instruments and medical devices are producing in your OR are stored either on the medical device hardware itself, or on your in-house servers. This data never leaves the health system’s IT infrastructure, which could include offsite data centres, a secure place to house these servers or the medical device hardware, and a team or individual to manage and maintain them.

“In general, the biggest disadvantage of on-prem devices is the upfront capital costs,” Gus Svab, Proximie's Principal Cloud Engineer, explains. “The other is the risk of hardware becoming obsolete. Technology is innovating so rapidly that hardware investments made today might need to be replaced in six months time. This problem is amplified by the number of critical devices that you have if you're really scaled up in the OR. That’s a huge disadvantage. Of course the other one is the constant maintenance of on-prem hardware. It requires work and supply chains need to be maintained.”

“In general, the biggest disadvantage of on-prem devices is the upfront capital costs…”

The OR is a terrible data centre

Although there are some benefits to on-premise storage, there are a number of drawbacks that healthcare teams should be aware of. Given the sensitivity of handling patient data, losing it or if data is compromised or mishandled it can be catastrophic from a cost, efficiency and reputation perspective. With on-premise storage, you have to create and maintain highly secure data infrastructure, which requires specialist and expensive skill sets that are often uneconomic unless applied at a scale far larger than usual medical data sets

“An operating room is a busy place and in truth a pretty terrible data centre,” Gus says. “Of course ORs are regulated but many of the people who come and go from them are focused on the patient and delivering the best care. It’s not always easy to always focus on the data centre, the devices and the data that you're managing.

“On prem data storage in an environment as busy as the OR isn’t always practical, efficient or secure. There’s no guarantee a hard drive of data or storage device goes missing and if it does it’s untraceable. That’s an immediate data breach as that data lost can’t be unshared. There is a fundamental lack of control over data security.”

“An operating room is a busy place and in truth a pretty terrible data centre…”

By harnessing the power of the cloud Proximie, by contrast, is secure by design and access to the system can only happen with an entitlement. The risk of data exposure and the need for secure platforms make cloud management of OR data safer than local management. Using Proximie, users are simply given a secure link which gives them full access to the platform with dedicated cloud network capacity.

“After that, everything is managed in a controlled environment by us and our federated data architecture ensures customers control their data and where it’s stored,” Gus says, “So once the video data enters the cloud there are no devices with data lying around that can be lost, stolen or broken. Also every access to the data is logged, so it’s easy to see who tried to access it when. As an engineering team, we have purposefully reduced the number of steps to record and archive the video stream and then make it available to our customers. That short journey reduces the potential risks that the data could be compromised.”

When handling data, Proximie ensures it is always encrypted in transit and at rest. The company’s processes for handling data are externally audited to internationally accepted standards, compliant with GDPR, HIPAA, ISO, and more. The security around that data handling is also independently tested.

Harnessing the cloud for better connected healthcare

Beyond the fundamental security aspect, the seamless data gathering as channelled through the cloud is ultimately helping to create a robust surgical ecosystem and a natural resilience in surgery. Using the cloud, Proximie is giving healthcare teams the ability to review and analyse their own performance, creating the endless potential for identifying areas of self-improvement and refining surgical technique, which is ultimately delivering improved patient safety and outcomes. Every action taken in any given OR in the world increasingly becomes the subject of a continuous process of improvement, rather than a set of historical events that could be lost.

Every action taken in any given OR in the world increasingly becomes the subject of a continuous process of improvement, rather than a set of historical events that could be lost.

The power of cloud computing means that Proximie is making it possible for healthcare teams to seamlessly collaborate with other permitted individuals - before, during and after surgery - to share techniques, data and learnings that would otherwise be siloed by geography, time or within on-premise devices. Proximie’s world-leading, transformative approach is built on collecting objective, reliable and transparent OR data, and having the capacity to share this information to optimise healthcare systems around the world.

"Federated learning in the cloud helps us improve model accuracy and value, with the ability to continuously learn and apply new findings that ultimately better serve our customer base," Gus says. "Every person or hospital that comes to Proximie is already benefiting from the fact that we are serving 1,000s of hospitals around the world. If we have video feeds from 10,000 operating theatres and we have learnt that certain actions taken lead to certain outcomes, there is a very good chance that these actions are already happening for new clients.”

"Every person or hospital that comes to Proximie is already benefiting from the fact that we are serving 1,000s of hospitals around the world.”

This federated learning cycle within the cloud is exactly what new customers of Proximie will be gaining. As the domain experts of over eight years and as one of the very first telepresence platforms on the market, Proximie’s customers all benefit from this federated learning experience.

The shift towards cloud management of data is driving innovation and creating a more favourable environment for Proximie to develop AI applications in healthcare. Proximie’s cloud-based software gives its user-base a level of agility that they would otherwise not have with on-prem edge devices. It offers low-risk innovation with agility and speed, bypassing obstacles that on-premise devices experience.

Gus says: “It's not just about the cloud bringing a level of data safety to our users, it's also the cloud’s ability to create an environment of technological agility and advancement. It can provide greater flexibility and economies of scale compared to on-premise solutions. One of the biggest advantages from the customer's perspective is the on-demand nature of the cloud.”

“One of the biggest advantages from the customer's perspective is the on-demand nature of the cloud.”

The cloud’s economy of scale

The cloud enables Proximie to seamlessly scale devices, retrieve data and run quick and efficient product updates, without customers noticing that there are changes happening in the background. This enables Proximie to test new product developments and web-based innovations through the software and remove elements that aren’t functioning so well.

The cloud’s agility also feeds into Proximie’s bigger mission to democratise access to its platform. Not everyone or every OR can afford expensive pieces of hardware and have the ability to frequently  update them. Across the global health spectrum, securing the data in the cloud is fundamentally more democratic and  it’s more readily available to a wider audience of users.

It’s not just about evolving the analogue environment of the operating room - where currently every surgical touch and patient interaction is siloed to one moment in time and then lost forever - it’s about leveraging the best of cloud computing and artificial intelligence to turn those interactions into archived records and analysis of performance and channel that insight back into healthcare system from which it came: at scale and in an agile and secure way.