cloud pacs interface


Cloud PACS, Cloud Native, On-Premises: What’s Best for You?

Published April 25,2023

In this blog, we will explore the differences between cloud PACS, on-premises PACS, and cloud-native PACS. A picture archiving and communication system (PACS) is an integral tool for managing medical imaging data in today’s healthcare systems. Cloud-based PACS systems have risen in popularity in recent years due to the flexibility, scalability, and low-maintenance they offer.

Comparably, on-premises PACS systems are hosted on local servers, providing healthcare organizations more control over their data and security. On the other hand, cloud-native PACS systems grant even greater scalability, business resiliency, and flexibility as they leverage cloud-native architecture.

Let’s dive in and explore the pros and cons of each type of PACS:

Table of Contents 

1. Definition of Cloud-Based PACS

2. How Cloud PACS works

3. Advantages of Cloud PACS

4. The Best Cloud PACS system

5. Cloud-Based PACS vs. Cloud Native vs. On-Premises

6. How to Select a Cloud PACS Vendor

7. Cloud PACS Integrations with Other Systems

8. Cloud PACS Pricing


What is Cloud PACS?

Cloud PACS is a medical imaging technology that stores and provides access to medical images and reports in the cloud, eliminating the need for on-premises hardware and providing anytime, anywhere access to patient data. A cloud-based PACS offers scalability, flexibility, and low maintenance costs compared to traditional in-house systems.

By eliminating the requirement for VPN connections between each location, these systems enable secure and quick access to medical images from anywhere. A cloud PACS system contains a PACS cloud storage archive with a PACS cloud viewer and generally includes features such as EHR/EMR integration, automated image processing, and worklist management. Many PACS cloud solutions use top-notch infrastructure and security standards to protect imaging information and safeguard the security of patient data.

The value to healthcare organizations in implementing PACS cloud computing systems to deliver faster, empowered care is incontrovertible: as Idonia Medical Image Exchange founder and CEO, Miguel Cabrer, points out in this HealthManagement article, Medical Image Exchange in the Cloud: A More Efficient Way, “It’s clear then that the cloud exchange of medical images can benefit medical centres to exchange and deliver image studies. Combined with PACS or working independently, it will facilitate the easy exchange of imaging. Using a cloud exchange platform to deliver image studies to patients can reduce costs over 50%.


How Does Cloud PACS Work? 

Through a cloud-based platform (generally equipped with a PACS cloud viewer and PACS cloud storage archive), healthcare organizations are able to store and share digital images and clinically relevant evaluations securely, thereby removing the need for manual tasking pertaining to the documentation and maintenance of physical records. The cloud PACS architecture within these systems works to electronically store medical images and reports during medical imaging exams using one or more computers hosted on a cloud-based server (“cloud PACS server”): this adds up to easy accessibility, and optimal accuracy, reliability, and operational cost-effectiveness for healthcare providers.

To access the cloud-based PACS, users need to validate their request and provision it through the cloud service provider’s OSS. Once validated, users receive access credentials and receive monthly invoices for their usage.


How Does Cloud-Native PACS Work? How Does Cloud-Native PACS Differ from Cloud-Based PACS?

A PACS software system that is cloud-native is one that is designed, developed, and deployed in the cloud utilizing highly scalable cloud-native technologies, such as containers, service meshes, microservices, and immutable infrastructure, so it can be seamlessly built and run in a modern, dynamic environment such as a public, private, or hybrid cloud. A cloud-native PACS enables doctors and patients to access medical images and reports from anywhere, at any time, using an IoT device (a device that is connected to the internet), with improved communication, increased efficiency, and reduced costs compared to an in-house system.

Great…but what’s the difference between cloud-native and cloud-based?

The fundamental difference between cloud-native PACS and cloud-based PACS is that cloud-native PACS are developed specifically for cloud computing, while cloud-based PACS are traditional PACS that are hosted on a cloud platform. Where cloud-based PACS applications are closely integrated and upgrades regularly required for the entire stack (precipitating downtime), cloud-native PACS applications are a different matter: they are tooled for flexibility, built to scale (thanks to microservice architecture), and allow for upgrades to be performed without disruption.


What Are the Benefits of Cloud PACS?


A chart showing benefits of cloud pacs

The key benefits consist of:


Cost-EffectivenessHealthcare providers can manage their medical imaging data in a more efficient and organized manner without the need to purchase and maintain hardware and software. Additionally, a cloud PACS system allows for easy scalability as per the changing needs of the practice, saving costs on unnecessary resources.
ScalabilityPACS on the cloud provides scalability in terms of both resource allocation and cost efficiency. As the needs of a healthcare enterprise change, PACS cloud can easily scale up or down without the cost of new hardware or software, making it a cost-effective option for growing practices. This scalability allows healthcare providers to seamlessly add resources without interruptions or a loss in quality of service.
AccessibilityPACS cloud computing solutions facilitate easier and quicker viewing of medical images and related data. Beyond the hospital use case, doctors can access patient data. Interfaces in web based PACS platforms allow patients to securely view their medical images and files online from anywhere, at any time.
SecurityCloud-based PACS promote strict security measures that safeguard medical imaging data privacy and integrity. These measures generally include password-protected connections, encrypted sessions, automatic logout of the session, and adherence to strict security and privacy protocols (e.g., FHIR, HL7, HIPAA, etc.). Also provided: controlled access via passwords, eliminating worries about storage capacity and local system failures. Overall, PACS cloud computing solutions offer secure, convenient, and economical storage of patient data.
InteroperabilityInteroperability in cloud-based PACS refers to the ability of two or more cloud systems to exchange and utilize medical imaging data seamlessly. It allows technologists and physicians to access and share patient information across different cloud platforms without any compatibility issues. Cloud interoperability eliminates hassles involving storage capacity, local system failures, and transportation of physical records.
Reduced IT BurdenThe burden on IT staff to maintain the imaging system is reduced. PACS cloud computing systems are highly flexible and can be viewed on more devices, including mobile devices, improving accessibility. Since the system is cloud-based, it equips healthcare providers with what they need to improve security, leverage systems that grow with their organizations, and reduce the need to budget every few years for new archiving servers.
Increased Efficiency & SpeedIncreased efficiency and speed in medical imaging by storing all data remotely in a secure location, thereby eradicating worries about storage capacity and local system failures. The radiology cloud system enables real-time access to radiology images and patient data, reducing redundant data entry and manual reconciliation of broken studies and files, resulting in an approximately 15-20+% increase in productivity*. The web based PACS also allows for streamlined communication between healthcare teams and the seamless sharing of images and reports, improving collaboration.

*With application of cloud-based PACS and RIS/PACS in radiology. Source: Nuvodia 


What is the Best Cloud-Based PACS?

When purchasing a best cloud-based PACS system, buyers should consider several features to ensure they choose the right provider. Key considerations include system performance requirementsapplication architecture componentsvirtualization and hosting architecturecode deploymentlife cycle managementscalability, and availability. Additionally, buyers should evaluate the cost and maintenance of the solution, including hardware requirements.

The medical imaging-focused procurement process should ensure the cloud based radiology PACS solutions being considered offer essential features including:

  • The ability to provide diagnostic viewing from anywhere (making it easier for radiologists to make diagnoses and to communicate and share images with others)
  • Scalability
  • Enterprise-level archiving
  • A user-friendly interface (allows easy access and storage of images on any device from anywhere in the world)

Other notable items that should be taken into account when evaluating various radiology cloud systems: a simple, cost-effective, fee-per-study model, and the ability to cater to rapidly growing healthcare ecosystems or imaging practices. At this juncture, a buyer may find themselves turning to consider cloud-native PACS solutions, where all the aforementioned features are offered more superiorly and extensively.

OmegaAI: Your Cloud-Native Passport to Accelerated Care

Discover the future-forward possibilities with AI-enhanced automation and patient engagement experiences.

Explore OmegaAI


Cloud PACS vs On-Premises vs Cloud Native

Let’s see how various functionalities compare between on-premises PACS, cloud-based PACS, and cloud-native PACS:

 On-Premises PACSCloud-Based PACSCloud-Native PACS
ScalabilityLimited in scalability due to hardware costs and recurring refresh expenses.Highly scalable to cater to rapidly growing healthcare systems, providing cost-effective storage, enterprise-level archiving, flexible configurations, and accessible from any device and location.Offer scalability advantages such as flexibility, cost reduction, easy sharing of resources, faster time to value, and always up to date.
MaintenanceMaintenance includes hardware repairs and regular software updates to meet evolving needs, resulting in high upfront and recurring costs.Cloud based PACS eliminates maintenance challenges of in-house systems. Vendors handle hosting and maintenance of data.Eliminate hardware procurement and setup wait, reduces maintenance and overhead costs, provides reliable remote-reading access, and ensures cybersecurity.
InteroperabilitySupport interoperability crucial for image sharing between healthcare providers. However, hardware and vendor constraints can limit interoperability.Cloud based radiology PACS offer secure and cost-friendly interoperability with advanced features such as AI and ML, empowering clinicians with all imaging for diagnosis.Grant seamless advanced integration with EHR systems via AI and ML automation technology, enabling unified patient records and more efficient processing of imaging orders.
CostCost depends on individual requirements, hardware, software licenses, installation/testing fees, and has high initial upfront costs. Annual maintenance and support add another ~15-20% of the software price.Have significantly lower implementation costs than on-site radiology cloud PACS, which can range from $50,000 to several hundred thousand dollars.Cloud-native offers the lowest cost to operate: users only pay for license and storage costs in the cloud provider. By comparison, cloud-based systems require a pricier investment in hardware & maintenance costs, as well as the cost of owning the whole stack.
Accessibility Can be accessed within the local network via a web browser without requiring an internet connection.Offer global accessibility, anytime, anywhere, on any device, better accessibility, reduced cost for staff and equipment, and a smaller carbon footprint.The cloud-native PACS provides the same features as cloud-based PACS however you will have faster time-to-value.
Data SecurityRequire constant monitoring and control of internal and external user accounts to secure medical image storage.Offers data security with TLS and data-at-rest encryption. Strict third-party checks and audit trials are performed.In cloud-native applications, compute services are transitory and have short lifespans, making cloud-native solutions inherently more secure.
IntegrationsIntegrations are customizable and offer seamless data sharing among systems but require hardware maintenance and are potentially expensive.Cloud-based PACS systems integrate with RIS, HIS, EMR, EHR, and LIS systems for improved efficiency.Facilitates worry-free integrations with various systems (e.g., RIS, VNA, HIS, etc.) using containerized, microservice applications, legacy and on-premises systems. Provides optimal disaster recovery.
PerformanceAllow local access and control but require upfront hardware costs and maintenance expenses.PACS cloud offers faster and higher-quality reporting, reliable transmission, remote access, and error-free management, leading to improved patient care.Cloud-native PACS performs best by offering easy sharing of resources, independent of infrastructure, is always up-to-date, and AI-powered.


Implementing a solution – whether cloud-based or cloud-native – provides more remarkable benefits to healthcare organizations looking to drive faster, empowered care over traditional on-premises PACS solutions. A 2022 Google Life & Sciences, Supporting healthcare delivery with cloud-native medical imaging article, offered this perspective, speaking specifically to cloud-native PACS solutions:

“With increasing pressure to reduce hard costs and uncover invisible costs, onboarding a cloud-native imaging solution not only offers seamless data migration and 99.99% or higher uptime, but can also reduce cost of ownership by 20%.”


Experience the Cloud-Native, Serverless Difference

Unlock everything you need to propel faster, empowered care – from consistent uptime to AI-automated workflows to reduced IT burden – with RamSoft’s one-of-a-kind Imaging EMR platform, OmegaAI .

Dive into OmegaAI


Best Practices for Selecting a Cloud PACS Vendor

Best practices selecting a cloud pacs vendor


Selecting a vendor requires careful consideration of several factors including open technologies, security compliance, adherence to governance, and EHR integration:


1. Evaluate the vendor’s experience.


A good place to start in obtaining an idea of a vendor’s experience is to assess their service level agreement (SLA). Any vendor should offer a basic service level guarantee.



2. Assess the vendor’s security practices.


Vendors should have several security practices in place to ensure the confidentiality, integrity, and availability of medical imaging data stored in the cloud. Such best practices include:


  • Encryption
  • Access controls
  • Threat detection
  • Compliance
  • Communication
  • Customer service
  • Data breach policies




3. Check for compliance with regulations.


Vendors should operate within industry compliance guidelines and adhere to strict security protocols (e.g., HIPAAPIPEDAGDPRSOC 2™, etc.)




4. Assess the scalability.


Scalability is a crucial factor to consider when assessing a cloud PACS vendor. Here are some key areas to keep in mind when evaluating a vendor’s scalability: infrastructure, storage, network, interoperability, and vendor*.


*Involves assessing the vendor’s ability to provide scalable solutions that can meet your enterprise needs as it grows over time.




5. Evaluate the interoperability.


The vendor should comply with industry standards such as DICOM™ (particularly key for PACS DICOM cloud solutions) and FHIR-HL7 to ensure seamless interoperability with other systems.




6. Assess the technical support.


Evaluating the technical support of a vendor involves assessing accessibility, responsiveness, SLAs, technical expertise, user-friendliness, and customer feedback.




7. Assess the implementation process.


During the process of considering vendors, it’s essential to evaluate their implementation process to ensure a smooth and successful transition. Questions to ask prospective vendors may include the following points:


  • Billing and ease of use
  • Data migration
  • Performance monitoring
  • Size of installation team
  • Storage size of system




8. Evaluate the estimated ROI of the software.


Estimating the ROI of any cloud software involves identifying the TCO (the cost of cloud) of the current PACS system, estimating the cost of the software, estimating potential cost savings and revenue increase, and using a formula to calculate the estimated ROI.


The following formula may be used to calculate the estimated ROI of software:




ROI = ((Estimated cost savings + Estimated revenue increase) – Cost of software) / Cost of software x 100


For example, if the estimated cost savings and revenue increase are $100,000 and $50,000, respectively, and the TCO is $80,000, the estimated ROI would be:


((100,000 + 50,000) – 80,000) / 80,000 x 100 = 37.5%




Cloud PACS Integration with Other Systems


Cloud-based PACS integration with other systems can greatly improve the efficiency and functionality of a healthcare organization’s digital infrastructure. PACS cloud integration with other systems, such as Electronic Health Records (EHRs) and Radiology Information Systems (RIS), can provide a more complete view of a patient’s medical history and improve medical efficiency.




There are a variety of integration approaches to choose from, including bidirectional and unidirectional integration. The amount of time it takes to complete a project depends on the type of integration and the actual EHR system being used. The integration process typically starts with a one-time integration fee and a monthly license and support cost.


Cloud based PACS system integration can offer several advantages. For example, the system allows radiologists to make diagnoses from anywhere, at any time*, which can improve patient outcomes. PACS cloud computing systems can also be disaster-proof and secure from threats because diagnostic imaging data is stored and backed up by multiple servers in different locations.


*It is crucial to note here that cloud-based PACS generally offers a “zero client” or “zero footprint client” model, which is a web based PACS that integrates diagnostic viewing and enables radiologists to make diagnoses at any time from anywhere.


Some companies offer PACS solutions in vendor-specific venues (e.g., AWS Marketplace) that provide cloud backup and archive capabilities to reduce business continuity risk. In comparison, other companies – such as RamSoft – offer Imaging EMR systems (e.g., RamSoft’s OmegaAI) that consolidate cloud based RIS PACS, VNA, and other integrated imaging tools and cloud based radiology PACS systems.


Future integration of PACS cloud solutions in radiology are expected to provide a more complete view of the patient’s medical history, leading to quicker diagnosesshorter lengths of stay, and improved overall medical efficiency. Technical and human factors are keys to success when undertaking system upgrades and replacements to improve the efficiency and functionality of a radiology department’s digital infrastructure.




Cloud Based RIS PACS


Radiology Information System (RIS) is a computer-based software used by radiology departments to manage patient data, scheduling, tracking of files, workflow management, and billing.


cloud based RIS PACS system allows radiology practices to store, manage, and access medical images and reports through secure cloud data centers instead of local servers. Key benefits include cost savings, easier access to images and reports, improved patient care, team optimization, and better disaster recovery.




Imaging EMR


An Imaging EMR is an electronic medical record (EMR) system that specializes in managing medical images and other clinical media, such as X-rays, MRIs, and CT scans, along with associated reports and patient data.


Integrating an Imaging EMR with other healthcare systems, such as electronic health records (EHRs), provides numerous benefits, including improved operational efficiencies through reduced time to capture, store, access, and share clinical media, improved patient care through access to comprehensive, contextually relevant information in a timely manner, reduced chart review time by delivering a holistic patient record in the EHR, and shortened time to diagnosis.


Additionally, imaging EMR integration and data optimization can help improve referring physician satisfaction with quicker, more accurate diagnoses, and increase revenue by providing billing and payment tools and reducing insurance claim rejection rates.




Discover OmegaAI, The World’s First Imaging EMR


Built to accelerate healthcare ecosystems to deliver faster, empowered care, OmegaAI’s cloud-native and serverless design is beyond compare.


Explore OmegaAI




EHR/EMR Integration


EHR/EMR integration pertains to the process of seamlessly connecting electronic health records (EHR) or electronic medical records (EMR) with other digital systems or devices. This allows for the sharing of clinical data and communication between systems, leading to improved patient care and reduced operational costs.



Hospital Information System (HIS)


Hospital Information System (HIS) integration can provide substantial benefits to healthcare professionals, patients, and healthcare organizations. It helps to improve the quality of care and make healthcare more cost-effective. HIS integration brings forward data and insights from digital health tools to provide relevant information, alerts, financial and operational guidance at the point of care.


Also, it reduces manpower and frustrations when providing patient care, resulting in an automatic benefit to patients.




What is the Pricing for Cloud PACS?


Cloud PACS pricing varies depending on factors such as the size of the practice, storage space needed, and the provider’s billing method. Some providers offer flexible pricing plans that allow customers to choose what works best for their practice, while others offer affordable monthly or yearly subscriptions that include additional storage and web connection options. Cloud based PACS pricing can be more cost-effective than traditional on-premises solutions, with no hardware or server room maintenance costs.






What are the benefits of cloud computing for PACS and archiving? 

Cloud computing provides significant benefits for PACS and archiving in the healthcare industry. Cloud based PACS eliminates worries about storage capacity and local system failures while offering controlled access via passwords. Cloud-based services (including PACS cloud computing) offer easy, scalable access to computing resources and IT services while adhering to government mandates for privacy and security of patient data. Cloud computing enables cost savings, data security, flexibility, and mobility for healthcare providers.

How secure is Cloud PACS? 

It is a secure and reliable solution for medical image storage and sharing. It employs various security measures using a cloud PACS server, such as encryption, access controls, and regular backups, to ensure data confidentiality, integrity, and availability. Additionally, cloud-based PACS is compliant with various healthcare regulations, such as HIPAA, to ensure patient data privacy and security.

What type of data can be stored in Cloud PACS? 

It allows healthcare organizations to store and manage various types of medical data, including PACS DICOM cloud images (CT, MRI, X-ray, ultrasound, etc.) and non-DICOM documents (JPEG, BMP, PNG, MP4) securely and remotely on cloud-based servers. This enables healthcare professionals to access and share patient data from any device and any location globally.






The choice of system depends on the needs of the healthcare provider. On-premises PACS offer control over data and security, cloud-based PACS offer scalability and ease of use, and cloud-native PACS offer the utmost in superior flexibility, access, user interface, uptime, and security. Ultimately, it is up to the provider to weigh the pros and cons and decide which system best meets their needs.


Faster, Empowered Care with RamSoft’s Cloud-Based PACS Solutions


See for yourself how the cloud can advance the best in effective patient-centric healthcare!



Book a Demo