Cloud PACS or On-Premise PACS: Which One Works for Your Practice?

If you're shopping for PACS medical imaging software, you've probably noticed there are two main options: cloud-based systems and on-premise setups. Both handle medical images, but they work in completely different ways. The choice between them can affect your budget, your workflow, and how your team accesses patient data.

Let's break down what makes each option different and help you figure out which one makes sense for your facility.

What Is On-Premise PACS?

On-premise PACS means everything lives inside your building. The servers, storage, and software all sit in your facility. Your IT team manages the hardware, handles updates, and fixes problems when they come up.

This setup gives you complete control. You own the equipment, you decide when to upgrade, and you keep all your data behind your own walls. For hospitals that want full oversight of their imaging systems, this approach feels secure and reliable.

But there's a catch. You're responsible for everything. When a server fails at 2 a.m., your team has to deal with it. When you need more storage, you buy more hardware. The upfront costs can be significant—think tens of thousands of dollars for servers, networking equipment, and installation.

What Is Cloud PACS?

Cloud PACS flips that model. Instead of storing images locally, everything lives on remote servers managed by a vendor. Your radiologists and doctors access images through a web browser or app, usually from anywhere with an internet connection.

The vendor handles maintenance, security updates, and storage expansion. You pay a subscription fee—typically monthly or annually—and they keep everything running smoothly.

This model works well for smaller practices or facilities that don't want to manage complex IT infrastructure. Setup is faster, and you can scale storage up or down based on your needs. No need to predict how much space you'll need three years from now.

Cost Comparison

Here's where things get interesting. On-premise systems require a large initial investment. You're buying servers, storage arrays, backup systems, and potentially hiring staff to manage it all. Over time, you'll also spend money on maintenance, repairs, and eventual replacements.

Cloud systems spread costs over time. Lower upfront expenses, but ongoing subscription fees. For a small practice, this might mean spending $500 to $2,000 per month depending on image volume and features.

Which is cheaper long-term? It depends on your volume and how long you plan to use the system. On-premise can be more economical over ten years if you have high image volumes. Cloud makes more sense if you want predictable expenses and don't want to manage infrastructure.

Access and Flexibility

Cloud wins here. Radiologists can read studies from home, doctors can pull up images on their tablets during rounds, and referring physicians can access reports from their offices. Remote access is built into the system from day one.

On-premise systems can offer remote access too, but it requires additional setup—VPNs, security configurations, and often slower performance when accessing from outside your network.

If your facility values mobility and flexibility, cloud systems have a clear advantage.

Security and Compliance

Both options can be secure, but they handle security differently.

With on-premise, you control the security measures. Your data never leaves your building unless you send it somewhere. This appeals to facilities with strict privacy requirements or concerns about third-party access.

Cloud vendors typically invest heavily in security—encryption, redundant backups, regular audits. Most are HIPAA-compliant and hold relevant certifications. But you're trusting another company with your patient data, which makes some administrators uncomfortable.

Neither approach is inherently more secure. It comes down to whether you trust your own security protocols or a vendor's expertise.

Reliability and Downtime

On-premise systems go down when your servers fail or your internet connection drops. You need backup power, redundant systems, and a solid disaster recovery plan.

Cloud systems depend on your internet connection and the vendor's uptime. If your internet goes out, you can't access images. Most cloud vendors promise 99.9% uptime, but that still means potential downtime.

We suggest evaluating your internet reliability before committing to the cloud. A practice with spotty connectivity might struggle with a cloud-based system.

Making Your Choice

There's no universal right answer. Smaller practices with limited IT resources often benefit from cloud systems. Large hospitals with existing IT infrastructure might prefer on-premise control.

Think about your priorities. Do you value control and ownership? Go on-premise. Need flexibility and lower upfront costs? Consider cloud.

Both options work. Pick the one that matches how your facility operates.