Cloud Computing: Changing HIT and HIE Deployment Strategies
Many professionals dealing with personal health information see
something akin to a flashing “danger” sign when someone mentions “the
cloud.” Similar to its natural namesake, “the cloud” seems fuzzy and
elusive and thus raises concerns about security. But “the cloud,” or
“cloud computing,” as it’s formally referred to, offers many benefits
that some healthcare organizations are already using to deploy health
information technology across their enterprises.
Cloud computing also enables
revolutionary research
accelerating the drug discovery process and lowering drug costs.
Healthcare professionals need to worry less about the infrastructure of
cloud computing, and focus more on understanding it as a new method for
deploying technology, helping organizations to meet new requirements for
data exchange and more coordinated, team-based care.
With proper safeguards, cloud computing offers powerful capabilities,
especially when it comes to acquiring and managing health information
technology (HIT) and extending data across the care continuum, what’s
now commonly called health information exchange (HIE). Voices calling
for greater data availability and use are reaching a fever pitch due to
new payment systems and healthcare delivery reforms.
The goal of cloud computing is quite simple: provide scalable and
easy-to-access computing resources and IT services. In fact, most people
take advantage of cloud computing already (i.e., Gmail and other
Web-based e-mail providers, Google Docs, DropBox, Evernote, Office365
and others). The General Services Administration recently awarded
contracts to 17 companies to
provide cloud-based e-mail
to different federal, state, local and tribal agencies under the Cloud
First Initiative. These technologies afford users free or low cost
applications for e-mail and storage of documents and images accessible
anytime and anywhere via the Internet.
For similar reasons, cloud computing is also appealing to healthcare
organizations as they balance IT and staff budgets with increasing
demands for a connected and patient-centered healthcare environment.
Cloud computing offers economies of scale and resource pooling that
enable cost effective storage and computing power for users across an
enterprise and for organizations participating in an HIE.
Across all industries, cloud computing services are considered the
fastest growing segment
of IT outsourcing worldwide, and are expected to grow 48.7% in 2012 to
$5 billion, up from $3.4 billion in 2011. Healthcare is expected to see
growth
from $1.7 billion in 2011 to $5.4 billion by 2017—a compound annual
growth rate of more than 20%. It’s really no longer a question of if
healthcare will use cloud computing, but when.
So what exactly is cloud computing?
In the most basic sense, cloud computing refers to delivering hosted
services over the Internet. The services tend to be divided into three
categories: infrastructure-as-a-service (IaaS), platform-as-a-service
(PaaS) and software-as-a-service (SaaS). The three service areas
typically afford organizations an economical, innovative and agile way
for hosting, building, delivering and accessing applications.
Cloud computing differs from traditional hosting options (i.e.,
client-server and application service provider) in that it is sold
on-demand, is elastic and is managed fully by the cloud provider. This
means organizations only pay for what they use, and they can leverage
internal IT resources for strategy and management of mission-critical
applications—most likely clinical and financial applications.
Clouds come in public or private varieties. Some organization may opt
for a variation commonly referred to as hybrid or community clouds. A
public cloud sells services to anyone on the Internet; a private cloud
is a data center or proprietary network that supplies hosted services to
a restricted number of people. Most healthcare
organizations—particularly large health systems—pursue a private cloud
because it allows more customization and control over security features.
Gartner’s cloud computing criteria provide a helpful definition
[1]:
1. Service-based. Interface is service based rather than technology
focused.2. Scalable and Elastic. The service is scalable depending on
client requirements.3. Shared. The infrastructure and resources of the
software are shared for maximum efficiency.4. Metered by Use. Multiple
payment methods are allowed based on tracked usage compared to the cost
of set up or equipment.5. Uses Internet Technologies. The service is
delivered using Internet identifiers, formats and protocols, such as
URLs, HTTP, IP and representational state transfer Web-oriented
architecture.
Cloud computing concerns
Adverse reactions to cloud computing stem primarily from the fact
that it is new. And, if nothing else, people understand that someone
else—the cloud technology company—maintains direct control of the
applications and services delivered. It’s been particularly difficult
for healthcare organizations to relinquish control because they believe
cloud technology companies are not aligned with the evolving regulatory
landscape. But cloud technology companies intent on making a serious
footprint in healthcare have actually built the requisite capabilities
for HIPAA compliance and they have improved security in general. It’s
also worth noting that many of the
top cloud providers are large, experienced technology companies.
Oft-cited concerns about cloud technology include:
- Service level agreements
- Security
- Compliance
- Privacy
- Governance
- Lock-in (switching costs)
- Business continuity
- Loss of IT control and ownership
- Enterprise and user inertia
- Return on investment
- Government snooping
But the benefits are equally compelling:
- Improved IT responsiveness
- Reductions in capital investments and operational overhead
- Flexible on-demand services; pay as you go
- Real-time collaboration
- More time to focus on strategy
- Taking advantage of new generation of innovative applications
- Better security and compliance than with a poorly-run private infrastructure
Similar to other technology decisions, choosing a cloud technology
provider boils down to due diligence in the selection process and the
negotiation of the
service level agreement (SLA).
Healthcare organizations need to inquire about the company’s
disaster-recovery strategy, backups, compliance with national health
standards (e.g., HIPAA and state law requirements), migration plan from
the existing IT infrastructure and security protocols and procedures.
It is possible for healthcare organizations to
negotiate effective SLAs
if they take the time to understand the risks and benefits and pursue
the right contract provisions to protect their patients’ data and their
own data.
One of multiple options for deployment of HIT and HIE
It’s important to remember that cloud computing is just another
method of implementation or deployment of technology and services. Cloud
computing can be used for ancillary business applications (i.e.,
payroll management system, revenue cycle management systems patient
billing tools), clinical applications like EHRs, computerized provider
order entry systems and imaging technology or myriad applications used
to stand up an HIE. On a spectrum, cloud computing would be on the
opposite end from the traditional client-server hosting option.
There are other options between the two, and pros and cons to all of
them. On one end, the healthcare organization is responsible for buying
and maintaining all the hardware and software, and on the other end
(cloud computing), an organization leverages hardware, software and/or
Web services managed by someone else.
The most natural fit for cloud computing and healthcare is probably
the deployment of HIE. Cloud computing makes tasks like image sharing in
an exchange environment possible. The massive storage space required
for images is cost-prohibitive for smaller hospital systems. Offering
radiology information system and picture archiving and communications
system software in the cloud saves money and time. Organizations will
pay less in storage fees and have to dedicate fewer IT staff for
maintenance. Providers will have more timely access to the images and
benefit from easier collaboration with other care providers who may also
access the image simultaneously.
Form a technical standpoint, cloud computing can offer such
capabilities as the “split-merge.” This means the technology encrypts
then strips PHI from imaging data before an image passes over the
Internet. The technology then decrypts and re-matches patient
identifiers if the image is forward to an authorized viewer.
Perhaps most importantly, cloud computing in an HIE saves on
interface expenses—the most costly. It has become more evident, as HIEs
pursued sustainable business models, that the complexity and expense of
integrating with every practice onboarding to an exchange was simply
untenable.
The cloud and beyond
With the acceleration of new payment and healthcare delivery models
like accountable care organizations and patient-centered medical homes,
many healthcare organizations could find success with cloud computing.
Areas like home health specifically will need new technology to gather,
process and analyze data coming in from at-home monitors and telemetry.
Cloud technology could accelerate capabilities and help providers
proactively manage the health of a community, preventing hospital and
even some clinic visits.
Cloud computing could help healthcare industry catch up to other
industries in terms of IT use. Some healthcare organizations are already
implementing cloud computing for such services as data sharing and
archival storage.
Emory Healthcare
in Atlanta turned over many of its ancillary applications to the cloud
and has since cut annual hardware, archival storage and Internet service
provider costs by as much as 60 percent. The hospital now asks all
vendors to deliver their Software-as-a-Service via the cloud.
The cloud originated mainly because many enterprise applications
require too much maintenance and support. Costs were also spiraling up,
and organizations needed solutions to avoid paying full price for using
portions of applications installed onsite. Cloud computing is now
enabling greater speed and access to data for healthcare providers and
patients. Better anywhere, anytime access to cloud applications will
enable more effective use of healthcare resources and more effective
exchange of information among patient care professionals.
