Note: This piece was written by Priya Ramachandran, a former IT auditor and freelance writer who blogs at www.pramwriter.com. We’d like to welcome her to EMRandEHR.com.
You gotta hand it to the IT folks. Once they come up with a catchy phrase like cloud computing, it spreads like crazy, and now it’s come to mean just about any architecture you can imagine. This Wikipedia entry explains how “cloud” might mean anything from software and services available on the web, to virtual servers created off of physical servers. Adding to the confusion, some leading names in IT willfully obfuscate the terms.
I really like Rob Pegoraro’s definition of the term and that’s all cloud computing is going to mean for the purposes of this post: cloud computing is “having an Internet site host your data and the programs you use instead of keeping them on your computer.”
Some benefits to putting health data in the cloud:
Now in the case of health IT, there are compelling reasons why a cloud may benefit your organization:
— Increased processing power: If you leave it to the folks who provide these services, you won’t have to administer/upgrade your own hardware
— Pay as you go: Pay for only those services that you end up using
— Data portability: If you keep your customers’ health IT records online, it’s a lot easier for you and your customers to access said data
— Freedom from the IT department guys: Yeah, it might be a pipe dream, but when you’re with a good cloud service, IT is really your vendor’s headache
— Security: Which, as we will see later, can be something of a double edged sword
Some models of cloud computing have evolved to better address data integrity. The costlier and most robust solution would be to create a private cloud. Open source cloud solutions such as osCloud allow healthcare organizations with some IT muscle to design their own.
Third party vendors often work with healthcare providers to create a secure version of the cloud for private use. The costs of this approach are significantly higher than investing in a public solution, where all your patient data is on a nebulous cloud. Pragmatic hybrid cloud solutions abound too, fixing the security concerns of a public cloud, and with costs cheaper than a private cloud solution.
Use cases in healthcare:
For health IT, there are several uses cases where cloud computing is probably a great option. Some of the more interesting ones I’ve come across:
— For hospital surveillance and security – Awarepoint, a fully managed service, provides GPS style RTLS (Real Time Location Systems) tracking of patients, personnel, equipment for reducing hospital theft prevention; Denver Children’s Specialists is utilizing ControlByNet’s cloud-based, hosted video security surveillance solutions, to monitor six locations on the cloud. The group moved from separate DVRs to ControlByNet’s solution to monitor its six locations throughout Colorado.
— Cheaper and better transcription services – Details courtesy of Lauren Richman, healthcare marketing director at Nuance Healthcare: “The doctor dictates a patient record (via phone or into an electronic health record system), the voice file is sent to the cloud where it runs through a speech recognition engine, a draft medical record is created and sent to a transcriptionist for review/editing and then sent back to the doctor for final sign off. Leveraging this cloud-based technology saves time on documentation for doctors and transcriptionists, which speeds efficiency and significantly reduces costs.” A whitepaper published by Nuance shows that 39 customers saved over a million dollar each for a total savings of 93 million dollars.
— Access and collaboration between specialists: ClickCare, a HIPAA compliant SaaS and iPhone application combines pictures, text, sounds, and videos to improve collaboration between healthcare providers. In one instance, at the Wound Institute in PA, 70 patients were treated solely over ClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs.
— Other business activities: SuccessFactors is a vendor that works with several hospitals to streamline their HR processes. Presidio Health, a service created by a former ER physician, helps hospitals enables hospitals, health systems and urgent care centers to efficiently collect patient payments at the point of service. (Interesting statistic provided by Presidio: once a patient leaves the ER, the facility only has a 20% chance of collecting any amounts due from the patients)
If you live next door to a mafia don, you’re more likely to get shot:
All these success stories in the media must make everyone else in the healthcare field salivate. But, moving to the cloud shouldn’t cloud one’s judgment about this relatively new IT paradigm. When you’re housed in some cloudy barracks, you have little say over what services you receive, as pharmaceutical giant Eli Lilly found in its experience with Amazon web services. Eli Lilly had long been promoted by Amazon as its poster (client) child, but found that it could ask (and receive) few guarantees from Amazon about power outages, security breaches and other unsavory aspects.
Also as in real life, the ‘hood you decide to live in might very well affect how secure your data is. Amazon Web Services found itself having to boot Wikileaks after it (Amazon) was targeted by groups intent on bringing Wikileaks down. Even though Amazon might be better able to protect itself against a DOS (Denial of Service) attack, its visibility might mean it is attacked more than an average client.
I’m excited by the services that are now available on the cloud, and even more excited about how much they can revolutionize healthcare. But given my background as an IT auditor, I’m wary of getting too excited about cloud computing just yet. Let’s see what the next year or two brings.