Information Week
Many healthcare providers have questions and doubts about adopting cloud computing for administration and hosting of their healthcare information. Steve Aylward, Microsoft's general manager for U.S. health and life sciences, has encouraged healthcare IT decision makers to embrace the technology, which he said could help them improve patient care and provide new delivery models that can increase efficiency and reduce costs."Just about everyone I know in healthcare is asking the same question: "What can cloud computing do for me?" Aylward writes in a June 28 blog post.
"Plenty," Aylward answers. "The cloud can allow providers to focus less on managing IT and more on delivering better care: It can, for instance, be used to migrate e-mail, collaboration, and other traditional applications into the web. It can also be used to share information seamlessly and in near-real-time across devices and other organizations," Aylward explains.
Generally defined as anything that involves delivering hosted services over the internet, a cloud computing model that offers a software-as-a-service platform is increasingly being offered to healthcare delivery organizations, especially small and medium-size physician practices that are budget constrained and have few technical administrators on staff.
What has helped information technology managers at health delivery organizations take a closer look at cloud computing, however, is the Obama administration's objective to move medical practices and hospitals away from paper-based systems and onto digitized records. Primarily through the Health Information Technology for Economic and Clinical Health (HITECH) Act, the government has established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified electronic medical record (EMR) technology.
The government's drive to have every American provided with an EMR by 2014 will mean that digitized clinical data is expected to grow exponentially. However, several doctors contacted by InformationWeek say that, even with those considerations, they are in no rush to outsource the maintenance of their important records and they have delayed their decisions to put sensitive information, such as their EMR systems, onto a cloud-based computing model.
Dr. Michael Lee, a pediatrician and director of clinical informatics for Atrius Health, an alliance of five nonprofit multi-specialty medical groups with practice sites throughout eastern Massachusetts, said that while he recognizes that cloud computing can be a cheaper and more practical model, especially for non-mission-critical applications, he is waiting to see what improvements in security will take place over the next five to 10 years before supporting a decision to put high-level data on cloud computing technology.
"The only cloud computing that we would contemplate at the moment is in the personal health record space, so that patients would own the dimension in the cloud in terms of where they want to store or access information," Lee said.
However, putting more mission-critical information like EMRs on a cloud computing model is not something Lee is considering.
"At the moment I'm not convinced that there's a secure enough place in the cloud or that the functionality exists for us to do everything that we need to do in the cloud. The cloud allows for a tremendous amount of interconnectivity between computers because it's using data storage that's free amongst different networks and I wouldn't want healthcare information being scattered in a way that I couldn't protect it appropriately," Lee said.
Dr. Richard U. Levine, president of ColumbiaDoctors, the faculty practice organization of Columbia University Medical Center, expressed similar concerns, noting that while he thinks there will be a drive toward greater adoption of cloud computing, "security is a big issue and is one of our biggest concerns with cloud computing."
That sentiment seems to be a consideration Microsoft's Aylward is all too aware of.
"To be sure, concerns about data security and [Health Insurance Portability and Accountability Act] regulations remain deterrents to widespread cloud adoption in our industry. The notion of moving most or all of a healthcare providers' IT resources, including patient data storage, to a cloud service still is cause for concern among providers large and small," Aylward said in his blog.
The Microsoft executive also said, "The value of the cloud can be leveraged by any sized healthcare organization, and in any combination that they want at a comfort level that is right for them at this time. For example, a multi-site provider organization can use SharePoint Online -- an intranet portal -- within a private, secure online network to facilitate collaboration and information sharing amongst hospital staff."
Mark Bowker, analyst at Enterprise Strategy Group, believes the best use of cloud computing in healthcare will be to maintain data that is non-transactional and isn't needed on a regular basis.
"There's certain data, for example, notes on a person who broke their leg 15 years ago, that a doctor needs to access only at the time of the patient's visit and only if that patient is having trouble with the leg. Up until the time of the patient's visit, the doctor doesn't need that data so it needs to be stored, secured, and maintained for regulation and compliance purposes somewhere else. Why not leverage the cloud to do that?" Bowker asks. "The cloud is great for non-transactional data, which is the majority of capacity," Bowker adds.
Still, for David Kempson, VP and CIO at Phoenix-based Maricopa Integrated Health System, cloud computing is a technology that's not an immediate consideration at this time.
"Talking about shared services for EMR, I don't know that that's really on our radar screen right now. We have had some discussion around aligning with a vendor like Google for e-mail services, or e-mail archiving services, and I think the value proposition of the cost benefit of doing that is certainly intriguing, but we haven't made any final decisions to move in the direction of a cloud computing model at this point," Kempson said.
A recently published study conducted by Ipsos Research on behalf of Microsoft highlighted the security concerns swirling around cloud computing among business decision-makers (BDMs) in healthcare.
Among the findings are:
-- More than 2 in 5 BDMs in healthcare say they know at least a fair amount about cloud computing.
-- Nearly half of BDMs in healthcare (49%) say their company has used cloud computing.
-- Concerns about data security and privacy are the greatest potential deterrents of cloud adoption among BDMs in healthcare.
-- Eight in 10 BDMs in the healthcare sector (79%) would be more favorable towards cloud computing if the platform was private and not shared, more than in any other sector.
Nevertheless, last month two major announcements may have been the clearest indication yet that vendors believe there is promise in offering cloud computing to healthcare delivery organizations, especially among small and medium-size physician practices. In June, GE Healthcare introduced Centricity Advance, a new Web-based, SaaS platform that offers a combination of EMR, practice management, and patient portal solutions for small, independent physician practices. Last month also saw Dell announce a partnership with SaaS provider Practice Fusion to offer an electronic medical record package for small and medium-size medical practices.
According to Aylward, the healthcare industry and technology vendors are working toward developing a more secure cloud computing environment that meets regulations of the HITECH Act in the way data is stored and distributed in the cloud.
"As those assurances emerge, we expect that over the next three to five years, we'll see more providers embracing the benefits of cloud computing. We'll see an increase in the use of online services for business applications, such as e-mail, CRM, and file-sharing," Aylward predicts. "We expect to see an increased adoption and mixture of private and public cloud deployment, with some larger organizations even experimenting with the cloud to create and sell custom applications. The possibilities of the cloud are endless for health organizations," Aylward added in his blog post.
