Health care cloud offers some risk, endless possibilities

While some physicians still need reassurances about the benefits of cloud computing services, they could be an attractive answer for storage, networking and EHR systems.

Health care information technology, in many ways, trails other vertical markets. Contract attorney Diana McKenzie

of HunterMaclean in Savannah, Ga. put it this way: When she first started practicing health IT law more than two decades ago, she found health care about eight years behind finance.

"People always thought I was really smart to know the future, but all I was doing was copying what was going on in the rest of the world," said McKenzie, in a presentation at the Health Information Management Systems Society's HIMSS 2011 conference. "That gap has narrowed now, but we're still three years or so behind what's happening in financial IT transactions."

McKenzie spoke about legal matters involving hospitals and their IT vendors, but one could say something similar about health care and cloud computing services. While the rest of the world more or less embraces cloud storage and applications -- whether it's something small such as Google Inc.'s Web-based Google Docs, large commercial services like Amazon.com or even elaborate private clouds -- health care is just warming to the idea.

Data ownership, regulations top health care cloud concerns

Part of the reason health care is just now taking its first tentative steps is because the sector's IT infrastructure is a few years behind. That's not surprising, considering the lives at stake when it comes to experimenting with new technology. Playing it safe is part of the science of health care.

Another part of the reason is fear of what could potentially go wrong when a provider entrusts protected health information to a third party. Physicians worry that cloud vendors won't be able to comply with state privacy laws as well as federal regulations -- chiefly HIPAA, but also Federal Trade Commission consumer protections. This becomes an even bigger fear when a cloud vendor outsources storage to foreign soil, where enforcement can be complicated.

Even in situations where a host company's security is robust, doctors have a hard time trusting outside vendors with patient data, said Robert Buchanan Jr., CIO of Anna Jacques Hospital in Newburyport, Mass. That perception will change, albeit slowly, as providers focus on implementing federal meaningful use requirements that incorporate data exchange in the cloud. "As we move forward, we'll overcome that cultural barrier. But it will take time for people to become comfortable with that."

Another issue is uptime and access. Since health care practitioners access data in the course of administering care, network access can literally be a life-or-death matter. That makes some physicians and their IT leaders leery of letting that data offsite.

Add to that the nebulous matter of ownership. Territorial physicians and hospitals compete and therefore do not necessarily trust third parties to handle patient data, assurances and contracts notwithstanding. Finally, what happens if either side fails to fulfill its contract -- that is, what if a health care provider cannot pay its bill on time, or what if the cloud service provider goes out of business? Is the data no longer available to the health care organization?

Cloud storage, data exchange the beginning

These are legitimate concerns, but prudent planning will reduce the risk that providers face. Necessity may drive health care cloud adoption anyway.

Many hospital data centers can't keep up with expanding demand from radiology departments producing X-rays, MRIs, CT scans and other imaging studies. Not only does increasingly sophisticated gear capture higher-resolution still images and videos than ever before, but state and federal laws are mandating longer terms of records storage -- up to 25 years in certain scenarios.

Prudent planning will reduce the risk that providers face, but necessity may drive health care cloud adoption anyway.

Most health care CIOs say that imaging comprises at least half of their data in storage, with some claiming it's up to two-thirds. With patient care documentation requirements escalating, electronic health record (EHR) systems, and their need for storage, are also growing. Add to that federal mandates to participate in health information exchange, or HIE, and it's a perfect storm for cloud storage and application vendors.

As part of the 2009 stimulus package, each state received funding to build an HIE organization, to which local physicians will connect. Eventually, the statewide HIEs will connect to each other. Meanwhile, private and public local and regional HIEs are springing up all over the country as well. Some cover a specific geographic area, such as the Brooklyn and Bronx boroughs of New York City. Others, such as Verizon Business' cloud-based health information exchange, aim to cover the entire nation.

The holy grail of HIE isn't single-patient data exchange, but whole-population health research that simply is not possible with current systems. By using clinical data analytics tools to examine disease trends and treatment patterns across the country, researchers will be able to better understand health care issues and respond more quickly to events such as food contaminations or pandemic flu outbreaks. On a smaller scale, some facilities have begun using data marts in private health care clouds as a portal to developing their own treatment innovations through research.

Private clouds also are proving to be a viable way for large hospitals to extend IT services to affiliated solo physicians in their communities. For example, Boston-based Beth Israel Deaconess Medical Center streamlined its EHR network by setting up a private cloud and virtual servers for remote physicians -- one server per doctor, with each containing practice management, billing and EHR modules. The service-oriented architecture (SOA) model may also suit the health care cloud, as it could potentially alleviate some security concerns.

Demand ultimately will push cloud computing offerings into the foreground of health care, according to Dr. Joseph Kvedar, director of the Center for Connected Health at Boston-based Partners HealthCare System Inc., which helps administer one of the most interactive telemedicine and personal health record (PHR) applications in the United States. As consumers push demand for telemedicine and PHR services, hospitals will have to turn to cloud computing services as their IT needs multiply beyond their technical ability to support them. Or for that matter, pay for them.

"The fact that you can buy unlimited storage for five bucks a month," Kvedar said, "[will] really help us lower our IT infrastructure costs."

Telemedicine, EHR systems on frontier of health care cloud

In May, the Centers for Medicare and Medicaid Services released a final rule that eases the credentialing burden for telemedicine services. This is important first step in legitimizing the use of Web videoconferencing for remote doctor-patient visits.

Experts on both the hospital and vendor side believe telemedicine will first be used to connect specialists to patients in either sparsely populated rural areas or inner cities. Beyond that, remote patient monitoring devices, which send regular updates to physicians' EHR systems via Wi-Fi enabled computers and phones, show promise for home-based care for chronic disease patients, who would not have to come to physician offices as frequently as they do now.

Meanwhile, though the Apple Inc. iPad and its tablet competition are popular devices among physicians and nurses, so far they seem to be used more as consumer devices than tools to enable care delivery. However, EHR software for tablet devices, in conjunction with desktop virtualization, is changing that. This solves the problem of storing patient data on remote devices and, as a result, makes compliance with HIPAA patient privacy laws much simpler.

A few small vendors, including Pulse Inc. and ClearPractice LLC, offer Software-as-a-Service EHR systems accessible from a laptop or iPad. Most large vendors, such as General Electric Co. and eClinicalWorks LLC, have SaaS instances of their flagship EHR systems in the works or already on the market. Perhaps the most ambitious cloud EHR vendor so far is athenahealth Inc., which also includes practice management and billing components that track and pool claims reimbursement data into one database.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

This was first published in June 2011

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