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Healthcare has finally abandoned fear of the cloud and now realizes the value of cloud computing.
"People are actually embracing [the cloud] in healthcare," said Ed McCallister, senior vice president and CIO at the University of Pittsburgh Medical Center (UPMC). "Now is the time [for cloud computing]. ... I've been in healthcare pretty much my entire career, and this is absolutely the most transformative time."
In the past, health IT professionals worried about the security of the cloud, but over the years, the stability of major cloud platforms has eased those concerns. Instead, healthcare organizations see the value of cloud computing choices, such as how cost-effective the cloud is and its role in value-based care, population health and patient engagement.
Of the three well-known cloud computing options -- public, private and hybrid (see "Three different cloud options") -- hybrid cloud has gained favor among some hospital CIOs.
Healthcare leans toward hybrid
"A lot of us ... use a hybrid approach," said Karen Clark, CIO at OrthoTennessee in Knoxville, Tenn. Along with Clark and McCallister, Indranil Ganguly, vice president and CIO at JFK Health System, and Deanna Wise, CIO and executive vice president at Dignity Health, are using a hybrid approach with the cloud.
Ed McCallisterCIO, University of Pittsburgh Medical Center
UPMC is among those facilities that favor a hybrid approach. It takes applications already used within the organization that have a competitive advantage -- such as storage -- and moves them into the cloud, leaving everything else on-premises. "That's probably the most prominent approach that people would take," McCallister said.
Ganguly and JFK Health take a similar approach. Many of the applications used by JFK Health, based in Edison, N.J., also reside on a hybrid cloud setup, Ganguly said. The facility uses "a vendor partner [cloud platform], and multiple customers [are] hosted on it, but it's not our infrastructure," he explained. "We don't even set it up or own it. It's not a private cloud, but it is a restricted cloud, and so that's what we use right now for a lot of our applications. It's a software-as-a-service type [of] model, and the software is housed at the vendor side, and we're accessing it remotely."
McCallister said the hybrid cloud model is popular in healthcare right now because the cloud still represents a bit of the unknown. The hybrid cloud acts as a testbed for certain things in healthcare, he noted, adding, "Some of it is kind of toe in the water -- not knowing the cloud as well as they know the traditional environment."
Additionally, the hybrid cloud can take the pressure off IT staff, Ganguly said: "I don't have to have people focused on [hybrid], and it allows our team to focus more on the application itself and making sure the application is set up well for our users."
Cloud boosts population health
For many CIOs, the value of cloud computing includes cost-effectiveness, scalability and easier access to data. The cloud also offers opportunities for improved storage, big data analytics, population health, patient engagement and value-based care.
Access to data and population health. At UPMC, the cloud has outdistanced legacy systems in terms of data access, McCallister said. "The cloud allows us to ... lift the data from those many different sources that we have and actually allow access to that data in a way that's not possible when you think about the legacy systems," he said. For example, the cloud allows patients or physicians to access any data living in the cloud wherever and whenever they need it. When it comes to legacy systems, certain computers and devices need to be networked to a physical server, and access outside this network is difficult.
Karen ClarkCIO, OrthoTennessee
At this point, McCallister added, the value of legacy systems lies in the data they hold from both the payer and provider sides. "It's a very rich data source to get," he said.
However, the value of cloud computing can be realized here because the cloud allows easier access to all of this data. And greater access can be applied to and help with population health efforts, which refers to a movement in healthcare to analyze care data across a group of individuals and improve wellness. "If I know about you through your payer activity, through your clinical activity, through the provider activities and we can have that in a cloud with tools that reside in the cloud that are accessible to the consumer, that's where the cloud actually enables a better strategy," McCallister said.
Patient engagement and value-based care. Meanwhile, the cloud is critical to greater patient engagement, OrthoTennessee's Clark said. "If you want to engage with patients, you can't say, 'Well, why don't you drive to our office and complete this survey,' right?" she said. "If you want to engage patients, you have to go where the patients are. And where the patients are is on [their mobile] phone. So for patient engagement, that would be a cloud-necessary area."
Furthermore, "value-based care always requires patient engagement," Clark said. Value-based care is a national trend being pushed by federal regulators in which providers are no longer paid for the quantity of services they provide, but rather for the quality of patient health outcomes.
OrthoTennessee, which runs several area orthopedic clinics, is already pursuing value-based care with a patient-reported outcomes tool, Clark noted. Before surgeries, she explained, the organization surveys patients via a mobile device to see, for example, how they're doing, how bad their pain is, where the pain is and whether they're able to walk up stairs. After a surgery is completed, the organization uses this tool to continue monitoring the patient.
Big data and storage. One issue that many discuss in healthcare is dealing with the flood of data that comes from initiatives like population health and technology trends like the internet of things. "We can't do big data in the traditional way that we did with data centers," McCallister said. "You can't do traditional data center and storage strategies when you have something like genomics at the doorstep." Genomics is the science of sequencing the human genome, and there's a lot of data behind that activity -- petabytes of information each year.
"When you think about how much data we're collecting, it's enormous," said Wise of Dignity Health, which is headquarted in San Francisco. "And it's only going to get bigger with [genomics] and everything else we're doing. You need a place that you can increase that size as fast as you need to without feeling like you've got to wait until the next budget cycle."
The cloud offers such scalability. McCallister predicted that in the future, there will be very few data center companies. Instead, today's big cloud storage players that have the ability to expand "the way that we need them to expand in healthcare" will become the new norm, he said.
Lower healthcare costs
While many healthcare organizations use routine applications hosted in the cloud, some CIOs are now moving critical apps over to the cloud, including their electronic health records (EHRs).
Ganguly said JFK Health is currently moving its core EHR system over to a cloud platform. "So it's all going to be hosted in [the vendor's] data center, and then we're accessing from our site over the web, over the cloud," he explained.
Cost is the main reason for the move. "If I was to build the whole infrastructure in-house, there's a significant cost, and I have to refresh that cost every three, four, five years maximum," Ganguly said. "Whereas now, if it's on [the vendor's] infrastructure, they're responsible for keeping everything maintained [and] upgraded. They're refreshing the servers as needed, and it's invisible to us."
Three different cloud options
A public cloud is usually hosted by a third-party company and can be free or on a pay-per-usage model. That third party is in charge of managing resources such as applications and storage and ensuring that those resources are available and working smoothly.
"I view Amazon and Google and other people like that as pure public cloud," said Indranil Ganguly, vice president and CIO at JFK Health System in Edison, N.J. For Ganguly, the value he sees in the public cloud is scalability and the fact that it can be cost-effective. "If you need to dial it down, you can dial it down," he said. "You're right-sizing based on your needs, and if it's flexible enough in terms of the arrangement, that helps you manage your costs more effectively."
Although the private cloud offers similar features to the public cloud -- such as scalability -- a private cloud is a proprietary architecture dedicated to one single organization. Furthermore, an organization's IT staff is typically in charge of managing and maintaining the private cloud. Usually, the private cloud has the same staffing, management, maintenance and expenses as a traditional data center ownership would.
Hybrid cloud uses a mix of on-premises private cloud and third-party public cloud services. Healthcare facilities potentially have greater flexibility since hybrid allows workloads to move between private and public clouds as computing needs and costs change.
Managing and maintaining EHRs in-house, "I'd spend a couple million dollars upfront, and I'd leverage that investment over five years," he said. "Here, what I'm doing is I'm paying this contract-type model, and it's a uniform cost throughout."
Ganguly said that some IT pros will argue that this approach ultimately will break even. Others will say because of the ability to negotiate due to economies of scale, the price point is actually much better and there's the added benefit of not having to manage it.
Meanwhile, UPMC decided to go with a colocation model and partnered with a tier-three data center company, McCallister reported. "We had some aging data centers, and probably five years ago we would've built a new data center," he said. "By the time we move into the new data center, we will have retired probably close to a thousand servers in our existing data centers because of our move to the cloud."
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