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Cloud for healthcare spawns benefits and challenges

Cloud systems for health IT applications are proliferating quickly in an industry resistant to cloud. In this Q&A, an expert says the cloud for healthcare is too compelling to ignore.

Shahzad Ahmad is vice president of cloud operations and delivery at patient matching system vendor NextGate Solutions Inc., which recently launched a cloud version of its main patient matching platform. In this Q&A with SearchHealthIT, Ahmad, a former vice president at Orion Health, a global population health and precision medicine technology vendor, talks passionately about the cloud for healthcare and what he sees as its compelling advantages, among them scalability, flexibility and storage. Ahmad also highlights some technical and cybersecurity challenges in building and running cloud for healthcare systems.

Up to now, the transition to the cloud for healthcare has been relatively slow, but it appears to be accelerating quickly. What technological and cost advantages will further spur adoption of the cloud in health IT?

Shahzad Ahmad: In my experience, there has been a lot of resistance over the last six or seven years. The word 'cloud' itself was a bit of a stigma. There was resistance to change that many industries, not just healthcare, faced in terms of letting go of their servers and getting into the cloud. But we, as consumers, have also had a shift in our understanding of IT by using smartphones and seeing the integration of cloud-based technology in our own lives, and it has helped greatly in understanding the benefits of the cloud. It's just there. You can use it. You don't have to have a large-scale infrastructure to keep it up to date. You don't have to have an army of people to keep it performing.

That message has started to go through to the entire healthcare market, where we have started to see a mega-shift in which people don't want to have capital expenses on their infrastructure and don't want to have an army of people to drag that infrastructure forward. If you just call out one aspect of healthcare and that's genomics, there is no infrastructure other than cloud that can cater to that. If our business is to provide value-based care and improve patient care and safety, all of those things, why not actually focus on our own business and outsource this constant issue of scalability that is required?

We don't even have to try to sell the word cloud anymore. It's understood that it's there.

Shahzad Ahmad, vice president of cloud operations and delivery, NextGate Solutions Inc.

Please talk about some of the cybersecurity issues associated with cloud for healthcare, and this notion of some healthcare organizations fearing that the cloud means less proprietary control over their -- and their patients' -- health data.

Ahmad: That fear is still there, to a degree. People do ask me that question a lot, about how data is secured in the cloud. My answer usually is that the security element is not specific to the cloud. If you look at the breaches over the last few years, a lot of them happened on the on-premises systems, and there were some cloud-based solutions that were breached as well. Basically it comes down to what kind of locks you're putting onto the system, and the entire security framework you're putting around the system where you're hosting the PHI (personal health information) data.

That message has started to go through to the entire healthcare market, where we have started to see a mega-shift in which people don't want to have capital expenses on their infrastructure and don't want to have an army of people to drag that infrastructure forward.
Shahzad AhmadVP of cloud operations and delivery, NextGate

It's our job as healthcare informatics system providers or solution integrators or any healthcare organization to come up with ... a robust framework for security compliance so we can not only match the requirements from HIPAA, but we should be able to exceed those standards.

The way the cloud system is set up, there is no difference between utilizing a cloud instance and utilizing your own server in the back of your server room in the hospital or your own data center.

What about the technical challenges of moving from on-premises systems to the cloud for healthcare, not only shifting customers over but also building the applications? Is that difficult for vendors?

Ahmad: It is. In terms of the application optimization for cloud, you don't do a 'lift and shift' of taking an application and putting it into the cloud. That has been the issue in healthcare for a while: A lot of the applications, minus the analytics and big data technology, originated many, many years ago. A lot of the EHRs have grown from legacy systems and they've not been optimized for the cloud. By optimization, I mean the flexibility and the scalability the cloud offers. These legacy systems were not able to cope with that infinite scalability, and they still require a lot of maintenance.

Once the application is optimized -- which could be a small or big challenge in itself -- then comes the question of the actual transition from an 'on-prem' solution to a cloud solution. That logistical aspect of the transition has been a challenge for most of the customers, partners and vendors I've dealt with in the past. It's a massive operation you have to undertake and sometimes the most experienced have got it wrong.

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