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Cloud computing offerings face barriers to health IT adoption

The development of cloud computing offerings for health care is well under way, but it could take years for cloud services to catch on. Security concerns stand in the way.

BOSTON -- Leaders convening at a health IT and cloud computing roundtable agreed that cloud computing offerings...

for health care are on their way -- for image storage, Software as a Service (SaaS) electronic health records (EHR) and telemedicine. But the services will be adopted at a slower pace than they are in other sectors because of cultural biases and a lack of trust that cloud vendors can deliver security in compliance with HIPAA privacy rules.

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 is starting to change, however, at least among doctors at his facility. For starters, the public in general is increasingly using, and therefore trusting, such cloud computing services as Google Inc.'s Gmail. In addition, physicians shopping for EHR vendors learn about such cloud vendors as eClinicalWorks LLC, which offers a SaaS plan for EHRs.

Perceived, actual risks of cloud services differ

"One of the meaningful use goals is the ability to provide a patient with an electronic copy of their medical record. There are many ways to do that," including flash drive and CD, Buchanan said. "But a lot of times it's going to be incorporating the ability to send data to a [Microsoft] HealthVault. As we move forward, we'll overcome that cultural barrier. But it will take time for people to become comfortable with that."

My prediction is, we're 10 years away from having a health IT cloud.
Hamid TabatabaieCEO, Life Image Inc.

Patrick Boyle, IBM's director of public sector solutions, agrees. His health care customers are worried about liability for the host's security vulnerabilities, and are concerned about access problems -- namely, that crucial data will be inaccessible at critical junctures in a patient's care. That's just a perception, he said, because cloud computing offerings have evolved over the years to overcome barriers limiting uptime and access.

"I can't think of technology barriers that come to mind that will prevent cloud applications from continuing to expand," Boyle said. "We may have had that over the years with network bandwidth, but for the most part there aren't any immediate technology barriers that say, 'I can't do this' with a cloud application."

Americans deal with risk every day, deeming such activities as flying in planes and driving on freeways acceptable, noted Hamid Tabatabaie, CEO of Life Image Inc. in Newton, Mass., which delivers medical images online between providers. Putting health data on the Internet is no exception. Ranking various cloud computing vendors in terms of risk, based on their past performance, might accelerate cloud adoption among consumers.

The health care business model itself is a barrier to cloud adoption: Hospitals are reluctant to release data to patients because they compete with each other for patient care dollars, Tabatabaie said. Nor does the proprietary nature of the biggest EHR companies help: They are even more hesitant to make the data they collect usable outside of their software systems.

"My prediction is, we're 10 years away from having a health IT cloud," Tabatabaie said. Projects like the open source health care app store, which is funded by the Strategic Health IT Advanced Research Projects program of Children's Hospital Boston physicians Isaac Kohane and Kenneth Mandl, could erode the big-vendor paradigm and break their stranglehold on the health IT ecosphere, he added.

Trust is key to cloud adoption

As people get more comfortable with the idea of cloud computing offerings, and experience their coupling of rapid deployment and low costs, more health care providers will jump on the bandwagon, Anna Jacques Hospital's Buchanan said.

That hospital has adopted one hosted service, which 95% of the physicians affiliated with it are using. The lab- and radiology-sharing application ports test results into the hospital's EHR system. When the application's previous vendor went out of business, it made sense for the hospital to switch to a cloud vendor, because it recognized that a hosted service could restore very quickly what had become a valuable service to physicians.

That said, Buchanan remains more comfortable keeping most data "within his four walls" and isn't planning to be an early adopter of cloud services, he said.

On the vendor side, IBM is seeing the number of hosted EHR installations grow exponentially because small physician practices just don't have the financial or technical bandwidth to maintain a network to support them. A majority of new sales for the EHR vendors that IBM has worked with over the last two years have been cloud-based or hosted "in a cloud-like fashion," Boyle said.

Hospitals are testing cloud computing offerings by starting small -- by backing up a small amount of data, for example -- and seeing how it goes, Life Image's Tabatabaie said. Getting data off-site can be a security plan that itself beefs up data security, because in many cases, hosting vendors demonstrate more due diligence than providers when it comes to personal health record (PHR) security.

"Chances are, you can walk up in a white coat to a medical records window in a hospital and look at things you shouldn't," Tabatabaie said.

Demand ultimately will push cloud computing offerings into the foreground of health care, according to Tabatabaie and 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 PHR applications in the United States. As consumers push demand for telemedicine and PHR services, hospitals will have to turn to the cloud 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."

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

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