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This article is part of our Conference Coverage: HIMSS 2018 conference coverage and analysis

Reprimand on healthcare and cloud computing spurs HIMSS debate

The benefits of the cloud are well-known, as is the healthcare industry's wariness about moving patient data to the cloud. At the HIMSS conference, the deliberations expanded.

LAS VEGAS -- Some might have called it chastising or even finger-wagging. Others took it as good business sense.

However one viewed it, the words from an enterprise tech veteran struck a nerve: Healthcare organizations are moving too slowly and conservatively to the cloud.

The HIMSS 2018 conference here started on that note, and throughout the week hospital IT professionals and vendors offered varying views about healthcare and cloud computing.

Speed, scale and security

The initial warning shot came from Eric Schmidt, a technical advisor and former chairman at Alphabet Inc., the parent company of Google. Schmidt said cloud infrastructures are better set up to handle healthcare data at scale and also offer tighter security from breaches -- and healthcare organizations weren't getting to the cloud fast enough compared to the overall enterprise computing market. Google Cloud Platform sells cloud services and hosting.

"We are a big believer that you have to move to the cloud to get agility and speed," said Vijay Venkatesan, senior vice president and chief data officer at Providence St. Joseph Health in Renton, Wash. The healthcare organization implemented a managed services system in the cloud using SAP HANA, an in-memory computing platform.

Dan Cidon, NextGateDan Cidon

Cloud migration for healthcare is becoming increasingly necessary because "you can't have these jerry-rigged [on-premises] systems you have today," said Dan Cidon, CTO at vendor NextGate. Moving the cloud "focuses the issue on efficiency, fast setup and API-based transactions."

NextGate, which sells products to improve patient record matching, is itself moving to the cloud using Amazon Web Services (AWS).

John Supra, vice president of solutions and services, Care Coordination InstituteJohn Supra

On-premises setups are a "caged environment," said John Supra, vice president of solutions and services at Care Coordination Institute, a healthcare consultant and services company in Greenville, S.C.  However, the healthcare industry has not fully embraced an open-API world, which makes the move to the cloud slower, Supra said.

Bobby Saxon, CTO of HealthCare.gov -- the federal government site for healthcare insurance exchange through the Patient Protection and Affordable Care Act -- has mandated a full move to the cloud for the website by March 31, 2019. Currently, HealthCare.gov has five software applications on a public cloud hosted by AWS.

We are a big believer that you have to move to the cloud to get agility and speed.
Vijay Venkatesansenior vice president, Providence St. Joseph Health

"We're all in with the cloud," Saxon said.

Workday, an HR and financial software vendor that exhibited at HIMSS, is already fully cloud-based.

"Moving to the cloud and taking advantage of what vendors can provide with [updating] applications and securing data has tremendous advantages for healthcare," said Keith Lohkamp, senior director of industry strategy at Workday.

For example, automatic patching in the cloud increases security for data and can happen without health IT departments needing to conduct the patching, Lohkamp said.

Aashima Gupta, global head of healthcare solutions, Google Cloud  PlatformAashima Gupta

Security is a complicated debate with healthcare and cloud computing, particularly public cloud platforms. Healthcare IT managers and CIOs have long worried about putting protected health information (PHI) in the cloud, potentially exposing it to threats out of a medical facility's control.

Google Cloud Platform addresses this concern by employing 750 security engineers to guard its infrastructure -- a roster that many healthcare systems could not hire, said Aashima Gupta, global head of healthcare solutions for the company.

Managing health data in the cloud

When considering healthcare and cloud computing, Venkatesan predicted a struggle between vendors and providers about who owns health data. In Venkatesan 's mind, that data should be healthcare's intellectual property, not a cloud provider's, he said.

"We're better off if health systems come together as a consortium [to pool health data] and negotiate with the Amazons and Googles," he added.

Google Cloud Platform's healthcare customers do not cede control of any PHI, Gupta said.

"Hospitals own that data on the cloud. We don't own the data," she added. "Our enterprise customers are concerned about that [control]."

Scott Richert, Mercy Technology ServicesScott Richert

Some health IT professionals, including Scott Richert, vice president of enterprise infrastructure at Mercy Technology Services, a division of Mercy based in Missouri, don't buy that the cloud can handle the intricate needs of PHI.

"I'll push back a little bit [against the idea] that healthcare shouldn't be as cautious as we are" about the cloud, Richert said. For example, he said, a hospital can't tolerate a drop off, even temporary, in cloud services; rather, healthcare organizations need nonstop connection to a cloud infrastructure to maintain safe patient care.

In his observation, Richert said, there is not enough experience among vendors in managing healthcare workload in the cloud.

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How has your organization blended healthcare and cloud computing, if at all?
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I’ve worked in Health IT for 16 years. I’ve seen a transition from everything having to be in house to following vendor recommendations regarding in house vs “hosted.” The rate of change in Health IT has been exponentially increasing, especially since ARRA. I believe part of the hesitation is also, in part, due to the high number of startups with solutions for niches. We do our best due diligence in vendor selection, but the “what if” scenario of the vendor going under and leaving PHI abandoned in the cloud is a concern. Some contracts have clauses built in that specifically address this issue that go as far as having source code and data access procedures in escrow. That said, I think a hybrid solution would be a great start. Having a parallel infrastructure not only allows for a smoother transition to a cloud based platform in the future, but is great for disaster recovery in the present. I’m also all for API based integration rather than the traditional HL7 transaction model, but the APIs should still follow industry standards like HL7’s FHIR. Too many variations or one-off APIs would further compound integration. A cloud based platform is ultimately inevitable, but it would do vendors and cloud providers well to recognize that Health IT has unique needs, increasing regulation, and the workforce is becoming more nimble. We'll get there soon!
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That's a great point about hybrid cloud. We've found in other stories we've reported that hybrid is a popular choice for some in healthcare (such as here: https://searchhealthit.techtarget.com/feature/Medical-imaging-storage-strategies-aim-for-the-cloud). 
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