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In recent years, the shift to the cloud has been an ongoing initiative for many hospitals in the U.S. This has been the result of cloud vendors offering capabilities around redundancy, scalability and management. However, despite the fact that some healthcare organizations have successfully reduced their infrastructure footprint by moving to the cloud, concerns still remain about the potential impact of cloud service outages on patient care.
When Amazon Web Services (AWS) experienced several hours of downtime on its services in the U.S. East-1 region on February 28, 2016, several clients experienced connectivity issues and loss of service as a result. While AWS' official statement said the incident was the result of human error, there have been cases where cloud services became inaccessible due to internet providers experiencing connectivity issues. These issues forced their clients -- including hospitals -- to lose connection as well.
The adoption of cloud services varies from one group to another, and the impact of an outage can include losing access to patient charts, medical images, email or administrative services. This highlights the realities of being at the mercy of the vendor when an outage occurs. In many cases, the organization's IT department is not able to provide an ETA on when the systems will be restored.
Preparing for cloud service outages
Organizations can prepare for a cloud service outage by implementing a disaster recovery and business continuity plan. However, for smaller health organizations that rely on their EHR as a service, losing access to their core online hosted system can't easily be mitigated. These small organizations can ensure they have a secondary line of internet to connect to if one of their internet service providers is down. If the EHR vendor itself is completely offline due to an outage in a service such as AWS, the healthcare organization may have to rely on paper charts until service is restored. If the organization has completely moved from paper to electronic charts, a physician may not have access to a patient's chart during a visit.
These cloud service outages serve as a reminder to healthcare IT executives that they need to ensure they have a robust contingency plan that can provide access to critical systems when the cloud service provider or connectivity to their workloads is disrupted. For larger health organizations, this can mean hosting their environment in multiple geographic locations either with the same or multiple vendors.
Disaster recovery options
One option that has been popular is disaster recovery as a service. Under this model, a hospital uses a service provided by a vendor such as Microsoft and Amazon, which will ensure their systems are replicated and ready to go in case of emergency. This option has proven to be one of the most cost-effective since it does not require the duplication of the environment.
An alternative to using the cloud for disaster recovery needs is to use the hospital environment itself as the disaster recovery site. In this scenario, if there is a cloud outage or connectivity disruption, end users can simply connect to the local data center within their facility and resume work. This is an attractive option because it allows hospitals to repurpose existing capital investment into their current equipment to create redundancy in case of an outage.
With cloud service outages happening from time to time, those who are already in the cloud are reminded of the importance of contingency planning. Those who have not made the move and are preparing to make the leap must take the appropriate steps in vetting cloud providers. This means confirming that the cloud provider will implement safeguards that will ensure the availability of services even if the cloud provider goes dark. It's hard to predict if these outages will increase or not, but with the realities of current cyberthreats and increasing demand for cloud services, healthcare IT should take all the appropriate steps to implement a new disaster recovery plan or reevaluate their existing plan.
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