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Cloud computing has much more to offer than simply hosting email services, sharing photos or backing up mobile devices. Those are functions most often associated with popular cloud services such as Google Drive, DropBox or iCloud. In many ways, healthcare organizations remain in the early stages of determining how the cloud fits into the healthcare information management and technology ecosystem. Providers are still calculating how to balance the possible benefits of cloud computing in healthcare with the obvious security, technical and legal risks.
One definition of cloud computing from the National Institute for Standards and Technology states it is "a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction."
According to a white paper titled Cloud Computing in Health by Canada Health Infoway, cloud computing models support three ways of provisioning computing resources as services:
- Software -- Applications such as monitoring and dashboard apps, content delivery, communications, and finance tools
- Platforms -- Such as middleware, databases and identity management systems
- Infrastructure -- Such as storage, CPU and networking
The white paper further states that deployment of these three services typically occurs in one of four ways:
- Private -- In which IT services are dedicated to a single organization
- Community -- Provides common services for organizations that have a shared purpose or business domain
- Public -- Offers IT services that are made available openly to a range of customers
- Hybrid -- In which some combination of private, community and public deployments are arranged to meet an organization's unique IT requirements
Rather than being a one-size-fits-all offering, it is clear that cloud computing offers a variety of services and deployment models from which healthcare organizations can choose in order to address current gaps and future needs in business provisioning.
Who needs cloud computing?
There are many reasons why healthcare organizations should consider the cloud to be part of their services delivery strategy, including important economic, technical and innovation benefits.
Most providers have invested heavily in their health IT infrastructure in the form of clinical and business software, hardware such as application and database servers, and extensive high-speed data networks. Due to continuing budget constraints, healthcare IT executives are under pressure to rein in costs while continuing to meet minimum service levels and deliver applications with the speed and availability that today's healthcare professionals require.
Healthcare organizations invest in health IT to be able to provide clinicians and administrators with information to make better, evidence-informed decisions. In many cases, the rate of change in many organizations is outpacing their IT department's ability to keep up with the newest software, processes and regulatory requirements. This is causing health IT provisioning to be a limiting factor in innovation and healthcare transformation, rather than the enabler that health IT was once envisioned to be.
The potential of cloud computing in healthcare is to enable providers to be more proactive and nimble in meeting changing regulatory and market demands by focusing their resources on the best use of technology. A cloud platform allows providers to offers this value to clinical and business end users beyond merely keeping servers, software and networks up to date.
Benefits of cloud computing
Healthcare organizations exploring cloud computing options need to identify where their greatest health IT-related needs are in order to determine if and how cloud computing offers an advantage. Provisioning of certain IT services over the cloud offers some distinct benefits over traditional self-hosting of the software, hardware and other networks associated with modern health IT.
Several commonly cited benefits of cloud computing include:
- Reduced cost pressure -- Depending on the exact deployment approach, healthcare organizations will pay for only the cloud computing resources they use.
- Speed and flexibility -- Cloud service options can be configured to meet the unique and changing needs of individual clients.
- Increased scalability -- Using cloud services, providers can increase the processing or storage capacity they require, rather than purchasing hardware that will sit idle until needed.
Risks and drawbacks of cloud computing
The security of healthcare information and the protection of individuals' privacy are major concerns facing the healthcare industry. It is a challenge for IT teams to keep their systems updated and protected from current threats, both external and internal, to their organization. Cloud computing providers are known to double-down their efforts to ensure the security of cloud resources.
Healthcare organizations understand that the use of the cloud is not without risk, and this is perhaps one of the most significant barriers to cloud adoption by healthcare organizations. A report from the Cloud Security Alliance, The notorious nine: Cloud computing top threats in 2013, identifies nine major security concerns associated with use of the cloud. Here are six of them:
Data breaches: Perhaps the most significant nightmare scenario associated with storing health-related information on the cloud, data breaches occur when sensitive or personal information is exposed to or stolen by individuals with no right to view that information.
Data loss: The cloud is not immune to sensitive information being deleted and rendered irrecoverable through an accidental or malicious act.
Account hijacking: Phishing, fraud and software vulnerabilities are used to gain unauthorized access to services and/or data on a cloud service.
Denial of service: Authorized users of a cloud service are denied access to applications and data as a result of a deliberate attack that causes an intolerable system slowdown.
Malicious insiders: Malicious insiders are employees, former employees or business partners who inappropriately use their privileges to access private information.
Insufficient due diligence: Organizations expose themselves to great risk if they don't fully understand their cloud service provider environment, the applications and services associated with it, and the incident response and security duties required of them.
Most of these security concerns also apply to a healthcare organization's self-hosted IT infrastructure. These issues should give pause to healthcare organization and spur them to ensure that prospective cloud providers expertly and completely mitigate these risks, and that a strategy and action plan are in place to identify and address evolving and emerging security and privacy risks.
There are clear benefits and risks associated with cloud use in healthcare. There are opportunities for significant financial, technological and service-related benefits that come along with adopting cloud computing. Yet, as with most emerging technologies, there are risks (both known and unknown) that must be mitigated to realize the potential benefits and, most importantly, to ensure the security and privacy of any data stored in the cloud. Healthcare executives must balance the risks, benefits, and business and IT needs of the organization to best determine if, how and where cloud computing should be featured in their health IT provisioning strategy.
About the author:
Trevor Strome, M.S., PMP, leads the development of informatics and analytics tools that enable evidence-informed decision making by clinicians and healthcare leaders. His experience spans public, private and startup-phase organizations. A popular speaker, author and blogger, Strome is the founder of HealthcareAnalytics.info; his book, Healthcare Analytics for Quality and Performance Improvement, was recently published by John Wiley & Sons Inc.
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