Data Center Advisors

This is part 2 in a series of posts on the role of cloud in improving patient care. Part 1 can be found here.

As with any industry, certain drivers need to be present in order for new technologies to be adopted. For many years, these drivers have been minimally present in healthcare, resulting in a reluctance to change. Recent investments and the increased visibility of healthcare on many country’s national agendas have raised the drivers for cloud adoption.

Delivery of Cost-effective Healthcare

The cost of healthcare delivery has grown to such huge proportions that governments now face serious funding issues if there is no resolution. Healthcare costs in some countries amounts to 35% of gross domestic product (GDP); an unsustainable model that could drive some nations into bankruptcy. The drive to lower the cost of healthcare delivery has become so predominant in society that governments have risen and fallen on these platforms. Alternative models of healthcare delivery that lead to cost savings and efficiencies must be explored in order to rein in the increasing costs.

Government Incentives

Governments around the world are providing financial incentives for healthcare facilities to adopt new technologies, such as electronic health records. The recognition that technology can improve patient care while reducing costs has meant that governments are willing to invest in the traditionally slow healthcare industry to incite a faster pace of adoption. Reimbursement, the development of standards, introduction of legislation and regulatory compliance are just some of the mechanisms governments are using to advance healthcare infrastructure. The result is an increased awareness and consideration of these new technologies by healthcare facilities.

Clinical Innovation

Healthcare is always striving to innovate. The ability for healthcare providers to adopt new technologies that drive better patient care has always been a challenge, born out of the cost and complexity of rolling out new technologies. Today, facilities seeking to improve their technology adoption must identify funding for a capital purchase and develop complex tenders—likely without a full understanding of the impact on their existing infrastructure and staff.

Advances in technology combined with government incentives push organizations to adopt new technologies. Thus, there must be mechanisms in place for these organizations to deploy, test and validate the effectiveness of these proposed solutions and prove the return on investment (ROI), without significant upfront investment. Increasing clinical innovation drives better patient care and outcomes, which is the main reason for the existence of healthcare facilities in the first place. Increasing responsiveness of facilities to deploy these new technologies in a cost effective manner will be a driver for cloud adoption.

Big Data Growth

Healthcare has become the best example of big data. As the amount of digital information increases, the ability to manage this data becomes a growing problem. Petabytes of data exist in storage devices. This data holds the key to future clinical advancement, but often remains inaccessible to researchers. The ability to access this data and utilize analytical tools against it can drive clinical and business intelligence. This will contribute to better utilization of healthcare practices, even driving new clinical decision-making processes. Big data analysis holds the promise to better treatment paths for diseases and faster recovery times through the understanding of best practices.

Administrative Simplification

Hospitals are patient care centers, not centers of technical innovation. IT departments are stretched to accommodate the different clinical systems that are introduced into use, dealing with different vendor systems, platforms and licensing models. Clinical departments drive the acquisition of relevant applications without always considering the existing infrastructure and the results are inefficiencies. Take storage purchases as an example. Departments typically buy 5 years of storage during the procurement cycle without any rationalization of the storage needs of other departments. This storage can sit unused—but paid for—for years, tying up valuable capital dollars. Add to that the requirement for the IT department to then manage the application’s backup and archiving needs with those of other departments. There can be 10 to 20 different applications that need managing, taking the IT department’s time away from being strategic in responding to physicians needs and being more focused on day-to-day operations. Simplifying administration in the IT department allows more time to be spent on clinical systems and less time on the infrastructure.

Cloud Challenges in Healthcare

We have established that healthcare lags behind other industries with respect to technology adoption, and embracing the cloud is certainly in that category. Healthcare providers face many challenges as they investigate moving to a cloud model. Once these challenges have been satisfied, cloud technology will become not a question of “if” and more a question of “when.”

Privacy Challenges

Privacy and security rank at the top of the list explaining the slow adoption rates. Putting personal health information (PHI) into a 3rd-party, remote data center raises red flags where patient privacy laws are concerned. The possibility that patient data is lost, misused or falls into the wrong hands affects adoption. What recourse does an organization have should the cloud provider lose data? It has happened, and it has the potential to be a very expensive problem to resolve. Violation of patient confidentiality carries heavy fines, including significant costs of recovery and patient notification. A cloud provider needs to demonstrate how they are dealing with this issue.

A potential solution is a private cloud model. In this case the data still resides at the customer data center and a certain degree of control still exists for organizations to manage patient privacy. The organization can also ensure that the data center complies with certain standards, such as NIST 800-146 Cloud Computing Synopsis and Recommendations. This model may be more expensive, but security and privacy are more visible.

Security Challenges

Security challenges may be a moot point where healthcare providers are concerned. One of the benefits of cloud technology is the ability to access resources that would otherwise be unattainable. A cloud provider will have security experts deploying the latest patches and software to its data center. Secure access to the physical property will be well guarded and many policies, processes and mechanisms will be in place to ensure security remains in place. Add to that the fact that any applications operating through the cloud will store all their data in the cloud. This means there is no protected health information (PHI) remaining on the computers within the facility and you have a more secure situation than today’s current environment.

Health and human services studies show that PHI violations have come from the theft of computers taken from various locations: facilities, loading docks and even physicians’ vehicles. These thefts have been more for the computer and less for the PHI. This raises the question: Wouldn’t it be better to have everything in the cloud?

Workflow Challenges

Healthcare providers are notorious for resisting change. Therefore, we should assume that the adoption of a cloud model would be a major change management issue for providers. Current processes are often inefficient, relying on paper in many cases to manage patient care. Any transition to a cloud would require significant support from the technology partners to ensure a smooth transition for users.

• Take for example the current practice of requesting a diagnostic exam:
• A physician fills out a request form with patient details, history and reason for exam
• This gets sent to the radiology department for scheduling (assuming it’s a magnetic resonance (MR), nuclear medicine (NM) or computed tomography (CT) type exam)
• The clinical staff books the appointment and informs the doctor, who advises the patient, who has a conflict with the time
• Back and forth it goes.

Now consider an electronic scheduling system based in the cloud whereby the doctor enters all the relevant information and the system determines the most appropriate exam and notifies the patient directly of possible options. The patient logs in, selects the best time for the predetermined exam and the system books the exam. This process relies on many people to do their part: the physician must enter the correct information for the most appropriate exam to be selected, the patient must cooperate by selecting the best time, and so on. It seems simple, but change management is required to ensure this transition is smooth.

As a part of this workflow transition, serious consideration should be given to the staffing needs within the organization’s IT department. As the cloud starts to permeate the clinical environment, no longer will the same skill sets be required. Different technology will need to be supported, new training will be required and new skill sets will need to be defined. An organization that had staff working on managing backups and archiving will now migrate to network connections and clinical applications. IT staff will focus on the rollout of the electronic medical record (EMR) instead of managing the storage layer the EMR sits upon. Access to this kind of skill set is in high demand today with experts suggesting the healthcare IT industry could be one of the highest growing areas for employment.

These challenges contribute to slow adoption of cloud technologies but should not stop cloud progress. Organizations are weighing the benefits against the risks. As more providers migrate to the cloud, we will see these challenges overcome with new and innovative solutions.

In my next post I will discuss what benefits cloud technology will bring to healthcare.

Previous posts in the series:

The Role of Cloud in Improving Patient Care