Security

This is part four in a series on cloud technologies in healthcare. You can read the previous three here.

It is a common misconception that cloud technology equates with inexpensive technology. There are economies of scale that must be achieved for savings to be realized. In the case of healthcare providers, a private cloud will cost more than a public or hybrid cloud because in a private cloud the resources are shared amongst fewer constituents. It should also be noted that price does not equal cost, and the total cost of ownership (TCO) should be evaluated when looking at a cloud architecture. (My colleague David Merrill has written about this numerous times over on his blog)

All of the costs important to the facility must be examined beyond just those of capital outlay. For example, if cooling and power are not a visible expense, any cost savings here will not be immediately tangible. Costs that are borne by other departments need to be considered in the overall business justification for cloud adoption.

Considering Cloud?

For those considering adoption of cloud technology, attention should be paid to the following financial areas:

• Architecture
• Total cost of acquisition (TCA)
• Total cost of data ownership (TCDO)
• Total cost of ownership — hard (TCOH)
• Total cost of ownership — soft (TCOS)

When choosing the architecture of the cloud provider, facilities should consider the underlying technologies. Direct attached storage will likely be the cheapest of technologies, but it carries a risk of performance issues with the very large-scale growth common to hospitals. Modular storage and enterprise storage systems have improved benefits of performance and features—such as thin provisioning and dynamic tiering—but bring increased costs. It will be important for adopters to consider what they are buying in any cloud model.

Total cost of acquisition is what most people think of immediately when making buying decisions. TCA takes into account the initial outlay or CAPEX but does not consider the ongoing costs. Only considering TCA will result in an architecture that may not fully support the initiatives trying to be achieved by the organization.

Total cost of data ownership takes a more practical view of the costs associated with managing data. When considering a cloud model, TCDO has real meaning as the OPEX costs are factored in and can be more easily compared to the current costs a facility is experiencing. This becomes an apples-to-apples comparison that will help in the decision making process. Cloud adoption brings with it additional benefits that need to be factored into the equation beyond just TCA and TCDO.

Total cost of ownership — hard includes items that are easily measured, such as maintenance, cooling, power and so on. TCOH should be considered with cloud technologies. However, TCOS is where the real financial benefits will be shown.

Total cost of ownership — soft for a hospital adds in the business and clinical impact that cloud technology enables. For instance, TCOS would encompass access to specialist storage or network resources that otherwise would not be affordable, or enable the adoption of new applications in a more dynamic and timely manner than through normal procurement processes. TCOS of cloud technology would have a business impact by reducing paperwork and process when the purchase of additional storage is needed scale to meet the demands of the department. These financial aspects can’t be overlooked when looking to make a decision on the adoption of the cloud.

Another area outside of operational costs that should be considered is the operational transition costs. There are some more obscure costs in this area, other than the labor and management, like the remedying a privacy breach—any agreement with a cloud provider should identify who bears the costs of such. Insurance policies that cover payments to 3rd parties as a result of a breach need to be included in the costs.

Cloud technology can bring many benefits, but due diligence will show what those financial outcomes will be. It is important that facilities look beyond just the acquisition costs, as many benefits will be found outside this single factor.

My next blog in this series will cover areas that healthcare organizations should consider when looking at cloud providers. Until then, I’m looking forward to hearing your thoughts…

As clinicians and health professionals across the nation are logging into their EMRs for the first time, they are quickly discovering that the “promised land” leaves them with a convenient but spotty view of the very information they desire.

Is this really a surprise, with only 30% of clinical data being neatly structured into efficient rows, tables and databases, and the other 70% of the data sitting in imaging files, wave forms, clinical reports and such? This is like driving a car where you can only see 30% of the windshield.

To be sure, EMR adoption is a major first step forward, but until we tackle the interoperability of these systems with the “other 70%”, it is going to be a long climb.

Here are a few interesting pieces I’ve found on similar topics:

• One More Reason For Slow EHR Adoption
• 5 Reasons EHR Functionality Hasn’t Changed Since 1982

This is part three in a series on cloud technologies in healthcare. You can read the previous two here.

While many challenges have contributed to slow adoption of the cloud, there are equally as many benefits for providers to embrace this new technology across the enterprise. These benefits encompass both business and clinical areas. In today’s world of cost cutting, many facilities must show clinical benefit in order to justify expenditures, and cloud technologies are potential tools to do just that.

Clinical Benefits

The single, biggest clinical benefit that cloud technology can provide is access to applications that were previously unattainable. For example, the implementation of digital pathology—managed through cloud services—has a huge clinical impact on an organization. The organization can now roll out a service that would have cost millions just for the storage alone, but now can pay for it as they use it.

Access to pathologists, previously located exclusively near centers of excellence, means that remote facilities can offer new services to its local patient population while relying on remote experts to render their diagnoses. Patient care can be improved by providing this service through the cloud faster and more efficiently. Since patients don’t need to travel, waiting lists are more easily managed as more patients can have the same tests in multiple locations with various experts now available.

These same experts can access patient data remotely and on demand through the Internet via a variety of connected devices. Physicians can review the latest diagnostic results from home and perhaps determine that the patient can be discharged immediately, rather than wait for their afternoon rounds.

Collaboration between researchers or physicians and allied health professionals suddenly becomes a reality, as the patient information is centrally located and accessible to authorized users. Patient information is now being shared between caregivers, regardless of location, allowing for more informed decisions to be made.

Business Benefits

Obviously there must be some business benefit for a new technology to be adopted, or it won’t be considered. Cloud technologies provide tremendous benefits that can contribute to the welfare of a provider organization.

Healthcare providers are in the business of treating and caring for patients. They are not IT focused; their purchasing patterns indicate that investment into IT falls far below other industry standards. In many cases providers’ IT staffs are stretched very thin and other staff must overcompensate.

For example, in radiology it is often a medical technologist—with a technical affinity but no formal technical background—who becomes the PACS administrator. The cloud offers providers the ability to access specific experts to manage and maintain their systems. A cloud provider will have a block storage expert, a network security expert, and an archiving and backup expert who will manage the different components. Providers need not build up these skill sets, but rather, for example, focus on a clinical applications specialist for PACS who helps clinical users maximize the application. These experts can spend the time and effort to implement the best practices for each component, which ultimately delivers added benefit to the clinical users and their patients.

Today’s purchasing environment through capital outlay usually works in cycles. A department will be given capital for the next 5 years and then will need to reapply and compete for funds to continue to operate their systems. The cloud provides a way to operationalize investments while guaranteeing that they can continue to operate.

Take the radiology example again. The department adds a new CT scanner and their data volume increases by 10%. Their storage is not scaled to handle this added volume and so they will deplete their available storage faster than expected. In a cloud model, the facility has access to the needed capacity and performance to meet the demand of the new CT. This “unlimited” scalability allows for the IT department to meet the interests of various departments simultaneously, and respond more quickly to changing needs as they develop.

This model lowers the barriers for adoption of innovative new technologies and helps to address the massive overhaul and modernization needs in healthcare.

Cloud models provide transaction-based pricing—as a facility uses more storage, they pay for it. Traditional capital models mean that the storage purchased in year 1 sits mainly idle, waiting for data to be captured. The ROI is low as utilization rates are very low to start.

With cloud technologies, utilization rates are 100% from the start, and the cloud provider is responsible for maintaining the hardware. For example, by year 5, cloud technology has probably been refreshed by the cloud provider, while the organization is looking to replace the capital model and migrate the data—a costly proposition.

Cloud technology shifts the paradigm for the delivery of healthcare. Consistent delivery of IT services and scalable hardware and software on a pay-per-use model enable healthcare providers to focus on what they really should be focused on: effective delivery of patient care.

In my next post I will explore the economics of the cloud in healthcare. In the meantime, let me know what you think.

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

It is no secret that healthcare organizations lag behind most other industries in adopting new technologies—by some estimates by as much as 10 years. Providers must modernize their IT infrastructures and massively overhaul their paper-based workflows, all while dealing with budget cuts and government reforms. It’s no wonder that healthcare organizations are often slow to move.

Healthcare providers invest 10% of revenue into IT, compared to other industries that regularly invest 25%. To date, their IT focus has been primarily around the digitization of images with picture archive and communication systems (PACS), payment and reimbursement applications and maintaining regulatory compliance. In addition, government incentives are driving providers to look at electronic health records (EHR), health information exchanges (HIE) and business intelligence or analytics tools as a way to push the boundaries of patient care.

The reality is, these types of initiatives can mean huge upfront capital expenditures, sizable ongoing operating expenses and a huge investment in change management. This is a major challenge in an industry that is historically reluctant to change.

Enter cloud computing.

Embracing cloud technology in healthcare may be the answer to enabling healthcare organizations to focus their efforts on clinically relevant services and improved patient outcomes. At the same time, it may reduce and even remove the burden of infrastructure management. Cloud technologies can provide access to hardware, software, IT knowledge, and resources and services, all within an operating model that drives down costs and simplifies technology adoption. Suddenly, management and migration of legacy hardware fall upon the cloud provider, allowing hospitals to get back to their primary intent of business—patient care.

As with any new technology, there are concerns that are both unique to healthcare and common to all industries. Security and privacy become a regulatory compliance issue while high availability is a must for systems that deal with life and death situations. Data movement across borders and ownership of that data are also important. Reports show as many as 30% of healthcare organizations are either implementing or operating cloud-based solutions,  and the result is a wealth of vendors moving their applications to cloud models. Unfortunately, these cloud technologies are mostly limited to email applications and collaboration tools like Microsoft Live Meeting, but the movement to clinical systems is starting to grow. Electronic health records, diagnostic imaging, analytics and the introduction of health information exchanges all lend themselves to be cloud-based with a clinical focus.

Over the next few months, this series will explore the different aspects of cloud adoption and how healthcare providers can move forward with a cloud-based solution.

But as the saying goes, you can’t know where you’re going until you know where you’ve been…

Current State of Healthcare

The healthcare industry has traditionally underutilized technology as a means of improving the delivery of patient care. Even today, organizations still rely on antiquated paper medical records and handwritten notes to inform and make decisions. Digital information is siloed between departments and applications, making access to a patient’s longitudinal record difficult, if not impossible. This lack of access costs the healthcare industry millions of dollars each year in duplication and waste.

The sharing of patient data among clinicians, departments and even patients is rare and complex. A hospital’s reliance on vendors to “knit” together their diverse technologies leads to expensive and unproven data experiments that fail to deliver the expected outcomes. Various countries have approached this issue in different ways, from the central national clearinghouse (UK) to regional health centers (Canada) to more granular HIEs; all realize various degrees of success. Those countries that have skipped over paper records and started with diagnostic imaging seem to have had more success albeit in a limited manner, and have yet to achieve success with the larger components of the patient record.

Most provider IT departments are accustomed to traditional technologies that require licensed software platforms, elaborate and hardware-heavy infrastructures supported by a large staff. The staff members need to be experts in all areas of the IT department, including hardware, software, networking, backup and archiving. As new technologies are introduced, the demands on the IT infrastructure start to push the limits of the promised efficiencies. While ground-breaking in its concept, government incentives simply don’t cover enough of the true costs of overhauling legacy equipment and modernizing a facility.

As EHRs, PACS and advanced clinical systems are evolving and becoming more prominent, the demands on current storage resources are stretched. The implementation of a digital pathology system alone could put petabyte-level demands on the current infrastructure instantly. Implementation time of these projects are consumed with ensuring the back-end technologies are properly configured and working, often taking focus away from the clinical aspects of these applications and what users need. Reducing this implementation time is critical to a facility’s ability to adapt quickly to changing needs and the introduction of new applications.

Patients today are better advocates for their own healthcare; they are more educated on their diseases and increasingly demand access to the latest technologies. At the same time, they seek the best care at the lowest cost, and are willing to investigate their options. As a result, the demands for access to personal patient records are increasing and organizations need to keep up. When citizens can access bank accounts from anywhere in the world, withdraw money, get balances and make payments it is hard to understand why we cannot travel across town and inform a physician what medications we are taking and what diagnostic procedures we’ve had, never mind what the results were. Patients require universal access to their secure health information.

This bleak picture is not all doom and gloom, however, as many facilities have recognized these challenges and still provide top notch care. Many developed countries are establishing healthcare data clearing houses or data centers that can help make data more portable. Canada has established diagnostic imaging repositories across the country with demonstrated benefits to both patient care and cost savings. Countries everywhere continue to invest in new technology that will improve patient care.

And this is where cloud computing can help drive the industry. CDW’s study (same reference as above) showed that 37% of healthcare providers have cloud adoption in their strategic plans, 22% are in the planning stages and 25% are in the midst of implementing. Only 5% have already embraced cloud computing and have recognized an average of 20% savings on those applications implemented. The next step is to move more clinically focused applications into the cloud.

In the next blog we will discuss the healthcare drivers for organizations to adopt cloud technologies. Until then, I’d love to hear your thoughts.

Data Movement Across Borders

While a cloud service provider may be located within the country of origin, some of the cost saving benefits that can be realized by customers are due to the economies of scale that the service provider attains by sharing the infrastructure between multiple customers. This may mean that a cloud provider backs up or replicates data at a secondary site that does not reside within the original country–think Belgian hospitals’ local cloud provider who backs up data into their German data center. In many countries this would violate their privacy regulations and can be quite a complex and expensive problem to address, particularly if there is a breach of patient information. Healthcare organizations need to ensure that their data does not move across borders that it is not allowed to.

Data Migration

It would be naive to think that a facility would stay with one cloud provider forever. Cloud providers are free to manage their infrastructure as they see fit—a benefit for facilities who don’t want to worry about this infrastructure component. But some caution is advised. Customers need to know that their cloud provider is using accepted standards to store data. Proprietary mechanisms of storage will make migration very difficult in the future. An understanding of the cloud provider’s infrastructure and contractual agreements that ensure not only the ability to remove data but also assistance in migrating this data should be considered a high priority for any organization looking to adopt the cloud.

Ownership of the Data

This has been highlighted as a concern, but it should be clearly defined. Patient data belongs to the customer and the patient. The cloud provider is providing a service – network, storage, application, infrastructure, resources – but they have no claim to the data. The regulatory constraints should support this, in that patient data is subject to privacy and security laws such that a cloud provider could not, for example, sell access to the data to a marketing company. The customer is entitled to move, manipulate, change and otherwise remove data from the provider as desired. It is worth having this written into the contract so that all parties are clear.

Privacy and Security Compliance

Many organizations are reluctant to give up control of their patient information as there are certain risks that may suddenly become beyond their control. A breach of privacy falls to the healthcare organization to manage, and a cloud provider becomes an entity that threatens that control. There are many aspects to mitigate these risks:

A. Contractual compliance with stiff financial penalties for any breach of privacy such that the healthcare provider has a course of action to rectify the breach without undo cost burden;

B. Requirement of the cloud provider to meet regulatory compliance, regular audits of this compliance by third parties and immediate actions to rectify any gaps;

C. Private cloud models that ensure the data is stored on the premises of the healthcare organization while still getting the benefits of the cloud;

D. Use of the cloud for non-critical applications such as email, clinical collaboration, analytic tools, etc.

There is as much talk about cloud security as there is about privacy concerns, and they are somewhat related. Interestingly, HHS claims that of all the HIPAA breaches, only 6% can be attributed to hacking a system. The majority of cases involve theft of a computer—likely for the value of the computer and not the information within. A cloud provider will have top notch security protocols and processes that any healthcare organization should understand prior to a contract. How does the DC handle phishing or denial of service attacks? Do they have virus protection? What are the physical security aspects to prevent unwanted access? In many cases the cloud provider will have better systems in place than the organization itself – but these should be investigated.

High Availability

Healthcare deals with mission critical and life or death information. A cloud provider needs to understand that the architecture needed for healthcare is typically more robust than in other industries. Down time can’t be tolerated and service level agreements need to clearly define the expected response times. In Canada, Canada Health Infoway specifies that medical images must be stored in and retrieved from the Diagnostic Repository within 15 minutes of acquisition or request. These types of requirements must be written into the contracts prior to agreement.

The cloud can bring many benefits to healthcare organizations, but as with any new technology, due diligence needs to be done to ensure that better patient outcomes can be achieved at the same level of confidence as they are without cloud technologies.

The intent was by “…using Google Health, physicians will be able to more efficiently share important diagnostic data with their patients. As patients become better informed and proactive in managing their healthcare, they may be more likely to practice preventive care, adopt healthful behaviors and practice other measures that promote improved medical outcomes.”

Well, as it turns out, Google wasn’t so successful. What!?! Google failed to make a go of something? How does a company that brought us Google, Chrome, Google Earth and the like not be successful in healthcare? Aaron Brown, senior product manager of Google Health, said the initial aim of the service was to offer users a way to organize and access their personal health and wellness information, and thereby “translate our successful consumer-centered approach from other domains to healthcare, and have a real impact on the day-to-day health experiences of millions of our users.”

And so here lies the problem that inundates healthcare. What Google didn’t realize was that people aren’t so willing to put their personal health records out in cyberspace as readily as they are willing to post their drunken party pictures.

Funny how that works.

Google then relaunched Google Health two and a half years later with a new UI and some more interactive tools. But alas that failed to catch on. Since then Microsoft Health Vault and Intel have offered to convert any Google Health files over to their format. The vultures are circling.

A personal health record has a lot of value if properly implemented. Ensuring that the content is accurate, that you can access this data from anywhere in the world and enable who you want to see your records is of immense value. Think about being on vacation and needing to have some healthcare treatment. If you have a cardiac problem, you can share your records with the local physician and they can see all of your medications (that you can’t spell or remember). They can see recent tests and the results and not repeat certain tests reducing your exposure to radiation and the like.

So what’s the problem?

The first issue: A personal health record that is maintained by a patient can’t be trusted by the physician treating the patient.

Patients may tend to put only what they want in the record. They may omit or even edit certain results, thinking that no harm can come to them. Who wants to share their positive HIV test or their mental health issues? How relevant is that to the chest pains they present with? In some cases the patient may even disagree with the results and omit them altogether. A personal health record that is not maintained by the parties providing the service is somewhat questionable when it comes to using it as a reliable source of information.

Second: Can we trust the Internet, the cloud and Google to maintain a level of security and privacy?

Most people do not trust companies to maintain their privacy when it comes to health records. Too many newspaper articles have front page stories where some hospital has leaked patient information. And recent stories about Google provide more proof that maybe Google has a conflict of interest in wanting to provide a personal health record. After privacy concerns were raised, Google’s CEO, Eric Schmidt, declared in December 2009: “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place. If you really need that kind of privacy, the reality is that search engines—including Google—do retain this information for some time and it’s important, for example, that we are all subject in the United States to the Patriot Act and it is possible that all that information could be made available to the authorities.”

Who would want this? Perhaps Eric Schmidt was the downfall of Google Health and didn’t even know it.

Personal health records have their time and place if properly administered, accurately maintained and controlled in a non-biased, healthcare managed way. But getting to this stage will be difficult with all of the issues that surround our need for privacy, not to mention the sheer task of trying to coordinate the massive amounts of data. Some facilities are doing this. Governments are investing in electronic health records, which may serve a similar purpose.

But today, personal health records are still something of a nice to have.

Earlier this year, leaders in the radiology space were pushing the industry to be better engaged with the Meaningful Use (MU) incentive program. MUs is a government incentive program that financially rewards healthcare professionals when they adopt certified EHR technology and use it to achieve specified objectives. Initially, radiologists were hesitant to participate, which raised fear that adoption delays could impact the ability to meet new clinical and technology demands. For an industry that has typically led the pack on clinical innovation, there seemed to be real risk of radiology being left behind.

Since that time, radiology’s participation in the MU program has been clarified, however radiology groups are still slower than expected in adopting these IT innovations – innovations that are essential both for improving patient interactions and for their promised financial reward. KLAS recently teamed up with the Radiological Society of North America (RSNA) to conduct a survey on this very topic.  Among the results were two very interesting outcomes, the first showed that 60% of those surveyed either have a plan or are considering qualifying for the MU  incentives…. and more interesting, only 6% considered themselves educated on the MU incentive program. To me, that says there is a deep disconnect between the needs of the radiology consumer and how the technology players in this market are delivering their message.

I bring this up because, after following this story and having just returned from RSNA, I would have expected to see a plethora of MU messaging – and while RSNA provided a number of professional sessions on the topic – the MU message did not seem to make it to the show floor. Does it mean that IT health vendors are not coming to the table with Meaningful Use Certified solutions?  Probably not. I think it means that perhaps, there was a miscalculation in what vendors believed the radiology community wanted or needed to hear. When only 6% of those surveyed have a comfortable understanding of MU opportunities, it means 94% need more information to make better educated decisions about their MU plans.

The same must be said for Cloud, which was surprising when private and public cloud was the message dujour this time last year. I expected attendees of RSNA11 to be able to see and hear a more mature and better defined cloud message with a lot of industry examples and success stories. Instead, with the exception of a very small handful, the big message appeared to be imaging. Relevant? Yes. Forward thinking? I am not so sure.

And with 40,000+ radiology professionals in attendance, imaging is a given. I would have expected RSNA to be THE place to learn more about cloud and MU offerings – because it is clear that the radiology market is working hard to learn more about it.

What were your thoughts on how RSNA promoted innovation in radiology?

Gaining access to unstructured data opens opportunities for organizations, but it is only a start. It is even more important that organization know what data to access because the advantage will go to the company that can mine the most relevant value out of the data.

Consider a pharmaceutical company. They conduct clinical trials in the drug development phase. Multiple departments generate massive amounts of data that all relate to the drug’s interactions: blood tests, biopsy samples, pathology images, nursing and patient notes, not to mention chemical analysis and more. Combined with race, gender and geography factors, there is too much data to make sense of. Aggregating this data into meaningful information is the key to driving better decisions, like, for instance, identifying trends that can uncover major discoveries.

It’s a little known fact that Viagra was discovered by researchers when they found that patients didn’t want to give up their medication. The “benefit” (or side effect, depending on your gender) was an accidental discovery. Being able to correlate data that is seemingly unrelated can lead to major finds, and a way to show a relationship between your data will drive data mining and analytics to higher levels.

So there are two main challenges facing pharmaceutical companies when it comes to big data.

1. How does a company manage to store big data?
2. How can they make sense of this big data?

As you have seen recently with our cloud announcements, HDS has cloud technology that can address both challenges. Cloud computing for pharma companies comes with its own challenges, like:

• Security
• Ownership of data
• Migration

And these are important factors to consider.

Also, object-based storage is a way to store unstructured data and mine the associated meta data. Both Hitachi Content Platform (HCP) and Hitachi NAS powered by BlueArc® provide a means to manage unstructured data. HCP also forms the core of HDS cloud technology.

The key to managing big data is to enable reduced cycle times for computing massive queries. This drives pharma and biotech to gain an advantage over their competitors. High performance computing has a big role to play here – but that is a blog for another day.