Healthcare: To Cloud or Not to Cloud

By Robert Barras, vice president of health solutions, CTG Inc.

Robert Barras
Robert Barras

There’s nothing like a good bandwagon to get everyone excited. Whether it’s the success of your favorite sports team, or a hot new restaurant in town, or a movie that’s breaking box office records, once something gets hot it seems everyone wants a piece of it.

For healthcare IT, one of the loudest and most visible bandwagons in the last few years has been the cloud. The idea of being able to hand off the expense and resource-intensive hassle of purchasing, implementing, and maintaining hardware and software is very attractive to healthcare organizations continuously being challenged to “do more with less.” Yet that expediency is often offset by continuing concerns about security, especially as it relates to protected health information (PHI), speed of access, and other issues.

The reality is the cloud is the right choice for some organizations, or even some specific applications, but it’s not a panacea for HIT. Following are some things to consider as you make the choice of whether to move to the cloud at all, and what makes sense to move to it.

Improved scalability

One of the top reasons in favor of moving data and/or applications to the cloud is the ability to scale them on an ad hoc basis – especially as healthcare data continues to grow exponentially. A report from EMC and research firm IDC projects the volume of healthcare data will grow from 153 exabytes in 2013 to 2,314 exabytes by 2020.

Of course, the growth won’t come in a steady stream. At some points, healthcare organizations will need to be able to manage a high volume of data. At others, they may need to boost their computing power temporarily to drive a specific objective.

Rather than trying to manage data or computing needs internally and ending up with over- or under-capacity, the cloud provides a convenient way to scale up or down quickly. It’s also more cost-efficient, as healthcare organizations only pay for what they consume, significantly reducing costs. Finally, expanding capacity through the cloud ensures processing-heavy analytics applications aren’t slowing down the performance of critical clinical applications.

Enabling interoperability

All of that data won’t be coming from a single source, either. As more of healthcare shifts to being value-based, providers of all types and sizes need to populate their population health management (PHM) and other analytics applications with data drawn from a variety of sources inside and outside of the organization.

Most organizations, especially those hyper-concerned with security, will not want all of that outside data flowing into their core systems or internal data centers.  The cloud presents an ideal alternative.

It can create a clean separation between the main storage of PHI and all other data by treating PHI as a source that feeds applications housed in the cloud. With the help of a partner, all the incoming data can be cleaned and normalized so it can be used within analytics or other applications, providing better, more complete answers to PHM, patient engagement, trends, and other questions than can be obtained with internal data alone.

As the use of data in this manner grows, it will simplify the exchange between providers – especially as standards such as FHIR proliferate throughout the industry. The result is interoperability almost becomes a byproduct of the use of data in the cloud, avoiding the need for expensive, time-consuming special projects just to send electronic health records from one provider to another.

Greater flexibility

Moving to the cloud also removes limits on the types of applications healthcare organizations can take advantage of. If an IT department is running a Windows environment, it may be reluctant (or financially unable) to create a separate Linux environment to run a specific application, no matter how valuable it might be. Almost any good cloud provider will have that environment already available, which means the organization can not only implement the Linux application, but get it running quickly.

Faster time to market

Another advantage the cloud offers is a faster development cycle. With a standard set of development tools available, and a platform to run applications on already established, healthcare organizations will be able to introduce innovations more rapidly – and see the ROI faster as well.

Security concerns

Ask most healthcare CIOs why they haven’t moved more of their IT functionality to the cloud and the odds are the most common answer will be concerns about security. With so much at stake between the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and other regulations and the regular drumbeat of headlines about stolen PHI and security breaches, they may not feel the benefits are worth the risk.

That may have been true 10 years ago. But the top healthcare cloud providers have gone to considerable effort to harden their security to meet HITRUST and other standards. They also have teams whose sole purpose is to manage security and keep up with the latest developments. Contrast that with the IT departments at many healthcare organizations where security is managed by individuals who also have other non-security responsibilities.

In many cases, the cloud today may actually be more secure than internal systems. Still, it pays to be cautious. Healthcare IT leaders should look in-depth into the systems, tools, protocols, and other measures used by cloud providers. They should investigate the certifications the cloud provider’s team hold, as well as the depth and frequency of training. The more information healthcare IT leaders have, the better-positioned they will be to determine how much of their data, and how many of their applications, they want to run in the cloud.

Multiple benefits

As data grows and the transition to value-based care accelerates, healthcare organizations will eventually reach a tipping point in their need for speed and flexibility their internal personnel and financial resources can no longer support. In reality, it’s not a question of to cloud or not to cloud, but more of a question of when.

By taking all of their current and future needs into account, and balancing them against their concerns, healthcare organizations can gain the benefits of the cloud while minimizing the risks.


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