Planning for Cloud in Healthcare

I was in Fargo this week for the third time in several months. It’s a cool place and I enjoy it. I haven’t been in winter, but the warmer months are pleasant.

I was there as a part of the Intelligent Insites Build Conference. It was an awesome event, held at the historic Fargo theater. While at the other end of the spectrum from HIMSS in terms of conference size, the attendees were great and I felt like the content was valuable. I’m already looking forward to next year.

One of the questions for my panel focused on the maturity of healthcare organizations in moving to the cloud. Cloud + healthcare is a topic that gets a lot of attention and news. In a way, it’s similar to big data. It got me thinking about healthcare and cloud, where we are, and where we might be headed. There’s also been some recent data, from HIMSS, Verizon and Accenture about the use of cloud computing in healthcare.

Where are most healthcare organizations when it comes to utilizing cloud computing? My anecdotal evidence mirrors much of the HIMSS survey from above. Most organizations are utilizing cloud computing for non-mission critical functions and applications. A common area where cloud is used is for HR software. Some specific technical functions utilize cloud resources as well, such as disaster recovery and backup.

Other areas in which healthcare organizations are using cloud are niche SaaS solutions. The adoption of these SaaS solutions is growing by leaps and bounds. Specific SaaS-based solutions are typically cloud-based, but I’m not sure this even counts as it is managed solely by the SaaS vendor.

An example would be a niche solution for telemedicine or bundled payments. A health system contracts with these vendors and these vendors host their applications in cloud environments, signing BAAs in the process. There are larger SaaS offerings that help shift the burden for managing infrastructure away from healthcare organizations. The major example here would be athenahealth.

The majority of these uses of cloud are not what most people think of when they talk about healthcare and cloud. They think of moving on-premises stuff into remote data centers. It’s taking computer resources that are in hospital-managed data centers and shifting to computer resourced offered remotely. Ideally those resources would be elastic, meaning you pay for what you use and you can easily scale up and down as needed. And cloud can be private, public, or a hybrid mix of the two.

There are models for the maturity of cloud computing. This model from Oracle is interest, at least in terms of laying out a general framework for maturity. As I read through it, I’d put the majority of healthcare organizations in the "ad hoc" stage. Organizations are keenly aware of cloud computing and most see the benefits clearly, but there is still skepticism about the ROI for cloud, the availability of mission critical services that are hosted, and there are still concerns about privacy and security with cloud computing. Personally I think cloud-based environments offer enhanced security models if done properly, especially in private cloud deployments.

With all the attention cloud is getting in healthcare, why are we stuck in the ad hoc stage? First, healthcare is not alone. Many large enterprises outside of healthcare have not fully embraced cloud computing. Many in the cloud industry feel new tools for cloud computing need to emerge that offer a seamless mix of private and public cloud.

With healthcare, there are other unique challenges constraining IT departments. Meaningful Use and the associated drain on IT to roll out or update EHRs is a major one. There are others, like ICD-10, that don’t exactly help free up resources to start migrating resources outside onsite data centers. Putting myself in the shoes of an hospital IT department, I’d probably push off thinking about moving to cloud as well.

One of the other challenges in healthcare is that many of the major systems, such as on-premises EHRs, aren’t simple to move to cloud environments. Take that all together and the current stage of the industry makes a ton of sense.

But what I am a bit surprised about is that it seems very few healthcare organizations have thought through a cohesive cloud strategy. Even if onsite data centers are here to stay — which is very likely in the short to medium term — the next stage should be figuring out what applications and resources fit well in a cloud-based environment and what cloud resources work well for those resources — infrastructure or platforms, public or private, managed, etc. It’s a lot to answer, but seems to be the necessary next step to pushing cloud adoption in healthcare.

It’s similar to big data. Before you can do anything with data, big or small, you need to understand what you are trying to accomplish with the data. Similarly, organizations need to decide what they are trying to accomplish with cloud computing across their entire organization to inform future decisions.

Most of this came out of a question during the panel about timelines before cloud computing is widely adopted in healthcare. I don’t think we can answer that question. But I think the most immediate next steps involve deciding how and when to use cloud computing. Once those strategies are in place, we’ll have a much better sense of the future of cloud computing in healthcare. 

If you’re at a healthcare organization and have a cloud strategy today, I’d love to hear about it.


Travis Good, MD/MBA, is co-founder of Catalyze. More about me.

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