Friday, November 23, 2012

The Momentum For Cloud Computing In Health Seems To Be Building. What Is Happening in OZ I Wonder?

A couple of articles in the recent past remind us it is happening at an increasing pace.
First we have:

Healthcare CIOs Opt for the Cloud

Scott Mace, for HealthLeaders Media , October 18, 2012

This article appears in the October 2012 issue of HealthLeaders magazine.
Cloud computing is taking hold in healthcare as a form of data sharing and for archival storage, an infrastructure cost-cutter and a time-to-market accelerator, and even as a method of recovering from disaster. But as author William Gibson famously said, if the future is already here, it isn't evenly distributed yet, and cloud computing is a textbook example. Concerns about security, privacy, regulatory compliance, and service-level agreements are just a few of those cited in and around healthcare as go-slow signals for adoption of the cloud.
Just don't show those signals to a growing contingent of CIOs and other healthcare technologists who are making real use of cloud computing today to help solve pressing needs.
"We have several examples of what we're doing in the cloud,” says Joe Bengfort, executive director and CIO of University of California San Francisco Medical Center, which posted net patient service revenue of more than $1.8 billion in 2011. "Some are quite closely related to the medical record system and patient care. Some of them are more back in the weeds of the infrastructure and the back-end technology.”
At the same time as UCSF is making these preliminary steps into the cloud, it's also just bet big on a traditional client/server-based electronic medical record from Epic, which went live in June 2012. "We use an approach we call development on the edges of the medical record,” Bengfort says. "Our strategy is to develop capabilities outside of the medical record, and then feed that information back into that system, or to link from the medical record environment into some outside system.”
One of those outside cloud systems,, has deep ties to UCSF. In 2010, its founder, Marc Benioff, pledged $100 million of his fortune to the UCSF Children's Hospital now under construction.'s development engine is powering a breast cancer research project spanning UCSF and the rest of the University of California system, Bengfort says.
"We're using the Salesforce platform to develop applications really around surveys—surveys associated with screening or survivorship, things of that nature—that our patients utilize,” Bengfort says.
"They can either utilize it by going into what looks a lot like a website, but it's really the Salesforce cloud,” he says. "Or they can access it through an iPad application that we've developed that they use on an iPad while they're at the doctor's office.”
UCSF has different programs written in the environment that do basic things like organize the data from the survey. These programs also do computations on the risk scores for developing breast cancer based on the input that they've gotten from the patient. These results can be linked to or moved into the medical record, so that if this patient presents at the hospital or at a clinic, that information is accessible by his or her care team, he says.
"We still have all the issues of patient information, PHI that has to be protected, that can't be shared unless it's agreed to by the patient, so you still have all those restrictions,” Bengfort says. "We've done a lot of work with Salesforce in certifying their environments for our PHI, so we think we're in good shape around all those issues.”
UCSF's boldest cloud move has been to develop a way to back up its new Epic medical records to the cloud. "All the infrastructure is in place,” Bengfort says. "We're replicating our data right now. We're through two rounds of disaster testing, and we're at a point now where we want to test the ability to not just fail over to switch to a redundant system but to fail back to restore the system to its original state.”
The capability is so new that the providing cloud vendor, Dell Healthcare, has only implemented it with UCSF, Bengfort says. This implementation was key to UCSF as it prepared to achieve compliance with Meaningful Use 2011; the 600-bed main hospital was on track to attest last month.
Those medical records predating the Epic system also found a home in the cloud. Legacy Data Access takes records from old medical systems and converts them to a format that can be stored and retrieved in the cloud. "They will custom-develop a webpage so you can see it in the format you want to see it back, and then you just pay a subscription service for the access to that data,” Bengfort says.
Lots more here:
and we also have:

5 ways cloud computing will transform healthcare

By Benjamin Harris, New Media Producer
Created 10/17/2012
As its name may suggest, "the cloud" is a mysterious yet increasingly ubiquitous presence in all parts of life. Realistically, its definition is simple: cloud computing takes advantage of economies of scale and resource pooling to provide massive amounts of storage and computing power to any users who sign up for the service. Google's suite of "apps," ranging from Gmail to its online document management system is one example. Amazon's S3 data service is another.
Cloud computing is still a relatively new force in computing, but it's already it is beginning to make big inroads in health IT as well. Greg Arnette, CTO at Newton, Mass.-based Sonian, which develops cloud-based technologies, describes five of the major ways the cloud will transform healthcare.
1. Data security: resiliency. "The cloud infrastructure offers durability and up-time that far exceed what any hospital's IT department could offer," Arnette says. Because of economies of scale, large cloud service providers are able to build large redundant data centers that place a higher emphasis on backup, data resiliency and uptime for lower costs. Cloud storage, for instance, can cost as little as 10 cents a month for "fast" storage and a penny a month for "cold" storage. "There's a higher bar of excellence for a cloud provider," surrounding the integrity and ease of access to data," Arnette says.
2. Data security: privacy. Is cloud data less secure? "The levels of security are much higher than what you see in a local IT department," says Arnette. Security in a hospital's server room can be as little as just keeping the door locked; when data is in the cloud, however, "it forces you to put all of your security in the application layer," says Arnette. Data on the server is "an encrypted blob of bits," that even the cloud provider has no access to. Cloud providers also rely on their economies of scale to maintain systems that attest to privacy standards such as PCI (credit card industry), HIPAA (healthcare industry) and FISMA, the Federal Information Security Management Act, which has more than 400 controls that need to be audited.
See the three other points here:
With all this going on I would be interested in hearing from providers who have e-Health system in the cloud for GPs, Hospitals and so on. I have had a couple of questions from people about this and it would be good to be able to link providers and customers.


Bernard Robertson-Dunn said...

Cloud Computing is a way of acquiring standard, commodity solutions to common problems.

In the eHealth space, the only area where this might apply is at the technology infrastructure level, which is about as far as you can get from data and processes.

AFAIK, eHealth is neither standard or commodity based.

My advice is: beware of technology vendors and service providers. They don't care about your problems, they just want you to buy their solutions.

Anonymous said...

David, in contrast to Bernard's comments there are many cloud based solutions in the market that can assist with eHealth most are sold in other vertical markets to health, reason health is to political and too academic when trying to deliver solutions to business problems, and too hard for most software vendors because of red tape, sale cycles etc. so health misses out on solutions that could make a difference in solving business problems.

And of course they want to make money, and that is why they don't concentrate on providing solutions to the health market

Bernard Robertson-Dunn said...


re: in contrast to Bernard's comments

I don't think your comments are in contrast to mine, I think you are saying exactly what I am.

If "there are many cloud based solutions in the market that can assist with eHealth, most are sold in other vertical markets to health" then they are not eHealth solutions.

IMHO, there are no common, standard eHealth problems and solutions. Those cloud solutions that may be useful to eHealth providers are for common business problems, not common health problems.

I don't have an issue with cloud solutions, they just need to be used to solve the right problems.

Anonymous said...

I could be too cautious but cloud computing is not meant for eHealth and eHealth is not meant for the "cloud". There is considerable resistance among eHealth stakeholders, predominantly patients, for the fear of both private corporations access to their EHR and privacy overall. Are we speaking of a state-owned cloud?

Anonymous said...

Please tell me this weaken your confidence in the use of cloud architecture for eHealth

Anonymous said...

@Bernard, some points you have raised are valid but what are common health problems, please explain?

@Anon, yes people are cautious about access to information and by whom, but encryption, authentication and separation of access key technologies at object level exist to give people confidence and there are Australian solutions that offer this level of security, but unfortunately just not used in health. Additionally the new Privacy Legislation will address some of these issues for better data management by third parties.

Privacy Paul

Bernard Robertson-Dunn said...

@Privacy Paul

re "... but what are common health problems, please explain?

My point is that there are none - at least not yet and not suitable for commodity solutions.

Andrew McIntyre said...

With virtually every GP network connected to the internet and subject to attack there is already a risk of information theft and I am sure its already happened.

Cloud based services are quite a good option for many practices that don't have a static location or good IT support. Its also good for very mobile users like allied health. Medical-Objects has been offering cloud based solutions in some of these areas for years. basically they get a standard set of HL7 messaging services which allow rich thin clients to access data using message level encryption. I think cloud based implementations of standards based messaging is very useful in health and its very scaleable.

Anonymous said...

I just wish people would stop saying !@#$ cloud. It is either outsourced infrastructure (Amazon)or a web based service - such as webmail.