Is there a cloud in your future? In all likelihood, it’s already here. “Cloud” computing is a new way of marketing centralized hosting technology, which actually dates back to the 1960s. Simply put, cloud computing is the delivery of your computing needs as a service rather than as a suite of products that you have to purchase and maintain, and it’s actually what makes the Internet work. E-mail, Facebook and online banking are all examples of cloud technology: You connect to an application, which then connects to a database somewhere out there in “the cloud,” allowing you to do whatever the application is designed to do. You are not involved in the maintenance of these applications or their databases. You just log into a site, Gmail or Yahoo mail, for example, and use it.
Why couldn’t we do that with an electronic medical record (EMR) or electronic health record (EHR) for our patients? This is precisely what cloud technology is designed to do.
Easy, Reliable Access
Think of cloud technology as a utility, similar to electricity or water. You don’t care how the electricity is generated; you simply want quality power to come into your computer or appliance when you turn on the switch. Similarly, you don’t necessarily care where water comes from; you just want clear, clean water when you fill your glass or take a shower. Cloud technology for healthcare records operates in much the same way: For a flat fee, you expect easy and secure access to your patients’ data through a familiar interface and through any device. You need instant access to an EHR, 24/7. Someone else can worry about maintaining the application and the database.
A central component of the government’s efforts to upgrade health IT and manage costs is the mandated implementation of EHRs. Inadequate capital is the most commonly cited barrier to this implementation, however, even with the help of incentives provided to encourage “meaningful use” as required by the American Recovery and Reinvestment Act of 2009. The second-highest barrier is the high maintenance costs of the systems not addressed by meaningful use. For example, there is no funding for the very expensive hardware replacement and maintenance costs required for an EHR system. Theoretically, the “cloud” could remove these barriers, because the provider bears the cost of the IT application and infrastructure. Further, because the provider also services multiple users, your maintenance costs are minimal and predictable. Think of it as a shift away from the investment in software, databases and labor to more manageable operational costs, such as rent and utility bills.
Emerging cloud computing models are based on user need. The software as a service (SaaS) and infrastructure as a service (IaaS) models are increasingly popular. The SaaS model provides an EMR/EHR and a database with access typically delivered through the Internet. It is sometimes referred to as “on-demand software.” This model’s service providers initially focused on managing third-party software and their associated databases, but now these providers are starting to develop and manage their own software. There is also a steady migration toward web-based applications that require only an Internet browser to access. This model is very common in accounting and customer service.
The IaaS mode takes care of the networking, routing, data storage and retrieval, but the software is housed on the users’ computers and is not part of the service.
Think of cloud computing as a shift away from the investment in software, databases and labor to more manageable operational costs.Security and Backup
Security is another major issue in health care, and vendors are expected to have special expertise and monitoring in this area, along with improved backup services for power, cooling and recovery of data. It goes without saying that your organization would need to perform due diligence to make sure that your vendors provide appropriate security, database backup and disaster recovery protocols.
There are now strict security measures in place for this industry, and you would want to make sure that your vendors comply with Statement on Auditing Standards No. 70 (sas70.com) and other best-practice security standards. Your organization, unless it is very large, would have a difficult time matching the standards adhered to by a hosting site, and you are unlikely to have the IT expertise necessary to manage disaster recovery plans yourself.
Small practices with limited capital and IT support, which currently represent most of otolaryngology, may find that the SaaS model makes the most sense for their needs. The cloud vendor would likely provide better security, backup, availability and disaster recovery than the practice could ever manage on its own. Connections to other providers’ systems (e.g., radiology, labs, pathology) would likely be easier to access through the cloud vendor. Larger practices or institutions are more likely to benefit from the connectivity of an IaaS system that allows more control of the data they already house. One solution will certainly not fit all, and you will likely need the help of vendors and consultants as you assess your options.
Like the Internet, these remote technologies seem to be here to stay. Cloud technology promises to provide cost-effective delivery of EHRs and could help practices manage their IT costs and minimize their IT liabilities. In our next segment (“Cloud Computing in the Health Care Setting: Advantages and Disadvantages“), we will discuss the advantages and disadvantages of this technology, along with the unique litigation issues they present.
Rodney Lusk, MD, is director of the Boys Town Ear, Nose and Throat Clinic and Cochlear Implant Center at Boys Town National Research Hospital in Omaha, Neb. He has been working with EMRs since 1996. He may be reached at rodney.lusk@boystown.org.