Is that a cloud I see, or is it already raining?

I have to admit that it’s somewhat baffling why more Canadian healthcare organizations have not moved more progressively toward cloud computing for clinical systems as they have for administrative systems such as payroll and financial management.

We have a burning platform: healthcare organizations can no longer afford to run their own medical grade IT solutions. And, we have a solution: cloud computing has proven itself to be a reliable and cost effective means of delivering such services.

So what’s stopping us?

I think it’s a combination of a lack of information and a few closely-held misconceptions that are creating an environment of endless debate:

  • It’s not yet been done; who will go first?
  • Can healthcare organizations adapt to funding the shift to a new IT model?
  • What about data privacy and security?

These are all legitimate – and addressable – questions and concerns. Instead of deliberating if the cloud is appropriate for clinical systems, let’s start critically assessing how the cloud can be an engine to move healthcare delivery forward.

It’s raining, it’s pouring
First, let’s dispel the misconception that cloud is new and unproven. In its 2011 report “Sizing the Cloud” Forrester Research estimated that the cloud computing market would leap from $40.7 billion in 2011 to more than $241 billion by 2020. Furthermore, it’s estimated that approximately 80 percent of businesses will be moved to the cloud within that timeframe. Cloud computing is, in fact, here to stay. In its recent cross-sector study across 11 regions worldwide, the Dell Global Technology Adoption Index found that only a scant three percent of those surveyed are not planning to deploy cloud-based solutions. While using the cloud in healthcare has been most prominent in the US, the Dell study found that across geographies 96 percent are either using or considering using cloud-based computing solutions. Most are using either a private cloud (43 percent) or a hybrid cloud solution (43 percent).

In Canada, many organizations have already gone first. Niagara Health, Royal Ottawa Hospital, eHealth Ontario, and Alberta Health Services are all veterans of managed services to provide wireless connectivity in their care environments. Similarly, the Government of British Columbia, Alberta Health Services and Royal Victoria Hospital use managed services to process payroll and related human capital management services. Now health regions and school boards in BC are signing up for community cloud solutions for their full ERP needs.

Remove investment barriers
Second, let’s challenge whether or not cloud is affordable. From a financial standpoint, cloud computing shifts health IT from a costly on-premise technology and maintenance model to an on-demand services model that, despite Canadian health organizations’ current funding structures, actually makes more economic sense. The payas- you-go approach lets organizations minimize their capital spending and scale up or down in response to real, versus projected, need.

It also places the design, implementation and management of complex health IT systems where it belongs: in the hands of expert organizations that are wholly focused on delivering IT solutions. Cloud computing can be affordable, however the issue is that current funding models do not support the shift. One-time funding supports old DIY health IT models, but not consumption-based pricing. This is an area that must evolve. Canada Health Infoway’s approach is a great model to provide seed funding for new initiatives, but the burden of ongoing operating costs falls to the health delivery organizations. To take advantage of pay-as-you-go models, we need to find a way of supporting, or at least not penalizing, the offsetting increased operating costs of these models. For example, the impossible situation of migrating to new systems, while at the same time paying the operating costs of the legacy systems is a double-hit on cost per weighted case. Were the government to provide a grace period of, say, two years while said migrations were taking place, it would remove one huge barrier.

Security and privacy
Finally, let’s take a look at security and privacy – the most frequently voiced concern in considering cloud-based solutions for clinical IT.

While Canadian statistics are scarce, many of the data breaches reported in recent media accounts are due to human negligence or error. Yet, in the US, close to 45 percent of all healthcare data breaches are now due to criminal activity; up 125 percent over the past five years and eclipsing employee negligence for the first time.

Obviously, security and privacy is of paramount importance. However, is health data any more secure in paper files or on laptops? I think not.

Security and privacy is a very real issue anytime data is stored, shared and processed, whether in a healthcare context or otherwise. What matters is how privacy is designed into a system, how quickly errors are mitigated and the level of transparency in reporting, escalating and fixing problems when they arise. According to respected privacy expert Ann Cavoukian, who heads Ryerson University’s Privacy and Big Data Institute, companies like TELUS have a leg up when it comes to managing personal data and privacy, crunching billions of bits of customer and network data in a way that respects and protects customer privacy.

New innovations are in the cloud
In closing, cloud computing frees up scarce capital, reduces health IT costs and makes the most of limited resources. The deployment of cloud solutions for administrative systems proves the case, so to speak. Now is the time to make that pervasive, and in so doing, unlock health organizations’ time, attention and resources to focus on clinical system needs.

By applying the same learnings and models to clinical systems, we open up opportunities for new innovations that will directly improve healthcare delivery. So I ask again: if cloud-based solutions are good enough for administrative systems, then why not extend this to clinical systems?

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