Cloud Computing in Public Healthcare – Where Are We?
The Potential of Cloud Computing in US Public Healthcare
The US public healthcare system is undergoing a tremendous transformation process through the realization of Accountable Care Organizations (ACOs) and the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act that champions the implementation and meaningful use of health information technology. This environment provides an opportunity for reshaping the creation, storage, delivery and exchange of information on several fronts, including:
I. Electronic Health Records (EHRs)
II. Computerized physician ordering systems (CPOE)
III. Picture archiving and communication systems (PACS)
The typical approach would be to use traditional servers to manage this data. However, the volume of information expected to be generated and exchanged to achieve the goals of the “Meaningful Use” criteria (Centres for Medicare and Medicaid Services) is forcing healthcare providers to rethink the norm. And this is where cloud computing is capturing the attention of decision makers with its inherent advantages, including: (1) reduction in IT costs; (2) scalability in performance; (3) customizability; (4) flexibility to easily change vendors, and (5) ease in interoperability. Presently, the two cloud computing models under consideration for the US public healthcare system include:
I. SaaS (Software as a Service): allows for cloud computing to be launched from a service provider (provides more control to end user) or from a remote site owned, managed, and operated by the service provider (provides less control, but is more cost-effective). This platform provides users access to multiple versions of the same software.
II. PaaS (Platform as a Service): allows end users full ownership of their environment (the operating system is cloned) where they can share a common library of software programs. A key feature of this platform is customizability where software development and configuration management can occur.
While there is debate over whether the SaaS or PaaS model is ideal, there are several key issues on the management of health data that will need to be addressed.
Challenges to Adoption
Some of the challenges contributing to the tepid adoption of cloud computing in the US healthcare system include current policies on security and privacy matters. Presently, patient health information privacy is protected by the Health Insurance Portability and Accountability Act (HIPAA) that was further enhanced by the HITECH Act. The HIPAA-HITECH Act combine has expanded the definition of responsible parties involved in maintaining the privacy of patient health information, included terms for privacy breach notifications, empowered patients with access to health information and an accounting of disclosures, increased enforcement and raised penalties for breaching of privacy. However, despite these measures healthcare providers are concerned that they are not adequately resourced to guarantee privacy and security of patient electronic data. Similarly, there is concern emanating from the industry that there remains a lack of standardized guidelines for all organizations to implement and verify the security of patient data from external partners. This may explain the resistance of cloud computing vendors from signing to a business associate agreement with healthcare providers to share responsibilities over privacy and security matters. Beyond healthcare providers and vendors, there is the issue of patient consent. Defining the right to govern who can collect, use, and disclose patient health information as part of EHRs will be tricky in a shared public cloud environment. Despite these challenges, a starting point for cloud computing technology in the public healthcare setting will be the creation of private clouds operated by large partner institutes. An example of this includes Emory Healthcare’s partnership with GNAX Health to build a cloud-based environment for niche applications.
China Rises to the Clouds First
As the US manages to sort through ownership, privacy and security matters related to health data in the coming years, there are a number of regions that are rising to the clouds to deliver healthcare. China in particular has taken the lead with two healthcare cloud computing initiatives. The first is in Shanghai, where the local government has partnered with Huawei to build a health cloud in the Zhabei area to manage inter-hospital transferring of patients, EHRs, and virtual desktop office services for administrators. And in Hong Kong and Macau, IBM is currently leading the management of a cloud environment for 600 medical centres.
The Future of Healthcare is Clearly in the Clouds
Demonstration of the operational and cost benefits to healthcare cloud computing may actually first be realized in China where solutions to ownership, privacy and security matters governing patient health information may be approached differently from the US. Nonetheless, the US public healthcare system can look to the Chinese healthcare cloud computing model as an example for further study to identify what may work for the US delivery of public healthcare and what can be tweaked to address specific legal and technical needs.
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