So, what is cloud computing?
Definitions, often wrapped in marketing lingo, are flying all over the Net, and while they don't clearly define cloud computing and what makes it different, they sure make it sound good. From IBM: "Cloud computing changes the way we think about technology. Cloud is a computing model providing Web-based software, middleware and computing resources on demand."
From Greenway Medical Technologies' explanation of its new cloud-based electronic health records hosting service from Dell Inc.: "Dell's cloud-based health information technology solutions simplify information, access, management and archiving for medical professionals and health care organizations."
From research firm HealthCare Performance Management Institute of Bethesda, Md.: "Cloud computing enables on-demand network access to a shared pool of configurable technology resources (such as networks, servers, storage, applications and services)."
From I.T. publisher TechTarget: "Cloud computing is a general term for anything that involves delivering hosted services over the Internet."
However, a cloud service has three distinct characteristics that differentiate it from traditional hosting, the definition adds. "It is sold on demand, typically by the minute or the hour; it is elastic-a user can have as much or as little of a service as they want at any given time; and the service is fully managed by the provider (the consumer needs nothing but a personal computer and Internet access)."
TechTarget takes a shot at differentiating cloud computing from previous iterations of Internet-based hosting, but some users of what's being termed "cloud computing" pay for the service not by time, but by transaction, such as per diagnostic imaging study. That brings us back to square one, searching for what really makes cloud computing different.
David Canellos is CEO at PerspecSys Inc., a cloud computing security vendor. But even he has a degree of difficulty separating the cloud from other hosting mechanisms. For instance, he was using iTunes years ago, but considers it a cloud application.
"Cloud is delivery of service over the Internet," Canellos says. "To me, if you've got a hosted service and Internet through a browser, that's the cloud. Facebook and Gmail are cloud. What's the difference between Google mail and Yahoo! Mail that we've had for years?"
The difference, he believes, is evolutionary. Canellos and other cloud computing users generally agree that the fundamental difference from past hosting iterations is that the cloud is the next-generation version that can take more advantage of the maturity of the Internet and its now-widespread broadband and wireless connectivity, Canellos says.
"Technology is more advanced, apps are richer and there are more devices to access apps. The term 'cloud' reflects the ubiquitous and mature level of today's Internet in our personal and professional lives."
The cloud is more sophisticated technology than its predecessors, says Greg Feld, director of the cardiac electrophysiology department at UC San Diego Health System.
He's also the founder and a board member of Perminova, vendor of a cloud-based cardiac surgical information system, which is used at UC San Diego.
Feld has used application service provider model and SaaS-hosted information systems, and says cloud systems truly are next generation.
With older hosting arrangements, users often had to refresh screens when moving to another search or function. And, ASP or SaaS vendors didn't always monitor their infrastructure performance and add servers before issues arose, whereas cloud vendors are better at continuously observing capacity and correcting as needed, Feld says.
Cloud vendors also can pull data from multiple systems and present it in a similar format.
A consistent look and feel of a cloud system is a big difference to clinicians, Feld says. He estimates only 10 to 15 percent of hospitals have some type of cloud system, but expects the technology to be very common within five years. Perminova is a relatively new vendor with two clients, UC San Diego and Mount Sinai Hospital in New York.
It's just better?
Gerald Harmon, M.D., a primary care physician and medical director at Greenville, S.C.-based Palmetto Physician Connections, a Medicaid plan, doesn't know if cloud computing is fundamentally different, but it's clearly more accessible than earlier hosting arrangements. "From a user standpoint, I find it easier than it was two or three years ago. Connections are more stable, the service is faster and it's more secure."
Palmetto uses cloud-hosted case, utilization and disease management software from MedHok Healthcare Solutions LLC of Tampa, Fla.
Harmon can run reports identifying patients with a particular medical condition, such as asthma.
He then can apply the vendor's analytics software against pharmacy and emergency department data to find high-risk patients who have been emergency departments more than twice in a year or fill more than four prescriptions, and target these patients for specialized prevention and treatment programs.
The search engine is fast, Harmon says. "I type in diseases and patients pop right up, almost in real-time."
Further, the software is more user-friendly. He previously used data management software that was slow, required users to crunch the data themselves, and then figure out how to use the information.
Consequently, Harmon views what he has now as a cloud-based service that is superior to what previously was available. "It's like getting time on an IBM mainframe in the old days."
But with off-site hosting of information systems comes some discomfort with not having those systems on the premises. "If I don't have an Internet connection, I'm dead in the water," he notes. "All our data is off site and that makes us nervous. We haven't has an outage, but the potential is there."