Robust debates
That's why as Harmon's 12-physician practice is preparing to select an electronic health records system, the physicians are in a "robust" debate about whether the EHR should be on-site or cloud-hosted.
Harmon's OK with the cloud system as long as the hosting servers are in the United States and the data therefore is managed under U.S. laws.
But he does face a generation gap: some older colleagues are balking at a hosted system, even if a standalone EHR would be pricier and require hiring an I.T. staffer. Recently, "we've had more meetings on I.T. than on how to treat disease," he says.
Rick Perez, administrative director of radiology at Winthrop-University Hospital in Mineola, N.Y., has his own idea of what cloud computing is.
If nothing else, the cloud makes accessing applications a little easier, he says. To get to hosted applications, he previously entered user names and passwords into the hospital's intranet, the virtual private network and then the application.
With a new picture archiving and communication system being installed that vendor Carestream Health will host via the cloud, one username and password via a dedicated VPN gets him in the system.
But there are larger business-related differences in cloud computing, as well, Perez notes.
With previous hosting arrangements, providers may have to pay for upgrades, or had a specific number of licenses for users. The cloud-based PACS comes with a site license and a pay-by-the-study financing arrangement.
There also is an "openness" to cloud computing that enables support for features that previous hosting iterations didn't have, Perez adds.
For instance, to have 3-D viewing of images, radiologists with the hospital's legacy PACS have to log into a specific server. Now, 3-D support will be inherent in the new system, which also will provide full access to PACS functions at home and via mobile devices.
"You may not be able to enter data from certain mobile devices but you can access it," Perez says. "I'm sure that will change over time as everything else changes."
Still, cloud computing is new for the radiology department and while Perez is confident the technology is ready for prime time and the uptime guarantees sound good, it's still unknown how well it will work.
"It performs well under testing, but how will it work under a full load?"
Merge and cloud
Medical imaging software vendor Merge Healthcare in late 2011 introduced the first phase of its new cloud-based hosting service.
Launched at the annual Radiological Society of North America conference in Chicago, the service, called Honeycomb, initially enables providers and patients to access their images and reports, which are sent to patients via a Merge-provided personal health record.
Later in 2012 will come a disaster recovery service where a second copy of the data will be hosted in an alternative location. Dell Inc. is the hosting vendor for Honeycomb.
Merge CEO Jeff Surges previously led Extended Care Information Network, which offered a database that held hospital census data and directories of post-acute care facilities, enabling hospital discharge planners and social workers to search for and communicate with long-term and extended care services in their regions. Allscripts bought the company in 2007.
ECIN used the application service provider computing model, Surges says. "If you toured our data center, there was nothing there. You had to drive to SunGard, which hosted the database."
It's fundamental
He says the computing model was an ASP because ECIN set up point-to-point connections with the proprietary database and an interface engine. Cloud computing is fundamentally different, he adds, because all entities access the same centralized source.
There are good and bad aspects of adopting a technology that is relatively new to health care, Surges cautions.
Cloud-hosted medical images and reports will be important in helping providers achieve later stages of electronic health records meaningful use compliance as patient engagement measures become more pronounced.
That should increase provider interest in the service as they won't face the daunting tasks of managing terabytes or petabytes of imaging data, or the resulting cost pressures, if they outsource the storage and retrieval.
The bad side: Any applications used for diagnostic purposes need Food and Drug Administration approval, which can cause delays before bringing them to market.
Seeking Security in the Cloud
There are 18 identifiers in a patient record that need to be protected, says David Canellos, CEO at PerspecSys inc., a Bolton, Ontario-based cloud computing security vendor. And if that record is in a cloud computing system, health care organizations don't have the same control of the data than if it was in their own network on their own premises.
PerspecSys sells software that segregates sensitive data, keeping it out of applications hosted via the cloud. it houses that data on an organization's network so it never leaves the premises. What remains in the cloud-hosted applications are "replacement values" or dummy data, either encrypted values or tokens--a randomly generated value. A proxy server translates requests for data. So, a provider would request John Smith's Social Security number from a cloud-based record and the value for that number, XYZ, is a reference point that is transmitted to a PerspecSys server behind the organization's firewall, which then translates XYZ to the SSN and pulls the number.
PerspecSys serves multiple industries and expects nearly 20 percent of revenue to come from health care by the end of 2012, compared with five percent a year ago. providers and payers, Canellos advises, need to understand some issues with data control that cloud computing users in other industries have experienced.
Some cloud customers have found it difficult to change vendors because the incumbent is holding their data hostage, so ensure that contact language clearly gives data ownership to the client organization. Further, data migration and abstraction tools in the cloud are not fully matured, so it can be tough to get all of your data with a high level of integrity if vendors are switched.
