"We're forming an accountable care organization and getting more involved with independent physicians, and everything has to happen fast because we're dealing with aggressive timelines, either because they're regulatory timelines or we have competitive pressures," Whyte says. "While we have the resources to do this internally, our cloud services partner brings a lot to the table-they can spin up data center capacity very quickly, and they have very skilled human resources that augment our own staff."
In addition, that partner, Phoenix-based ClearDATA Networks Inc., serves only the health care market, and consequently is steeped in the sometimes esoteric health security and privacy requirements required, Whyte says.
And while it might not matter in every case and to all providers, the cloud services also enable Dignity to expand its I.T. environment using operating expenses instead of capital outlays for more servers and other infrastructure, he adds.
Dignity Health also has found that many of its new partners, be they competing hospitals, or insurers or independent physicians, want to have all the collaborative data stored in "neutral" territory separated from their larger infrastructures, Whyte says.
Not only are there competitive reasons to want to ensure the data is on neutral ground, but it also means there are fewer legal and compliance hoops to jump through to share the necessary data, which enables the organizations to speed up the development timelines.
Sharing metrics
One example is the physician metric reports being used for the emerging ACO, Whyte says. "That's an application that is really well-suited for a Web-based cloud environment: we need to share data among partners and make it widely accessible to physicians using all different types of devices to access it."
Cloud computing at Dignity will grow, but likely won't encompass its core legacy systems, Whyte says. "We are not fork-lifting legacy applications to the cloud: We use Cerner Corp.'s hosting services for our EHR, and we have no plans to move our core financials [from Lawson Corp.] to a cloud environment. We are using the cloud for the new types of collaborative applications we need to offer."
Collaboration doesn't necessarily have to be external, either.
As health systems continue to grow through consolidation and buying up physician practices, the management of internal data needed for collaborative efforts is getting more complex.
Jonathan Teich, M.D., the chief medical information officer at Elsevier Corp. and a practicing physician at Brigham and Women's Hospital in Boston, says the use of cloud platforms for knowledge is far less daunting than the idea of changing the entire computing paradigm.
Elsevier, an Amsterdam-based provider of clinical decision support information, plans to soon make a new service generally available that enables health systems to manage and maintain their clinical order sets via a cloud service.
"Health systems with hundreds or thousands of order sets have a hard time having local staff maintain them, and many are widely dispersed, which makes it more difficult to collaborate," Teich says.
That idea of fork-lifting core applications into a cloud environment is a task that many providers seem unwilling to tackle at this point. Much of that big legacy technology, as White from Aspen Advisors points out, is built of proprietary architectures that are not well-suited to transition into a cloud environment.
Not only that, but most cloud providers at this point can't guarantee the reliability and service levels health care organizations require for those applications. "When it comes to core systems, providers have invested heavily in the infrastructure around them, including investments in virtualizing their servers and to provide a level of redundancy, that they're uncertain they can get from a cloud platform. If you look across different industries, including the financial sector, you're seeing cloud adoption, but they're not running their businesses over the cloud."
Dan Riskin, M.D., CEO of Menlo Park, Calif.-based Health Fidelity and consulting assistant professor at Stanford University, says that his is one of a new wave of health care cloud companies providing a low-cost bridge to convert data into knowledge.
Health Fidelity uses natural language processing technology-which incorporates the Medical Language Encoding and Extraction system from Columbia University-to identify and encode clinical information in caregiver narratives to standard code sets, such as ICD-9 and 10, CPT-4 and LOINC.
The company works with solution providers to standardize all that unstructured data in feeds from providers for use in analytics, revenue cycle and compliance efforts. "Even with the all the efforts at making health care all about discrete data, around 80 percent of the clinical information is unstructured in clinical notes," he says.
Mining the mountain of unstructured data takes a lot of computational power. Cloud platforms, Riskin says, are ideally suited for the task.
"Analytics requires processing power and expertise, and cloud computing is proving in health care and other markets that it can deliver faster and cheaper than internal resources," he says. "What we and other start-ups in this space are doing is bypassing the manual processes of data collection and standardization that take such an enormous amount of time and resources to perform."
In Riskin's mind, new health I.T. start-ups, many of which are using cloud computing platforms, are the ones that can work with the data holders in the market-the hospitals, practices and health information exchanges among them-and find ways to embed new knowledge into care processes.
"What the country bet on, and is paying for, is that if the industry can digitize its information, it could make it rapidly useful for those innovative approaches to improve care." Riskin says. "That simply isn't going to happen if health systems and hospitals are trying to use internal resources to mine their Big Data. Cloud computing platforms enable processing power to be spun up, and adjustments to be made on the fly. "When I think about the power and flexibility of cloud computing, I'm frankly shocked that we're still having multi-million dollar, on-site installs."
