The cloud holds great potential for health data exchange interoperability, perhaps even including hopes for international standardization to support the Internet of Things, and it may be used to leverage intense data exchange initiatives, health IT experts believe.
Precision medicine based on genomics, with its huge amounts of complex digital information, will tie masses of information to a single electronic health record, says Lee Kim, director of privacy and security for the Health Information and Management Systems Society North America. Test results, summaries of imaging studies and genomic data will make using a clinical server model impossible, Kim says. “It’s way too much data. I could definitely see the cloud playing a future role.”
“I’m not sure that cloud technologies by themselves necessarily enhance interoperability,” says John Halamka, MD, chief information officer of the Beth Israel Deaconess Medical Center and a professor of medicine at Harvard Medical School, who has co-chaired federal workgroups on the standards needed for interoperability. “However, there are cloud-based services that could reduce the burden of interoperability implementation.”
Still, the healthcare industry has some catching up to do when it comes to using the cloud, says Ed Cantwell, executive director of the Center for Medical Interoperability (CMI), a nonprofit with mainly health system members that is striving to accelerate the seamless exchange of information. Sectors like the financial industry have relied on the flow of data to survive, but something has blocked the healthcare industry from following suit, Cantwell says.
“You can walk into any hospital in this country and systems don’t talk to each other. They don’t work in a plug-and-play manner,” says Kerry McDermott, vice president of public policy and communications at CMI. “Health systems want change,” she says. “They are living and breathing the problem every day.”
CMI is currently working to select 100 engineers for participation in the development of a blueprint for interoperability, which will include cloud and non-cloud solutions. The blueprint will be used to certify healthcare products as being capable of working on the cloud. Up for consideration for working on the project are “some of the biggest players” in other industries, Cantwell says.
CMI’s membership represents $100 billion in procurement power, and it is this, plus the opportunity to expand into the healthcare sector that has drawn interest. When the selected engineers are revealed in a few weeks, they will work in CMI’s centralized lab to tackle interoperability. “It’s a game changer,” to have the providers, which have purchasing power, implementing the drive for change, McDermott says. CMI aims to include all devices across continuum of care in the blueprint. A pilot of the blueprint will be ready before the end of the year, she says.
In Massachusetts, Halamka says, some of these services include a cloud-based provider directory for fast, reliable lookup of any provider’s direct address. It also has a cloud-based master patient index, consent registry, and record locator service to support patient identification and assembly of records for multiple sources. The state also has a cloud-based quality registry for aggregation of quality data.
Interoperability issues have been exacerbated, not lessened, with the adoption of electronic health records. To advance healthcare through the use of data, the federal government sees the need to boost interoperability; for example, rules to enact the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) emphasize achieving interoperability through the use of application programming interfaces (APIs).
In January, Centers for Medicare and Medicaid Services Acting Administrator Andy Slavitt gave a hint at the government’s direction when he said the agency will promote innovation "by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications."
“Interoperability will be a top priority, through the implementation of federally recognized, national interoperability standards and a focus on real-world uses of technology,” he said of CMS’s plans to interpret MACRA.
Even as interoperability is still up for grabs, it’s clear that the cloud is going to provide a great deal of help toward achieving other healthcare goals, such as facilitating currently complex activities such as finding participants for clinical trials and holding the data to conduct trials.
“The cloud is extremely important for clinical trials,” says Luca Emili, founder and CEO of Promeditec, an Italian-based company that develops technology to accelerate clinical trials. About 10 years ago, the quantity of data collected per patient was quite low. Now, with the addition of wearable devices, digital images and genomic data, hospitals need to find a new strategy for collecting this data, he says.
Promeditec recently chose Verizon Cloud to support the delivery of its AppClinical Trial solution, a software as a service (SaaS) through a collaborative platform that can be scaled to set up trials, and capture and manage trial data. Use of the cloud with this platform has helped to cut the expense and time of clinical trials, which can cost as much as $3 billion over the 10 to 15 years required to conduct a trial.
A patient’s genomic information often has 300 gigabytes of data, and hospitals that want to participate in clinical trials in the future will need to use the cloud because of the sheer volume of data that large trials could involve. In addition, the cloud enables the use of data gathered worldwide, and hospitals can no longer store this quantity of data in-house, Emili says.
Jim Hollingshead, president of San Diego-based ResMed, a provider of connected healthcare solutions for remote monitoring of patients with respiratory illnesses, has found a way to use to cloud to save money and increase the flow of data. ResMed’s clients, mainly home health medical equipment (HME) providers, are required by Medicare to show proof that patients are using VPAP and CPAP breathing devices. Previously, removable data cards were used for this purpose, but ResMed replaced them with cellular chips that send data straight to the cloud. Now an HME can go online and verify the usage. It greatly reduces the labor required by the HMEs to verify usage, saving them money.
A completely unexpected aspect of going to the cloud and online was the ability to identify patients that need intervention for compliance. Adherence levels jumped, as did the interest on the part of consumers. Some 900 of them go on the site per day to check the data regarding their usage and several hundred thousand patients persistently look at their data. “We were shocked” patients latched onto this, he said. There was unquestionably an underlying need.
The software platform has an API that enables hospitals to connect with the HMEs through the cloud, making the EHRs interoperable, which is especially important to providers in networks and ACOs. “We see the world going to an integrated place,” Hollingshead says.
In 2014, the company launched its SaaS API, and it was quickly adopted. Berg Insight confirmed that ResMed in a 16-month span had become the the world’s leader in remote patient monitoring with more than 1 million connected devices. . “The cloud is the next wave of creating value,” Hollingshead says.
The cloud fits many of healthcare’s needs to exchange information and will play a vital role, says CMI’s Cantwell. “It’s not an issue of whether or not healthcare is going to going to adopt the cloud; healthcare has already started to.”
But the speed of adoption depends on open data. “Once data becomes democratized, almost the only way you can allow that data to really be a source of true innovation is to open it up to more cloud-based services,” Cantwell says.
However, “it’s only a matter of time,” says Kim from HIMSS. Some hospitals are becoming more geographically diverse, and they’ll need data on demand. The cloud is scalable and can provide not only computing power and storage space, but also convenience, she says.
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