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Leveraging Public Clouds for Patient Portal Development

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Patient portals are the information aggregation and user interface engines now linking several applications, such as the organization’s electronic health record, including admission, transfer, discharge, or any hospital information system. They are based upon the traditional (and very old) commercial portal concept where information is presented to users in meaningful, usable, and configurable ways. 

The idea is to place this very complex data into an understandable context to provide the patient with a complete view of their health, including recent diagnostics, treatments, medications, and, most importantly, the monitoring of current health data to work more productivity with their doctors.  Indeed, some portals track blood pressure, exercise activity, and calorie intake, transmitting the information directly to the patient’s physician. Of course, you can also use your patient portal to schedule appointments and pay bills. 

So, how does public cloud computing and patient portal development come into play? Cloud-based patient portals provide some key advantages, in terms of development, deployment, and operations, including:

* Self and auto-provisioning of resources, thus allowing the portal to scale to thousands of simultaneous users as needed, as well as scale back when the resources are no longer needed. 

* The ability to avoid hardware, software, and data center costs to support the patient portal. 

* The ability to leverage the ubiquitous nature of cloud computing to easily support any number of interfaces, including most mobile platforms, and programmatic access using open APIs (e.g., REST-based Web services).

* Access to development and deployment tools layered within platform-as-a-service (PaaS)-based cloud providers, such as Google App Engine and Amazon’s Elastic Bean Stalk. 

* Access to scalable “Big Data” systems that exist in the public clouds Big Data system provide the ability to manage and leverage both structured and unstructured data.

* The ability to leverage pre-defined patient portal systems that are SaaS (software as a service)-delivered. 

The core limitation to this approach is that the patient data and the hospital information systems typically reside on-premise (albeit SaaS-based solutions are on the rise). Thus you need to add the ability to integrate the data with the cloud-delivered portal. 

This problem is easily overcome with cloud-aware middleware solutions that can communicate with the core applications and data stores that exist within the healthcare provider, drive that data to a staging structure in the cloud, and then, when requested, transmit that information back down the portal interface. Many PaaS providers have built-in middleware services to solve such problems, even pre-built “adapters” for your core hospital systems that may have very closed and proprietary interfaces. 

While latency may be an issue in a few cases, for the most part, the performance is equal, if not better than, on-premise systems where the number of storage and compute resources are physically limited. In some instances, the data is replicated with cloud-based storage ongoing, and later served up directly from the cloud to the portal interface. The approach you take will be largely based upon your existing problem domain, and the location and interface to the critical data required for the portal. You should keep in mind that more data and systems will migrate to cloud providers over time. 

Security and governance are other aspects of cloud-based patient portals that require some planning. Many in health care I.T. push back on the use of cloud computing because of the privacy and security issues that come along with maintaining patient data. In many instances, they are ill-advised. 

The reality is that, if proper planning occurs and the right security mechanisms are leveraged, it’s likely that you’ll have better security around your patient data when it’s leveraged within a cloud-based patient portal vs. the traditional methods of process you probably employ now. You need to look into more advanced security models, such as identity-based security. It’s also a good time to do an internal audit around compliance with any relevant laws and regulations. 

Cloud computing is here to stay. While many consider this a huge change in technology, it’s more of a change in how we consume technology, using more cost and operationally efficient mechanisms. The core patterns remain much the same.

Healthcare providers need to look into the value that cloud computing brings, and start with that first project. While it’s not a fit for all health care providers, many will find that building a patient portal is a good way evaluate the true opportunity behind cloud computing. It’s time to get started. 

David Linthicum is an SVP with Cloud Technology Partners, a cloud computing consulting and advisory firm. David’s latest book is "Cloud Computing and SOA Convergence in Your Enterprise, a Step-by-Step Approach." His Web site is www.davidlinthicum.com/ 



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