The Cloud and it's impact on Health IT

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Cloud based services have exploded in recent years and many consumer services run on large cloud infrastructures hosted by companies such as Google and Amazon. Many consumers don’t realize how much of the internet runs on cloud services until there is an interruption of service.

This article examines the fundamental cloud infrastructure characteristics and how Health IT can be transformed using the different service models available in the industry today.


Fundamental cloud infrastructure characteristics

Although many providers claim to be cloud based, it’s important to apply a common set of characteristics to evaluate their claims. According to the National Institute of Standards and Technology, five essential elements need to be kept in mind (1):

On-demand self service: This enables a user to sign up for services automatically (email accounts, server computing capacity, storage space etc.) without requiring human intervention.

Broad network access: Services should be available over the internet by a variety of network capable devices (phones, tablets, laptops etc).

Resource pooling: The service provider shares resources in order to effectively serve multiple customers and these could be physical or virtual: the customer generally does not have visibility to how this is managed and the complexity is abstracted away.

Rapid elasticity: Services can be elastically scaled up or down to meet variable demand.

Measured service: Cloud service providers should be able to provide granular control and reporting of services consumed in an appropriate metric (e.g gigabytes for storage, users accounts for email) and provide this transparency to the customer.

The “As a Service” Alphabet Soup

In addition to the characteristics mentioned above, cloud services can also be modeled based on the level of abstraction and control a customer has to the infrastructure

Software As a Service (SaaS): The lowest level of control is the SaaS model where an application is entirely provided as a cloud service and a customer has very little transparency to the underlying infrastructure. Salesforce.com and Gmail are good examples of this consumption model. Although a certain level of customization is possible, the service provider largely assumes the role of maintaining the environment and assumes all the data privacy and security risks

Platform as a Service (PaaS): At the next level of control is PaaS where a customer can deploy their own application in a service providers infrastructure. The service provide is responsible for the core programming language tools, middleware applications (like databases) in order to support development of the customer’s application. Risk is shared in this instance as the provider is only responsible for maintaining the platform components and the customer is ultimately responsible for the design and functionality of their application. The Amazon Elastic Beanstalk is a good example of the PaaS model.

Infrastructure as a Service (IaaS): At the highest level of control (and lowest level of abstraction) lies the IaaS model where a customer can consumer the basic building blocks of computing power: servers, storage and networking. This model provides the greatest flexibility and carries the greatest risk as the customer has to carefully design, secure and backup their cloud infrastructure. With the rapid commoditization of this service model, many providers have scaled back commitments around service level agreements (SLAs) for reliability and redundancy. A good example of this is the Amazon EC2 service.

Health IT and the Cloud Transformation

Healthcare has traditionally lagged in the technology domain and cloud computing is no exception. However, for a healthcare system grappling with the challenges of higher quality, better patient outcomes and lower costs, cloud computing is a transformative technology that can help in these areas.

Electronic Health Records: (2) Several providers have cloud based solutions that can completely bypass the traditional onsite deployment model for software. These provide the benefits of reduced implementation time, lower capital expenditure and better scalability. Athenahealth and Practice Fusion are good examples of a SaaS based EHR solution.

Office productivity: (2) Moving email, file and document sharing and office applications to the cloud have huge advantages over traditional licensed software models. Microsoft’s Office 365 solution is a great example of a legacy software provider recognizing the market need for SaaS as an option to customers looking to minimize their CAPEX in this space.

Health Information Exchange (HIE): (2) HIEs are an ideal application for cloud computing as they are generally too cost prohibitive to be built internally and requires cooperation from a number of organizations to function

Backup and archiving: With strict regulations around retaining patient related information, the cloud becomes a cost effective alternative to scaling up internal storage. Image archiving to the cloud has especially gained popularity in recent years as it results in substantial cost savings when compared to scaling up an internal PACS solution

References

1. The NIST definition of cloud computing. [Online] 2011. http://csrc.nist.gov/publications/PubsSPs.html#800-145

2. The Cloud Computing Guide for Healthcare [Online] 2012. http://smb.blob.core.windows.net/smbproduction/Content/Microsoft_Cloud_Healthcare_Guide.pdf


Submitted by Edwin Sequeira