Widely acknowledged as a laggard in adopting IT, the health care industry seems an unlikely breeding ground for one of the hottest trends in IT -- cloud computing.
But some cloud proponents contend health care's relatively late embrace of the benefits of IT might in fact produce excellent conditions for cloud formations.
"The fact that a lot of health care has not already moved into second and third generation IT solutions could definitely pave the way for cloud computing solutions," said Randy Barnes, COO of Unifi Technologies, an Oregon company specializing in health care cloud computing.
The situation can be compared with bringing phone service to third-world countries without developed phone systems. Just as areas with no or little ground-based technology are ripe for rapid deployment and adoption of cellular phone technology, health care providers without large (or any) investment in electronic record keeping may be more inclined to seek answers in the clouds.
Proponents say the two greatest advantages of a cloud approach to electronic health records are low cost and ease of use. High cost and "poor usability" are often cited as the two biggest obstacles to adopting EHRs.
Definition, Industry Works in Progress
Defining the term "cloud computing" is a little like -- pardon the predictable simile -- talking about the weather. Anybody can do it and everybody's point of view has merit, to the extent that it applies to the way he, she or a company uses cloud computing. One thing most people can agree on is that the term and the industrial landscape it inhabits are works in progress.
Here's the beginning of the National Institute of Standards and Technology's latest definition (version 15):
"Cloud computing is a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction. This cloud model promotes availability and is composed of five essential characteristics, three service models, and four deployment models."
More simply put, cloud computing is using the Internet to store, manipulate and deliver data, using already existing Web browsers or some other easily learned and managed tool. Access is available anywhere, any time.
The use of the word "cloud" is generally considered a synonym for the Internet and often ascribed to the shapes created on flow charts explaining how the Internet works. It also lends that nebulous quality of information being "out there, somewhere in the clouds."
"However you define it, there's no question cloud computing is working in many places right now," said Damon Young, vice president at G2iX -- Global Gateway Innovation Exchange. He said, "It's working in the retail sector, the financial sector, and there are a lot of similarities between health care and both of those sectors. Security is a big issue and economies of scale are important in all those areas."
Amazon, Google, Microsoft, and many banks and financial companies use clouds for a variety of internal and public-facing services.
Turbulence in the Clouds
A raft of recent problems has raised concerns about cloud computing's reliability and security. Users of Microsoft's Sidekick mobile device were denied access to the cloud earlier this month when a computer and its backup failed. Google's e-mail system was knocked out of the skies twice last month when the company pulled wrong switches during upgrades. And during the summer, Twitter was locked out of its cloud by a hacker somewhere in eastern Europe. It took Twitter several days to get back to normal.
"The fact is nothing is 100% secure, period," Barnes said, adding, "That was true before computers, before the Internet and it's true now, as well."
Barnes said Unifi's health care cloud is "as secure as the FBI or the CIA systems and it's totally HIPAA compliant. We require authentications, we have firewalls, but there is no such thing as 100% secure."
Young, leading a workshop on cloud computing at Kaiser Permanente's Garfield Innovation Center in San Leandro earlier this month, conducted a quick poll of the room. He asked, "How many of you have your credit information, addresses and other personal data online at Amazon right now?"
Everybody's hand went up.
"And how many of you stay up nights worrying about it?"
Nobody's hand went up.
Inexpensive Option for Small Practices
Because the cloud philosophy makes use of the Internet for storage and Web browsers for access, startup costs are relatively low, a particularly appealing feature for small practices.
"I think it's definitely the way of the future," said Michael Moore, office manager of a small medical practice in Eugene, Ore., that is signing on to be part of Unifi Technology's cloud system. Unifi, started in 2006, is one of only a handful of companies specializing in cloud computing for health care providers.
"I come from a technology background and this seems to me one of the best ways -- if not the best way -- for medical services to be integrated," Moore said. "Lab tests, pharmaceutical information, patient history -- pretty much everything is available in one place for a reasonable price and you don't have to go to college again to learn how to make everything work," Moore added.
"It's not a magic bullet," Moore continued. "There are still wrinkles and it is something new, but for most of the health care system in this country which is still working with faxes and manila folders, the idea of putting everything online with tools already available makes a lot of sense," he said.
Government Clouds on Horizon?
Some health care experts, who believe cloud computing offers the easiest, least expensive way to achieve interoperability of electronic information, believe a government cloud with tougher firewalls could be developed for health care information.
"I really don't think there's any better way to achieve high levels of interoperability quickly than by using clouds," Barnes said, adding, "And I think more and more people will come to realize that as we move forward with national health reform and its emphasis on interoperability."