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Article

Cloud Computing and Health Care

Health care organizations in US are truly concerned about their existing IT infrastructure

While the whole world is embracing the new religion of IT infrastructure, Cloud Computing, there have been a few apprehensions among industries which deal with hyper-sensitive data. Health Industry, for instance, is continuously looking at innovative ways to reduce healthcare costs and improve customer service but at the same time wants to exhibit compliance with the guidelines set by its administrative bodies, HIPAA and HITECH. With IT always remaining an easy target when it comes to reducing operating costs, this article advocates the adoption of cloud computing in healthcare while maintaining the same level of protection mandated by the administrative bodies.

Introduction
According to 21st Annual HIMSS Leadership Survey, operating budgets are expected to increase in 2011, driven by the overall growth in number of systems and technologies and additional staffing required complying with governmental regulations. In the same survey, approximately 40 percent of respondents reported that IT can have the most impact on patient care by improving clinical and quality outcomes. This clearly suggests that healthcare organizations in US are truly concerned about their existing IT infrastructure and transforming it to streamline and optimize their processes, improve efficiency and gain flexibility. While an array of options are available but with limited IT budget at the disposal and pressure to reduce ever-increasing healthcare costs and staffing costs in US compels the healthcare IT departments to adopt measures that delivers a significantly high ROI. With the advent of cloud-computing, organizations see an opportunity to re-examine their IT ecosystem and tap into the services and advantages offered by different cloud models. This is not easy as they will have to negotiate the flip sides which jeopardize the adoption of cloud computing.

Challenges
Complex Infrastructure: Today’s Healthcare IT infrastructure is highly complex. This is also due to the fact that organizations have taken extra measures to safeguard patient’s vital data and make it HIPPA compliant. It now requires a tremendous amount of exercise whenever an organization wants to offer new healthcare services or revamp its internal processes. Maintaining confidentiality and integrity of information stored in all forms and ensuring data backup and recovery processes in case of disaster are of paramount importance and allow no half-measures.

Control and Security: It is also imperative that information stored in data stores is available through right channels and to the right parties. Enforcing a greater degree of administrative control over all channels of operation is not optional anymore and requires rigorous monitoring.

Legacy applications: Some applications used by healthcare organizations are tightly-coupled to each other and require a high degree of customization and does not offer immediate benefits. While any business will want its application to talk to other enterprise applications in a seamless manner, this is not always possible and the business need to make tough decisions to either retain or retire such applications/ services. Consider a third party service offering the same service and is available on cloud in a pay-as-you-go mode. Do you really think re-inventing the wheel is a smarter choice?

How Cloud-Computing can transform the healthcare business?

Supply Chain benefits: For large organizations, healthcare service is not the only line of business. A major share of business profit comes from retail or pharmaceutical operations. To ensure that these lines of business are performing well, one of the requirements is that they have a better supply change management and capacity planning. With multiple vendors operating on cloud, inventory management (especially VMI) will become much simpler than before.

Scalable Infrastructure: Any business is bound to grow and will require more physical and computing resources to match the growth. A well managed business makes sure that the infrastructure remains scalable and dynamic. As platform-as-a-service is gaining more maturity, in future there are opportunities for organizations to enhance their infrastructure as per their needs. It will be easier for business to shift technology base because they are paying only for what they are using. Data can be stored and managed well in servers than on private servers. It will no longer require IT personnel to worry about keeping software up to date. This will be handled by vendors themselves.
Rapid provisioning is a key element in supporting this scalability and elasticity, because of its highly scalable nature; businesses can easily optimize their resources as per the need to run their business successfully and can help them to lower the cost efficiently.

Collaboration: Cloud computing has given opportunities for healthcare companies to enter into an agreement with companies offering similar services and share data with the consent of patients to improve service. Imagine a patient who requires immediate medical attention and cannot procure services of his preferred healthcare organization. Patient’s clinical data can still be made available to other healthcare providers during emergencies provided the patient provides his consent. Using the opportunity provided by cloud computing the need for healthcare information such as availability of pharmacist, specialists, products or services, details of refill of prescriptions across the health care companies will provide more benefit to:

  1. Patients who want to enroll for services
  2. Payers who want to access patients prescription information according to the insurance plan, so that the healthcare organization can easily handle reimbursement of patient’s prescription purchase without much effort.
  3. The providers across health care organizations to provide better care and counsel them.

Accessing Insurance Details over cloud: Many Insurance companies offer assorted health insurance products and related services including medical, pharmacy, disability plans etc. to endow with better service to their customers. Imagine payers having millions of customers who want their insurance policy to help them effortlessly deal with payment process in any health care organization who in turn contacts either patient’s insurer, pharmacy benefit manager or other health care payer to determine whether it will pay for patient’s medication and the amount of their co-payment. Dealing with this ongoing process is time consuming, might lead to inaccurate claims assessments, delayed settlements…etc. since they access and verify patient’s demographic details with their records and acquiring their health information i.e. medical bills, prescription information…etc to reimburse according to the insurance plan that their user has enrolled for. However providing access to insurance details of a patient over cloud can ease the claim process.

Using community cloud as the deployment model, patient’s medical information will comply with medical data privacy and its security as per HIPAA law. This will immensely help in providing a better customer service. This will not only reduce time of payers as well as the providers but will also be cost effective and will attain customer satisfaction which is significant in any business to run successfully.

Easy and Fast Access: Primary Care Physicians, pharmacists, clinical and administrative staffs need more information and that too in a faster way to improve quality of healthcare and control costs.  Imagine a physician who has a patient to see but is not available in the clinic for some reason. What if the physician can access patient’s details and provide counseling using his mobile or palmtop?

Lack of IT budget: Lack of financial budget is what most Healthcare IT departments face. Since IT does not directly contribute towards profit of an organization, it is sometimes neglected and is expected to deliver more with less. In the HIMSS survey, nearly one-quarter (24 percent) said lack of adequate financial resources/lack of budget would be the most significant barrier to successful healthcare IT implementation at their organization. Providing a cost-effective alternative solution to cloud is a much bigger challenge for decision makers in these organizations.

Standard Based Integration: Increased collaboration with multiple healthcare players over cloud will encourage the use of standard based integration. It is important for systems involved in the integration to support a set of messaging standards and talk common language. Information stored in HL7 format is well understood by all healthcare subsidiaries and systems. Such systems can be seamlessly integrated with the mainstream to extract more value from the infrastructure.
Pay-as-you-go: The cloud’s pay-as-you-go mode helps organizations to monitor their costs. If an application or system or service is not utilized or is planned to be used in future, then a cloud model makes sure that it is not adding to the liabilities in the expense sheet. With pay-a-you-go mode, one can pay for what is required and almost having zero capital outlay.

Report Generation: It is easy to generate reports with essential details as there is increased visibility into the usage of services on cloud. A dashboard displaying the KPIs and statistics (such as Net sales, dividend per common share, prescription drugs refilled, visits per month on website, stock price performance, income statement, balance sheet, cash flow statements) and valuations (price-to-sales ratio, price-to-earnings ratio and others) pulled from cloud will help the executives in tracking the performance and making better business decisions. A report can include details such as number of stores opened in new locations, the employee count per year, total prescriptions filled and the number of customers served daily. These details can be used to continually improve the quality and effectiveness of the health care and services that is been provided. Health reports to business associates can be disclosed only under HIPAA rules and regulations to maintain protection of health information.

Control and Security Measures
Using a public cloud as one of the deployment models whereby resources such as applications and storage are dynamically available as well as the information to the general public over the internet compounds the security concerns and is not a feasible option with the imposed restrictions but collaboration with companies with like interests/ needs and payers (Insurance companies) has paved the way for building a community cloud.

Community cloud as the name suggests is one of the other deployment models that can share infrastructure between several health organizations and payers (Insurance companies) from a specific community with common concerns (like mission, security requirements, policy, and compliance considerations). As data privacy and security policy revolves around patient’s medical data, it is always vital to be concerned about patient‘s crucial medical information when stepping into new technology era. To deal with the concerns, community cloud promises to protect the data and share it among the health organizations depending upon patient’s consent and since all parties are governed by HIPPA, it is likely to produce a more secure environment.

A community cloud may not offer the same advantages as that by a public cloud but it does allow organizations to facilitate and alter their needs on an ongoing basis with appropriate security controls. Using the community cloud means that a bunch of third party services on public cloud will not be available. Even if these services are present in community, there will not be many options to choose from.

Imposing security policies at various levels is always cumbersome. Governing and managing the infrastructure which has always been a challenge and requires considerable human effort in a healthcare company can be addressed in a community cloud which is governed by a team of few experts.

The regulatory demands for healthcare data are among the most stringent in industry. Thus with community cloud patient’s medical and other respective data can be well monitored, shared across the healthcare companies in community and can be easily accessible by the payers (Insurance companies).

As most organizations store each patient's medical records and other data in a digital manner, it will allow the healthcare providers (pharmacists, nurse practitioners…etc) across the community to diagnose, perform counseling and track patients faster and more effectively irrespective of location, especially when multiple specialists are needed. It results in lower costs and better care for the patients who require scheduled or immediate service.

Increased Customer Service Quality:
Since healthcare providers can access their virtualized desktops from anywhere using devices such as mobile, laptop etc, it is possible to serve customers even when the provider is not present in a store or clinic.

Patients suffering from chronic diseases can receive counseling by medical experts if the patient’s data is available over cloud.

Benefits offered by cloud-computing will help Healthcare players to improve their business processes and hence the way they offer services to customer  keeping in mind that offering better customer service always remains the main agenda.

Conclusion
The concerns shown by many healthcare organizations over the use of cloud-computing are well justified. However, these concerns cannot outweigh the benefits of cloud computing. Many organizations still believe that cloud-computing is the way to go if they want to improve customer service while keeping a check on the healthcare costs. Considering that cloud computing is still in its nascent stage, these organizations want to defer their decision regarding its adoption.

Authors

Shabnam Shaikh: Shabnam is working as a senior developer and analyst with one of the largest global IT consulting firms. She has worked extensively on Retail and Pharmaceutical domain. Her current work includes providing cintegration solution to a leading healthcare organization in US. She has substantial experience on various Java and J2EE technologies.

Vivek Raut: Vivek is a technical architect and senior developer with one of the largest global IT consulting firms. His areas of expertise include SOA, web services and Java/J2EE. He has also co-authored various articles and white papers in leading journals. His current work includes providing integration solution to a leading healthcare organization in US.

More Stories By Vivek Raut

Vivek Raut is working as a technical architect and senior developer with one of the largest services provider companies. His areas of expertise include SOA, Web Services and Java/ J2EE. He has designed and developed a SOA Governance solution for a large product-based company. He has also co-authored white papers and articles in leading journals.