Management

Challenges of Moving Healthcare IT to the Cloud

The concept of cloud computing fuses new ideas with established concepts such as timesharing, thin clients, virtualisation, distributed and grid computing, and service-oriented architectures

"Confusion also surrounds the term 'cloud', which suggests something amorphous and intangible. This is also reflected in the multiple definitions to be found for cloud computing" - Matthias Meunier Physician and Medical Director Clinical Innovation at iSOFT

At 5 am on Sunday, 3 September 1967, Sweden switched from driving on the left-hand side of the road to driving on the right — a change with an enormous impact. Will cloud computing require healthcare to make an equally drastic change in direction?

Cloud computing presents numerous considerations for IT solution providers in the healthcare sphere. While it offers benefits and opportunities, entering the cloud is not a move to make without a thorough risk assessment and carefully honed objectives.

So, what exactly does cloud computing represent? Is it just another technology doomed to fail due to complexity or a lack of standardisation? Does it offer the security and data protection levels healthcare providers need for compliance? Is now the time to embrace cloud computing, or does caution still apply?

The range and complexity of cloud solutions for healthcare technology make a precise forecast difficult, but the time is ripe for the healthcare industry to explore the benefits available to early adopters of this technology.

Cloud formation

The concept of cloud computing is far from new. Instead it fuses new ideas with established concepts such as time-sharing, thin clients, virtualisation, distributed and grid computing, and service-oriented architectures (SOAs).

Confusion also surrounds the term 'cloud', which suggests something amorphous and intangible. This is also reflected in the multiple definitions to be found for cloud computing. The National Institute of Standardisation and Technology (NIST) describes it as a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources - networks, servers, storage, applications, and services - that can be rapidly provisioned and released with minimal management effort or service provider interaction. Put simply, users of a cloud access IT resources without maintaining or controlling the underlying infrastructure.

Healthcare Technology Today

We may be able to fly to the moon, but on Earth we still rely on a vast array of disparate IT platforms that often lack proportional vertical and horizontal scaling. Many systems are highly sophisticated in their own niche, but lack the integration and flexibility to connect with other platforms and adapt to change. There are many obstacles to overcome before we achieve a visionary global healthcare IT scenario, where providers collaborate across national boundaries to deliver care, particularly in emergencies. Cloud computing may provide answers to some of these shortcomings, but not without a thorough analysis of current delivery models for IT services and products, and a strong set of strategic objectives.

Scalability & Cost

Cost is a primary consideration when comparing traditional and cloud-based systems. The expense of running a datacentre, including hardware, space, power and cooling, and management time, can be hard to control. The cloud, with its horizontal scalability, compares favourably. It connects multiple hardware or software entities so that they work as a single logical unit, while further units can be added almost without limit. The cloud's software layer provides fundamental resources to higher level layers, which could ease the problems associated with globally distributed development. Companies could benefit by converting these capital expenses into operating expenses, with an overall reduction in costs.

Healthcare IT could also benefit from improved scalability and performance in areas where large, batch-oriented tasks, recognition algorithms or just sheer computing power are required. Biometrics, genomic databases, semantic web and data mining are obvious candidates. But we need to solve several technical obstacles — many of them linked to regulatory issues —before we can reap the rewards.

Migration & Licensing Challenges & Avoiding 'lock in'

Migrating existing applications into the cloud of a single vendor still requires a lot of effort. For example, a service delivered in this way now has a single-point-of-failure (that of the cloud vendor). And if you do decide that you need to build in redundancy, there's no guarantee that the modifications required to run the system in another vendor's cloud will work due to a lack of standardised APIs.

As well as avoiding 'lock-in' to a single vendor, debugging large distributed systems can be problematic, particularly when trying to reproduce the error in smaller environments fails.

In addition, healthcare solution providers moving their products onto cloud platforms need to manage existing contracts and service level agreements, which may not fit the constraints of the cloud model. Adjustments to established software licensing models will be common.

Compliance Matters

We have some way to go before the cloud model meets the rigorous security and data protection demands of the healthcare industry. Data transfer between a local client and a remote server is not secure, although development work using SSL/TLS encoding could solve that problem soon. Another approach is encryption and decryption of transferred data, but there has to be a guarantee that performance won't suffer.

Data privacy is a big challenge, particularly in relation to Government regulation such as the Health Insurance Portability and Accountability Act (HIPAA). A lot of countries have compliance policies regarding record-keeping, including the physical location of medical data. Cloud vendors could address this by providing bordered and locally-defined clouds.

Compliance in the medical device sector is particularly complex, and the redefinition of the term 'medical device' by the FDA in the US and MHRA in the UK, for example, may well create new requirements.

Managing the Cloud

Technical administration is job of the cloud vendor, but there is also a need for Government bodies that control and define standards for cloud-related healthcare regulations across national borders. A cloud platform is independent of geographical boundaries so international standards, that govern operation are therefore crucial.

The resources, responsibility and expertise required are considerable, but these developments are necessary if the healthcare cloud is to become a globally connected IT landscape that drives standardisation, collaboration and better patient care. If not, clouds will simply host isolated systems.

Surveying the Horizon

But in time, the cloud will be ubiquitous in everyday computing, and it's highly likely that healthcare IT will follow suit. While the future of healthcare technology is difficult to predict, global players must consider cloud computing sooner or later. Early explorations will weigh potential benefits against the time and cost of migration, and the level of risk in areas such as data protection. Outcomes will alter as the technology continues to develop.

How will all this affect healthcare? Are there unforeseen consequences that will affect our judgement? Returning to the example given at the very beginning, Sweden's conversion from left-hand to right-hand traffic caused the shut-down of the tram system in several cities. Trams had to be modified extensively to ensure the safe transport of passengers within the new system. The costs were extensive. When healthcare IT switches to the cloud, as surely it will in some areas, we must be equally prepared for the unknown.