In an article posted in Healthcare Innovation Journal titled, “Cloud Computing and Health Care” the Author, Vivek Raut makes some very good points about the potential of cloud computing in health care practice. While I agree with many of his points; in a number of areas the ability to utilize the cloud in the manner he is suggesting are quite problematic.
The use of the Cloud has tremendous potential to bring benefits in the areas that he cites like; reducing the complex and expensive infrastructure for providers, benefits of vertical integration and improvements of supply chain within a large provider, more appropriate infrastructure to improve collaboration, and more rapid and better access to vital care information among providers – it is the fundamentals of incorporating changes into the existing base system that doom such an approach to failure. Without changes in the fundamental systems, other factors, naively considered in this article, prohibit or significantly impede the gains envisioned.
The problems of incorporating cloud based solutions under the current health care model come in three areas;
- The current legal requirements under the various privacy laws and HIPPA will not allow the kind of sharing and integration necessary to get the real benefits of such a system.
- The potential scalability and related benefits of economies of scale are lost due to the technical and legal requirements of the current transaction model.
- Simple movement to a Cloud based solution, either public or community, will not provide the improvements sought; as for each potential gain there is a corresponding offset in unintended consequences, infrastructure limitations, or cost of implementation.
This said, I do support the effort and agree there are significant savings to be had by the movement of health care systems to a Cloud based model. With the proper redesign of the system itself into a comprehensive supply chain methodology, real gains from the cloud based approach can be realized. Further, the most needed gain is the overall reduction in the cost of the provision of care through the elimination of duplication of services, fraud and abuse. This can only be gained from the Cloud when the underlying methodologies for application of care and benefits is fully coordinated across all available sources.
Health care dollars in the U.S. are only woefully inadequate due to the percentage of loss due to fraud and abuse in our underlying system. When only about thirty cents of the health care dollar spent makes it to the provision of care of a patient, it is clear that efficiencies need to be gained. But the typical gains from solutions like the Cloud are focused in the areas of operational and administrative efficiencies. In the health care continuum only ten to twelve percent of the dollars are lost due to administrative or operational inefficiencies. The main loss of approximately fifty percents of the monies spent is in the area of duplicated/unnecessary services and fraud or abuse of benefits.
Clearly, the concepts inherent in the argument for Cloud computing apply here as well but only with a redesign of the current system and the underlying transactional model. For instance; a community sharing of health data across a cloud to providers will still require written agreements under HIPPA between the providers and agreements with the cloud provider, all including the requisite business associate language. The provider of cloud services would likely under the law be required to assure that each entity receiving any information had the proper legal documentation on file. The provider would also likely carry full liability for any breach by any agency under such a sharing arrangement.
Under the current health care transaction model, each agency stores and maintains full and multiple, sets of data on each patient in their system. As patients see multiple providers their information is typically copied from provider to provider or supplied by the patient. In a cloud based system there would be significant gains since the data could be shared a copied electronically and could also be regularly synched to provide accuracy and consistency. The upside of this approach has major benefits to both the economy of the provision of care and to improved patient outcomes. The down side is such a system, without a major change in the underlying transaction model, will overwhelm the current and foreseeable future of connected communication and likely yield significant cost increases for data storage and security.
Policy based controls over security in such a system under the current transactional model will yield little effect as the amount of data held in each location multiplies exponentially and the requirements of access to assure accurate and timely synchronization opens many additional corridors of access for hackers and data thieves. The problem is not the Cloud itself. In fact, the Cloud offers the opportunity to significantly improve security but to achieve these improvements a different transactional model needs to be adopted. Even a singular public or community cloud warehouse point does little to provide the improvements in security due to the nature of putting all the information in one place. No matter how secure we try to make it; one breach yields so much on so many it becomes a major problem.
To reiterate, I agree the Cloud will offer tremendous benefits. In fact, I think the movement to the Cloud is already fait-accompli. It is not just the movement to the Cloud that is required.
There is an answer! There are some very gifted people working right now on how to realize the gains that the author elucidates in his paper. These changes are occurring and they will continue to occur despite our reservations and despite the inevitable short term unintended consequences that will show up along the way. How can I be so sure of this? Because this is not a revolutionary change that is occurring – it is evolutionary and the selection pressures forging these changes are both irresistible and irreversible.
I have always like this quote from Jim Morrison,
“The Future is uncertain and the end is always near!”
These words are a truism to the extent that they exist as a singularity. Individually, we should all hold this advice very dear as we can be gone in an instant. But as a species, or in the abstract as a system, while we would have individually ceased to exist more than a millennium ago, it was adaptation cause by partially catastrophic events (selection pressures) that have led us to survival. Our evolution and decisions we have made along the way have both benefited us and caused unintended consequences. Our discovery of the antibiotic properties of penicillin, for a brief period in our history significantly reduced death and disability from infections but along the way the organisms we were fighting have adapted and gotten more resistant. We are now in the same position in our technologically based systems. Health care is perhaps the one most evidently in need of change. These changes are both inevitable and fundamental. Without them the survival of the system itself is seriously in question.
If you would like to learn more about the efforts of those divining the answers on this subject, please contact me.