Many within the healthcare industry are somewhat hesitant about using the Cloud and Cloud services. Its understandable why given the tremendous amount of regulation healthcare faces and the responsibility we bear of protecting our patients’ health information. It’s time for us to catch up with the rest of the IT industry and take that giant step to the Cloud—but we can only make that leap after healthcare IT carefully understands what’s at stake.
Healthcare IT is a strange beast. Most healthcare IT organizations grew organically, with no overall system structure. Decades ago, applications designed for healthcare IT addressed only specific specialty or clinical practices. There was no centralizing push or pull—no center of gravity pulling things into one. We were still living through the “Big Bang,” but drifting further and further away from each other.
That changed in the mid-90s with the arrival of the NT networking software. All of a sudden, these various organically grown systems could link, store and share data. It was truly a catalyst for some huge steps in the industry. All of a sudden, we began to share data between those disparate medical applications—why should those working in obstetrics have to enter the same data in their system as the radiologists had in theirs? (As a patient, I can tell you I’ve asked the same question when filling out forms!) But, alas, true integration of data proved much, much harder to do than anyone thought. The concept did generate a bunch of organizations trying to standardize (to this day!) how medical applications talk to each other. So, some real good came from those efforts.
To extend our metaphor…then came the sun. For healthcare IT, the “sun” was the advent of comprehensive electronic medical record software. The VA and DoD started using it in the early/mid 90s, but they had other centers of gravity around which to form. For civilian healthcare IT, it was the MediTechs, Epics, IDXs, and Cerners of the world that became our “sun”—something around which all the medical specialties and clinical practices could orbit and form. It was when healthcare providers began installing these applications they fully realized the decentralized, haphazard way in which IT grew in their organizations was no longer sustainable. Things in healthcare IT became centralized, and it was good.
Massive installs—and in some cases de-installs—happened, it seemed, overnight thanks to the HITECH Act and Meaningful Use dollars available for healthcare organizations that fully implemented an electronic health care record. Health care IT organizations are just now starting to catch their collective breaths from the furious pace! Now, their attention centers on more day-to-day operations and further use data to advance care. That’s right! The electronic record generates all kinds of surplus information that take up considerable storage—a compelling argument to move to the Cloud
To make the leap into the Cloud, I recommend that healthcare IT repeat some of the best aspects of our collective history. Going down this well-traveled path should offer some reassurance. Look at getting your “commodity” type services to the Cloud first: email (the bane of many of our existences anyhow!) file storage and file sharing. All those services take up considerable space and cost. After this test, you’ll consider expanding your horizons more.
The world of “Big Data” suddenly opened up with the development of Hadoop, a way to query and store data in a non-relational database format, either in the cloud or on premise, by the Apache consortium. This product breaks down the expertise barrier and, somewhat, the “don’t have time” barrier. Now, you can pipe all that data you weren’t using into Hadoop and start using some easy query tools much like Bing or Google, to start finding out new and interesting things about your previously unused data—freeing up your talented staff for something better. Because Hadoop is predominantly a Cloud-based application, the expertise that’s developed around it can be accessed very, very easily. So, you don’t have to have a Hadoop “expert” on your staff. Of course, you could deploy Hadoop on premise, which I’ve also done, and then you may want to have that expert around. I guarantee, though, once your staff and clinical and business partners start using Hadoop they’ll want more and more and more. And, you’ll want to move it to the Cloud where storage is cheap and compute is even cheaper. But, don’t take my word for it.
Given our history, I think it’s pretty clear where we need to go. Those who remain stuck on the ground, and not in the Cloud, run the risk of falling further and further behind those who didn’t expand their reach. The Cloud…it’s time.
Wes Wright Corporate CTO, Sutter Health
