Cloud-Based Patient Data Holds Allure, Risks
For years, hospitalists at University of Utah Healthcare have yearned for a fast, elegant way to share information with referring physicians.
When patients are referred from nonaffiliated practices, "they arrive with medical records burned onto a CD," said Dr. Mike Strong, a hospitalist and the chief medical information officer for the university’s hospitals and clinics, which are based in Salt Lake City.
"One of the big frustrations is the referring physicians say ‘we love the care that you give us, but it feels like our patients are going into a black hole,’ " Dr. Strong said. "We take care of them, and the patients come back, but the physicians feel that they don’t see the whole story."
For Utah Healthcare and others grappling with similar problems, the solution may lie in the "cloud," medical IT experts say. With cloud technology, electronic medical records (EMRs) and images, and the programs used to access them, can be stored and processed on the Web.
The cloud can be likened to a public utility. Under the cloud model, computing power, like electricity, draws from the equivalent of a grid. Giant server "farms" – such as those now supported by Amazon.com and other cloud vendors – can provide not only storage but also processing power, making applications and information accessible at high speed to anyone with a computer or even a smartphone.
"A CD takes 2 or 3 days to arrive," Dr. Strong said. If a referring hospital were able to upload images into a cloud, and we would have the records up and running before a patient even gets here, it would be great, he said.
Cloud-based services are already widespread in business and personal use – think Gmail, Facebook, Google Docs, or online banking. Proponents of cloud in health care suggest that its flexibility (hospitals can use as little or as much storage and computing capacity as they need), its processing power and speed, which can help smaller hospitals perform sophisticated modeling programs the way large ones do and allowing them to run the kind of algorithms that would tie up or crash their own servers.
Those less keen on the cloud cite its vulnerability to crashes and privacy violations.
Freedom and Flexibility
Cloud applications promise greater physical freedom to hospitalists, who need to gather information on patients from a wide variety of sources and to retrieve or deliver information from wherever they happen to be in the hospital. And hospitalists, members of one of the younger-demographic medical specialties, are hardly technology-averse.
"As a practicing hospitalist working in a system that has computer-order entry and electronic records, I live in the IT world," said Dr. Robert Pendleton, Dr. Strong’s colleague at University of Utah and codirector of its hospitalist program. EMRs and portable devices "have changed my work flow. When we were paper chart–based, I had to go to the patient’s unit." Now, Dr. Pendleton said, "we pull up data as we’re rounding, and I come back to my office and put in my notes electronically."
A shift to the cloud and mobile technologies could eliminate the trip back to the office or, better still, offer hospitalists more intuitive approaches to information sharing.
"Health care is about teamwork," says Dr. Jonathan Bloor, the cofounder, along with fellow surgeon Jonathon Shaw of DocCom, a U.K.-based company that sells cloud applications modeled after such social networks as Facebook, as an alternative to traditional e-mail in hospitals. Dr. Bloor and Dr. Shaw developed the platform while working together at University Hospitals Bristol, part of the U.K.’s National Health Service, where they noticed gaps in team communication that they felt threatened patient care.
Yet while hospitalists’ work flow could greatly benefit from Web-based applications designed for physicians, cloud dependence has a flip side: The April crash of Internet behemoth Amazon’s cloud server was a stark and devastating reminder that the cloud is hardly invulnerable. Some high-profile websites that rely on Amazon’s server were left with minimal or no processing power for a week.
Safety or Speed?
With the cloud, security and encryption are also handled offsite, and information is only as secure as an individual user’s password.
This in part is why hospitals like University of Utah have been hesitant to embrace it. Migrating to a cloud model – in which many businesses and institutions, not just hospitals, store information – could collaterally expose hospitals to hackers aiming at banks or other businesses. "If you’re a hacker, are you going to target a hospital system?" Utah Healthcare’s Dr. Strong said. "If we combine storage onto a cloud [used by other types of business], we could get hacked for other reasons."
