EXECUTIVE SUMMARY:
Because of competing priorities as well as cost, security and implementation concerns, cloud-based storage development has gotten off to a slow start in healthcare. CIOs, CTOs and other healthcare IT leaders are adopting a variety of strategies in this area, based on their organizations’ needs, resources, and priorities.

With healthcare data set to spike over the next few years due to the advent of electronic health records (EHRs) and the ongoing digitization of diagnostic images, a new debate has emerged in the industry over the value of the cloud. While a considerable number of healthcare providers are turning to cloud computing as an alternative to traditional servers for storage purposes, others remain skeptical.

Cloud computing gives providers the opportunity to store data on a virtual server, and can be either public (operated by a third party vendor) or private (kept strictly in-house); or it can be created as a hybrid, using a combination of both public and private clouds. There’s no doubt that the cloud has become a trendy idea to solve storage-related cost issues. Consulting firms like Accenture (Chicago, Ill.) say cloud computing can save up to 50 percent of a provider’s hosting costs on an annual basis.

However, a look inside the front lines of the healthcare industry shows that CIOs and other technology leaders in healthcare aren’t fully sold on the concept. Questions about its security and reliability have cropped up while a multitude of other, more pressing IT issues have kept cloud development on the backburner. Even its cost savings have come into question. In short, when it comes to the cloud, there seems to be more doubt than certainty.

COST DOUBTS
Curt Kwak, CIO of the Northwest and Southwest Regions of Providence Health & Services, could be a poster boy for those who have expressed public cloud-based doubts. Kwak’s particular region of Providence Health & Services, which is a 27-hospital network encompassing the Pacific Northwest, uses a traditional data center with physical servers that are currently being virtualized.
Kwak, who notes his opinions are not necessarily reflective of the other regions of the Renton, Wash.-based Providence Health & Services, is not ready to switch to a public cloud anytime soon.

“I’m not convinced yet that the cloud environment is ready to accommodate and support healthcare,” he says. “I wish it were, because I see a lot of benefits from it. Things like HIE [health information exchange] and other community needs can be hashed out and resolved by a good, efficient cloud-based solution, but we haven’t seen that yet.”


Curt Kwak

According to Kwak, the cost factor has also kept him leery of the cloud. He says he hasn’t seen any solid proposals or strategies that prove it can cut costs. Even if there are some operational savings, Kwak says the return on investment is not nearly enough to justify a full-fledged shift to the cloud. “There might be some savings, but at the end of the day we only have a finite amount of resources on hand,” he says.

Additionally, between the ongoing conversion to IDC-10 and the streamlining of their health informatics systems, Kwak says there are a lot of priorities that come ahead of infrastructural needs, which are pretty good as are, in his view. Often, Kwak tells others in the industry to proceed with caution regarding the cloud. “If you have a tough time articulating your value proposition, don’t do it for the sake of doing it,” he says.

SECURITY CONCERNS
Chuck Christian, CIO of the 232-bed Good Samaritan Hospital in Vincennes, Ind., has his own reasons for doubting the cloud. For Good Samaritan, he has chosen to virtualize his traditional servers rather than go for a public cloud solution. Christian says there are six servers on one farm running 65 to 70 virtual servers on one farm and three servers running 15 to 20 virtual servers in another. He considers this solution a type of private cloud, although both keep operations in-house.


Chuck Christian

For Christian, the reason to keep everything in house has to do with security more than anything else. “We’re a hospital and we’re very concerned about keeping this data as safe as we possibly can,” he says. “I’m concerned with the idea of turning that data loose.” He notes how under federal regulations, data breaches are the responsibility of the healthcare provider, not the cloud operators or other third parties.

“If it’s in our data center, I know where it is,” he adds. “If it’s in the cloud, then I’m not sure where it is. The only thing I can be assured of is that we have a really good contract in place, but that doesn’t ensure the data will or will not be comprised.”

According to Jeff White, principal at Aspen Advisors (Pittsburgh, Penn.), the fact that most vendors won’t sign a business associates agreement (BAA) with healthcare providers is a strong deterrent for the cloud.  Without a BAA, data breaches, as Christian says, would fall under the jurisdiction of the provider and the provider only.

TEST CLOUD
Brian Comp, chief technology officer of the 2,000-bed, eight-hospital Orlando Health System, also thinks that security is a drawback to the cloud. Comp’s Orlando Health has some cloud-based experience to draw back on if its leaders choose to adopt such a solution in the future.


Brian Comp

The organization previously worked with Symantec (Mountain View, Calif.) to create a cloud-based imaging storage system that would allow physicians who worked outside of Orlando Health to connect and access images. Comp says the system was a test project for both Symantec and Orlando Health, with both having reservations about the project even during the development stage. Symantec ended up shutting the project down after a while, likely because of cost concerns, says Comp. “My perception was that they didn’t perceive there was going to be a worthwhile return on investment,” he says.

With diagnostic image-based volume growing at approximately 40-50 percent annually, Comp says, Orlando Health will continue to look at cloud solutions in the future. However, the organization is not under much pressure to adopt the cloud, since it has recently made a capital investment with an archive hardware provider. “We will continue to investigate and keep our finger on the market, and determine whether or not it’s right for us, but at this point there is no timeline,” says Comp.

This “wait until later” attitude seems to be reflective of many in the industry. For all of his reservations, Good Samaritan’s Christian says in the future he would like to look at a cloud-based backup system, where data could be duplicated. He’d also like to eventually treat storage as a commodity, pay-per-use. White of Aspen Advisors says this is one of the most likely uses for a public cloud in healthcare.

A SUCCESSFUL IMPLEMENTATION
Brad Harrison, executive director of technology for The Regional Medical Center of Memphis (the MED), is a bit of a rare breed when it comes to technology leaders in healthcare. His organization not only uses an offsite cloud solution, but Harrison himself is extremely pro-cloud.  The MED, a level-one trauma center that takes in patients from multiple states in the south, uses Iron Mountain’s (Boston, Mass.) Digital Record Center Medical Images (DRCMI) solution.

Thanks to aging technology, a lack of storage availability, and limited capital expenditure funds, the MED was practically forced into adopting a cloud solution for imaging purposes, he says. The DRCMI system provides a long-term storage base for any image created at MED. According Harrison, it has more than worked out. “It was almost like they had a custom, tailor-made solution for us,” he says. “Come to find out, that’s really just the DRCMI solution as a whole. But it really fit what we were trying to accomplish.”

Harrison says the system is so low-maintenance that the MED‘s IT professionals often forget it’s in place. He says the system bailed out the MED when the organization lost 400,000 image-based studies from its database. While the MED’s Carestream (Rochester, N.Y.) imaging system couldn’t recover the studies, the DRCMI was able to restore all but two percent of those studies.

Even the leaders in the MED’s radiology department, who were skeptical at first about a cloud-based solution, have been won over by the DRCMI, Harrison says. “They have done the biggest about face. They were skeptical at first, but now they believe, especially when we had those lost those studies. This solution that we had engineered a year-and-a-half earlier, it ultimately saved the day.”

LONG-TERM VIEW IS CLOUDY
The apprehension in healthcare surrounding public cloud solutions is very real and it comes about for multiple reasons, according to Aspen Advisors’ White. There are the security/data-breach concerns that Christian and others have expressed, and there are other legitimate concerns with performance, he says. There’s also the fact that vendors are for the most part not able to guarantee complete 100-percent space availability. Even only guaranteeing 99.9 percent availability isn’t good enough for healthcare providers White says.

In addition, White says that vendors are holding back on the cloud, because of platform specific issues. He says a lot of healthcare providers use certain platforms for their core systems that are reliant on certain technologies. For instance, any group that uses Meditech (Westwood, Mass.) systems relies on Dell (Round Rock, Texas) platforms. This specific code, he says, may not necessarily run on cloud computing. “There are so many infrastructure things like data transfer and performance that need support,” he says. “There’s no guarantee for performance sitting out in these cloud services. People know that it works, but is it really designed for high-transactional environments? Not really.”

White doesn’t foresee widespread cloud-adoption any time soon based upon the nature of healthcare and the industry’s move to integrated systems. Some, like Comp of Orlando Health, say the cloud may end up as a viable solution for smaller, community-based hospitals that don’t have large investment funds.

Others, like Providence’s Kwak, say there will be a place for the cloud once organizations figure out how to leverage its positives. He says organizations should build it into their long-term strategy. “It’s hard to do this with other competing priorities, government mandates, ministry requirements and business requirements, which take away from innovation,” he adds. “You just have to keep your pulse on it and execute when that opportunity comes. That’s the hardest thing, though, for any CIO, healthcare or otherwise.”