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A New Computing Environment

February 21, 2011
by John Degaspari
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Cost and Capability Issues at a Time of Rapid IT Change

Technological change is driving awareness of what it takes to function successfully during an era of healthcare reform

The vast changes taking place in healthcare today are as much cultural as technological, and the two have gone hand-in-hand in allowing providers to begin to make care delivery more patient-centric. Indeed, walls are coming down when it comes to providers exchanging patient information with each other, and in the ways physicians interact with their patients.

On the patient side, many of the tools that are driving changes are all around us, in the form of smartphones, iPads, and other personal computing devices, as well as social networking, which has served as a rallying point around specific health issues. On the provider side, technological developments such as cloud computing and software-on-demand models are encouraging networking between physician groups and hospitals and breaking down the cost of entry to electronic health records for smaller physician groups. Hospitals are also adapting to a world in which their clinicians are bringing personal handheld devices into work.


Mark Roman, president of the Falls Church, Va.-based CSC Healthcare Group, believes the healthcare industry is on the verge of a fundamental change in the way provider organizations communicate with their patients. “Today the infrastructure at many providers is hospital-centric as opposed to patient-centric,” he says. “Agility is a core issue that hospitals and insurance companies are going to face in the next few years.”

Accountable care legislation will require hospitals to be responsible for a patient's entire care, Roman says. This means having the ability to communicate with the patient via a variety of methods, whether through a home-based computer or any of a number of wireless devices, he says. The core challenge on the provider side is to have the flexibility to adapt to the patient's environment.

One example of that is social media, which Siki Giunta, vice president of cloud computing at CSC, believes will play a more prevalent role in healthcare. Social media give the patient a sense of comfort by putting him or her in touch with a community of people who have similar health issues, she says. Social media also provide an important tool for providers, which can address healthcare issues for multiple patients and communities, she adds.

The crowd-sourcing effect of social media creates a way for health information to move very fast, Giunta notes. It allows creation of general networks of wellness that will make healthcare more pointed and geared to understanding, she says. One of the key pieces of technology to support this is analytics, the ability to put the data into context. One of the biggest challenges is the ability to accommodate data in all of its disparate forms, according to Giunta.

Several experts point to cloud computing as an enabling technology that will grow in importance in the next few years. According to Giunta, the cloud offers a platform that can accommodate disparate types of information from various sources, accommodate multiple users, and has enough capacity to offer analytics.

Roman observes that the cloud also offers cash-strapped hospitals an affordable point of entry as a communication venue for patients and providers through social networks. “There is a good value proposition around care management, making information available and protecting the integrity of it,” says Roman. “Cloud is a critical technology that is going to shape how the healthcare community addresses some of these technologies and business issues in the future.”


Steve Bennett, chief technology officer of Concordant Inc., North Chelmsford, Mass., says health providers in the ambulatory space face several key infrastructure issues, for which the cloud is especially suited:

Rapid and cost-effective deployment of sustainable technologies. Once a practice has made its initial infrastructure investments, it must turn its focus on keeping it sustainable and useable for the long-term.

Security, compliance, and disaster, which can be particularly challenging when there are multiple constituents who are also competitors.

Reporting requirements necessary to qualify for reimbursements, can be challenging for small practices that lack sophisticated IT resources.

Interoperability among physicians who are affiliated with various types of organizations.

Paul conocenti
Paul Conocenti

“Cloud computing offers the ability to create a services-based utility and per usage applications. It's a model that should be embraced to be able to parse this out in a cost-effective, controlled and secured basis,” Bennett says. “It's for the retail market that can't afford the overhead, footprint, and infrastructure necessary to monitor traditional application architecture in the individual physician practice.”

Bennett characterizes cloud computing as a nascent technology, and adds that healthcare has lagged in its adoption. Applications exist, he says. “The last-mile solution is extending the services beyond the four walls of the hospital or delivery network, into the individual physician offices where the point of care is,” says Bennett. This could be a key driver behind the Patient-Centered Medical Home, as well as to medical device manufacturers, which have been successful at expanding device interaction, reducing the cost of gathering the information, and being able to collaborate on diagnosis and treatment.

The potential benefits of the cloud for providers in the ambulatory market are significant. One intriguing example is the software-as-a-service (SaaS) business intelligence model, to slice and dice information so providers can put it to use. Right now physician practices in the ambulatory segment are gathering information in the aggregate, but the reporting is done by enterprise data warehouse solutions such as IBM's Cognos-a non-starter for smaller physician practices, Bennett says.


Organizations that have successfully implemented the cloud model have the capital to create private cloud infrastructures that have the advantage of being able to enforce standards and govern it centrally, while pushing it out to its own physicians. Some providers have opted to create a private cloud, which Bennett says is less expensive to implement; it allows control of deployment and adoption; and it allows higher levels of security and disaster recovery.

One major provider organization that has taken this route is NYU-Langone Medical Center in New York. Paul Conocenti, vice president and vice dean at NYU-Langone, says that the mobility and global communications around HIT standards will be prevalent in the next few years. Social computing and various personal computing devices are challenging infrastructures at large medical centers and other health providers, both internally and to outside providers such as independent physicians, nursing homes, and home care facilities, he says.

These communities need to connect, while maintaining control of the information's security, Conocenti says. “Using the NYU cloud is the same as using everyone else's cloud, but I am doing it on ours, and now I have the peace of mind of knowing it is secure,” he says. Noting that many healthcare workers are IT savvy, Concenti says that it is important to provide a secure environment that is not cumbersome to the users.

NYU-Langone has invested heavily in technology that has allowed it to pursue a strategy of connecting communities. “NYU's Academic Medical Center is one of the organizations to facilitate the connecting of communities together. With the technology investments and innovations that we have made, we are making these solutions available to our affiliate physicians who are part of our community,” Conocenti says.

“At the NYU community we can connect you to our community, and you will be able to take advantage of a patient-centered way of providing care. Hospitals and specialists and nursing homes and home health agencies and primary care physicians can all care for a patient across those care settings. That is something that will be evolving over the next year or two,” Conocenti says.

In January NYU-Langone went live with a connected community tying in private practices to the organization. When a patient enters the hospital, whether a planned admission or ED situation, the primary care physician (PCP) is notified and clinical information from the PCP is transferred to the hospital to care for the patient. The PCP is in constant communication during the patient's stay. When the patient gets discharged, the patient information is delivered to the physician's vendor solution.


Meanwhile, technology and industry changes are poised to make an impact in the arena of PACS/imaging infrastructure as well.

Joe Marion, founder and principal of Healthcare Integration Strategies LLC, Waukesha, Wis., sees a trend in increased modularity in PACS solutions. In December, for example, Round Rock, Texas-based Dell Inc., announced plans to acquire InSite One Inc., Wallingford, Conn., a cloud-based imaging archive provider. In his view, the acquisition is a step in the creation of an infrastructure that will make it easier for HIEs to occur, and imaging will be a part of that, he says. He also says the Dell acquisition could be a tipping point in terms of small vendors being developers in that market, because large Dell competitors will acquire smaller providers.

In addition, advanced visualization is making it easier to automate images into the workflow process by allowing 3D visualization to run in the background in a workstation and be applied to an image set.

Meanwhile, with the concept of the zero footprint viewer, it's possible to view the image within the EMR with any device with a display that can access the Web. That is done by putting the processing capability back at the server.

Healthcare Informatics 2011 March;28(3):22-26

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