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Clear To The Cloud and Collaboration - Don’t Forget To BYOD

January 18, 2013
by Joe Bormel
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It's 2013. Healthcare information technology is far more prevalent and standardized then it has ever been in the past. Some concepts that have been evolving from other industries, as well as in healthcare IT, have important applications and implications.

Cloud Computing

The notion of doing things “in the cloud” has become a buzzword and an almost faddish term in recent years. Initially, it was used to put a new shine on old things. Simply storing information on remote servers as standard files was called cloud computing. Many of us are currently using services like Dropbox, Google Docs, SugarSync, etc. Similarly, connecting to a remote server as opposed to doing something locally on one's desktop or laptop computer is also dubbed cloud computing. An example here is simply web-based email.


In both philosophy and in practice, cloud computing has become something distinctly more and in some ways different. I'll highlight just two aspects of this, surpassing file storage (and even traditional database record storage), and transcending the tyranny of an implied single concurrent user.

Files and the closely related notion of document storage has become a terrific and convenient way to store and exchange information. Cloud computing has brought the availability and the expectation of concurrent versioning with undo and redo of multiple steps, and transcending the distinction from each end-user’s device.


For example, today I can open an existing file on my smartphone and add three sentences to it. Moments later, I can access that same file in its current and recently updated states on a tablet or laptop computer without explicitly opening it to undo one or two of the new sentences.  


The applications are not behaving like old-school word processors, requiring me to open, save, and close the file. Instead, they are maintaining the transactions against that document, apart from and in addition to any static snapshots of that file. The result is the need to back up, send, print, continually rename, and other operational requirements of the old file/document/word processing metaphor are now gone. So are some of the tasks required to collaborate with others.

I referenced the issue of the tyranny of the single concurrent-user model. A common manifestation of this tyranny was that if one user opened a file, changed it and saved it back to a shared space on the network, they have the potential to overwrite changes made by another user during the same period of time. Someone's work would be deleted, invisibly, and unceremoniously, without any notification to any party involved in the process.


In the world of cloud computing, with applications designed and engineered to achieve the behaviors I’ve described, this lethal overwrite tyranny is replaced. Instead of having to resort to old-school techniques, such as “checking out a single copy of the document,” the cloud computing world surpasses that. When changes are made concurrently, either by multiple users, or by the same user on multiple devices, they are reconciled in real time.  


Where there is a concurrency going on (actions happening at the exact same time, potentially in different places, and on different, often mobile devices by the same person or by different people, in cloud computing the  divergence or “forking” of the document is automatically captured and maintained. There is no additional work, duty, or responsibility by the person editing the document.





Interesting post. You've really covered a lot of ground here.

My group does use the cloud on a somewhat limited basis, but I have seen it used by large healthcare providers with huge amounts of data to significant advantage. I must admit, I'm enthusiastic about the cloud's potential as it matures a bit more.

You're absolutely right about videoconferencing for collaboration. I use it often. It saves time and costs, which my clients really appreciate. One thing I found fascinating is that certain VA hospitals have been using it for quite a number of years to guide surgeons in remote or rural areas through complex procedures.

I know you mentioned that security is covered well in other areas, but you have to admit, it is or should be of serious concern. I have yet to talk with a lawyer about this, but in a "what if" scenario, if a doc has private patient info on their own device and that device is stolen and the info compromised, who is liable? The doc, the hospital, or both? That really worries me.

Keep up the good work!


Thanks for your comment and kind words.

People who can use video conferencing and dont, behave that way for a reason. It's incumbent on any manager and executive to understand the drivers with each direct. It's almost in the same category as hand washing; when and where it's advisable, failure to do so creates an avoidable hazard.

Your right to be concerned about privacy protection; I'm not minimizing the need for good practices, encryption and native device support.