Health IT And Cloud Computing: A Promising Start

Note: This piece was written by Priya Ramachandran, a former IT auditor and freelance writer who blogs at We’d like to welcome her to

You gotta hand it to the IT folks.    Once they come up with a catchy phrase like cloud computing, it spreads like crazy, and now it’s come to mean just about any architecture you can imagine. This Wikipedia entry explains how “cloud” might mean anything from software and services available on the web, to virtual servers created off of physical servers. Adding to the confusion, some leading names in IT willfully obfuscate the terms.

I really like Rob Pegoraro’s definition of the term and that’s all cloud computing is going to mean for the purposes of this post:  cloud computing is “having an Internet site host your data and the programs you use instead of keeping them on your computer.”

Some benefits to putting health data in the cloud:

Now in the case of health IT, there are compelling reasons why a cloud may benefit your organization:

— Increased processing power:  If you leave it to the folks who provide these services, you won’t have to administer/upgrade your own hardware

— Pay as you go:  Pay for only those services that you end up using

— Data portability:  If you keep your customers’ health IT records online, it’s a lot easier for you and your customers to access said data

— Freedom from the IT department guys:  Yeah, it might be a pipe dream, but when you’re with a good cloud service, IT is really your vendor’s headache

— Security:  Which, as we will see later, can be something of a double edged sword

Some models of cloud computing have evolved to better address data integrity. The costlier and most robust solution would be to create a private cloud. Open source cloud solutions such as osCloud allow healthcare organizations with some IT muscle to design their own.

Third party vendors often work with healthcare providers to create a secure version of the cloud for private use. The costs of this approach are significantly higher than investing in a public solution, where all your patient data is on a nebulous cloud. Pragmatic hybrid cloud solutions abound too, fixing the security concerns of a public cloud, and with costs cheaper than a private cloud solution.

Use cases in healthcare:

For health IT, there are several uses cases where cloud computing is probably a great option. Some of the more interesting ones I’ve come across:

— For hospital surveillance and security – Awarepoint, a fully managed service, provides GPS style RTLS (Real Time Location Systems) tracking of patients, personnel, equipment for reducing hospital theft prevention; Denver Children’s Specialists is utilizing ControlByNet’s cloud-based, hosted video security surveillance solutions, to monitor six locations on the cloud. The group moved from separate DVRs to ControlByNet’s solution to monitor its six locations throughout Colorado.

— Cheaper and better transcription services –  Details courtesy of Lauren Richman, healthcare marketing director at Nuance Healthcare: “The doctor dictates a patient record (via phone or into an electronic health record system), the voice file is sent to the cloud where it runs through a speech recognition engine, a draft medical record is created and sent to a transcriptionist for review/editing and then sent back to the doctor for final sign off. Leveraging this cloud-based technology saves time on documentation for doctors and transcriptionists, which speeds efficiency and significantly reduces costs.” A whitepaper published by Nuance shows that 39 customers saved over a million dollar each for a total savings of 93 million dollars.

— Access and collaboration between specialists: ClickCare, a HIPAA compliant SaaS and iPhone application combines pictures, text, sounds, and videos to improve collaboration between healthcare providers. In one instance, at the Wound Institute in PA, 70 patients were treated solely over ClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs.

— Other business activities: SuccessFactors is a vendor that works with several hospitals to streamline their HR processes. Presidio Health, a service created by a former ER physician, helps hospitals enables hospitals, health systems and urgent care centers to efficiently collect patient payments at the point of service. (Interesting statistic provided by Presidio: once a patient leaves the ER, the facility only has a 20% chance of collecting any amounts due from the patients)

If you live next door to a mafia don, you’re more likely to get shot:

All these success stories in the media must make everyone else in the healthcare field salivate. But, moving to the cloud shouldn’t cloud one’s judgment about this relatively new IT paradigm. When you’re housed in some cloudy barracks, you have little say over what services you receive, as pharmaceutical giant Eli Lilly found in its experience with Amazon web services. Eli Lilly had long been promoted by Amazon as its poster (client) child, but found that it could ask (and receive) few guarantees from Amazon about power outages, security breaches and other unsavory aspects.

Also as in real life, the ‘hood you decide to live in might very well affect how secure your data is. Amazon Web Services found itself having to boot Wikileaks after it (Amazon) was targeted by groups intent on bringing Wikileaks down. Even though Amazon might be better able to protect itself against a DOS (Denial of Service) attack, its visibility might mean it is attacked more than an average client.

Bottom line:

I’m excited by the services that are now available on the cloud, and even more excited about how much they can revolutionize healthcare. But given my background as an IT auditor, I’m wary of getting too excited about cloud computing just yet.  Let’s see what the next year or two brings.

About the author


Priya Ramachandran

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.


  • I agree with you that it will take a few years before providers either wholly embrace cloud computing (or at least become pretty comfortable with it) or deny it altogether. In conversations I had with Dell for on article on this subject, I got the impression that perception has a lot to do with providers not being totally gung ho about “losing control” of their data just yet. It seems like a similar position to how they felt a few years ago about making the switch from paper to digital.

  • Jennifer – great comment. I’ve seen the same need to control data in small IT shops as well. I really don’t blame them – data is valuable, and unless clients are reasonably sure about where it’s been stored and how it will be used by a vendor, they’re not going to be very forthcoming with using a cloud service.

  • My definition of the Cloud is this:

    1. the application is hosted on a server that is not on our network
    2. the application server is connected to our network via the Internet
    3. the application is accessed by the user using a standard browser without any plug-ins, active-x controls or java requirements. Just HTML5.

    The third one is the most important one to me. Conflicting PC software is a nightmare. Our user’s PC is now more complicated than any server. Once everything runs in a browser our support costs will go down and we can easily access our apps remotely.

    Businesses like mine are looking to spend less time managing data centers and fixing PCs and more time driving business value.

  • Will, thanks for the comment. I’ve dealt with legacy application deployments on PCs and DLL compatibility issues, circa 1998. The move to clouds is a leap I can live with.

    I’m wondering about the HTML5 rider though.

  • Will,
    The third one is the most interesting. What about Flash based applications? Are you ok with those?

    I don’t have much problem with an active-x control, but those are going away anyway, so not a big deal. The other plugins and particularly the java requirements have always been a pain in the desktop administrators backside.

    “Our user’s PC is now more complicated than any server. ”

    What a sad statement that is so true.

    I don’t know if you have this issue in your organization, but I know a number of EMR software that required IE 6 until just recently. I think they’ve finally moved to IE 7. So much for the cloud in those cases.

  • Cloud solutions while still early will only get better with faster connection speed, better browsers, more eficient load balancing and servers.
    The benefit in healthcare is obvious. Since most of outpatient physicians are in small practices, it is impractical for them to run data centers, deal with servers, backup etc. The cost savings on cloud platform will also continue to push down the price to make Health IT affordable to all. EMR/EHR will be a race to the bottom in term of pricing because they will all function the same.

  • I think it is important to point out the differences between a public cloud (google, amazon, etc) and a private cloud. With a private cloud a practice can run all of their IT (EMR, email, file shares, phones, etc) in the same secure location that is always backed up to a second location. They are basically consolidating their IT vice their data in multiple locations. The practice can also have a physical copy of their data (via tape) if they desire. The benefits of running your practice in a private cloud are numerous and I have a white paper on the topic. If interested, please email me at

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