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Healthcare CIOs Opt for the Cloud

Scott Mace, for HealthLeaders Media, October 18, 2012

This article appears in the October 2012 issue of HealthLeaders magazine.

Cloud computing is taking hold in healthcare as a form of data sharing and for archival storage, an infrastructure cost-cutter and a time-to-market accelerator, and even as a method of recovering from disaster. But as author William Gibson famously said, if the future is already here, it isn't evenly distributed yet, and cloud computing is a textbook example. Concerns about security, privacy, regulatory compliance, and service-level agreements are just a few of those cited in and around healthcare as go-slow signals for adoption of the cloud.

Just don't show those signals to a growing contingent of CIOs and other healthcare technologists who are making real use of cloud computing today to help solve pressing needs.

"We have several examples of what we're doing in the cloud,” says Joe Bengfort, executive director and CIO of University of California San Francisco Medical Center, which posted net patient service revenue of more than $1.8 billion in 2011. "Some are quite closely related to the medical record system and patient care. Some of them are more back in the weeds of the infrastructure and the back-end technology.”

At the same time as UCSF is making these preliminary steps into the cloud, it's also just bet big on a traditional client/server-based electronic medical record from Epic, which went live in June 2012. "We use an approach we call development on the edges of the medical record,” Bengfort says. "Our strategy is to develop capabilities outside of the medical record, and then feed that information back into that system, or to link from the medical record environment into some outside system.”

One of those outside cloud systems, Salesforce.com, has deep ties to UCSF. In 2010, its founder, Marc Benioff, pledged $100 million of his fortune to the UCSF Children's Hospital now under construction. Salesforce.com's development engine is powering a breast cancer research project spanning UCSF and the rest of the University of California system, Bengfort says.

"We're using the Salesforce platform to develop applications really around surveys—surveys associated with screening or survivorship, things of that nature—that our patients utilize,” Bengfort says.

"They can either utilize it by going into what looks a lot like a website, but it's really the Salesforce cloud,” he says. "Or they can access it through an iPad application that we've developed that they use on an iPad while they're at the doctor's office.”

UCSF has different programs written in the Salesforce.com environment that do basic things like organize the data from the survey. These programs also do computations on the risk scores for developing breast cancer based on the input that they've gotten from the patient. These results can be linked to or moved into the medical record, so that if this patient presents at the hospital or at a clinic, that information is accessible by his or her care team, he says.

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2 comments on "Healthcare CIOs Opt for the Cloud"


Erin Gilmer (10/24/2012 at 11:15 AM)
Really good article, well researched. I think there was short shrift given to HIPAA concerns in the cloud. Though some cloud providers are more versed in legal requirements and implications, most are not. Cloud providers are starting to realize they need to take this more seriously but still are often unwilling to complete business associate agreements. And there are real concerns with cloud services that all levels of health care providers and vendors are not aware of. I think though the benefits discussed here are important, more consideration must be given to the legal side. Because HIPAA compliant is more than just encryption and backup storage - most of the law is focused on policies and procedures, training, and responding to breaches. HITECH regulations are anticipated to change the landscapes of Business Associates, which include cloud providers. And the last issue not acknowledge are the international laws affecting cloud services. See this IBM developerWorks article for more information. https://www.ibm.com/developerworks/library/cl-hipaa/

Dan Haley (10/22/2012 at 10:59 AM)
Great article. The fact that so much health IT is stuck in a 1990s technology rut is one of the biggest challenges facing cloud-focused innovators like the company where I work, athenahealth. The example in this article of a health system spending buckets of money to retrofit a legacy software system (which already cost buckets of money) for cloud storage is a perfect example. That makes no sense - none - when technology like ours that was developed for the cloud is readily available. As the writer points out, government incentives for rapid adoption of EHRs in a way exacerbated the problem, as systems rushed to purchase anachronistic, software-based systems, thereby putting technologies that should be phasing out on a few more years of life support. Some related thoughts here: http://www.athenahealth.com/blog/2012/09/21/ehr-innovation-breaking-news-from-disparate-poles/