The Inevitability of Health IT in the Cloud

Health IT 2.0

Health IT version 1.0, the basic digitization of clinical care, is largely complete. The widespread deployment of electronic health records (EHRs) has succeeded in replacing pen and paper with keyboards, and given where we started, is a significant accomplishment. This first generation leveraged well-established EHR solutions in efforts that largely replicated existing workflows (sometimes referred to as “paving the cow paths”).

The results have been mixed in terms of safety, quality, efficiency and satisfaction. In complex socio-technical systems like this, there are many factors that contribute to these outcomes. Within the technical realm, the basic design of these older systems, lack of interoperability and legacy infrastructure amplify workflow and cultural challenges. In short, Health IT 1.0 was a valiant first step on the road to effective digitization of healthcare in pursuit of the Triple Aim—improving overall population health, improving the patient experience and reducing healthcare costs.

Fortunately, many of these challenges can be addressed as we evolve into health IT 2.0. In this next iteration, powerful and flexible applications linked together with robust interoperability solutions will be deployed to support new workflows. We know this is the case because these applications and approaches already exist in nature and have proven themselves in other high-performance industries. One of the key attributes of these modern approaches: they are built from the ground up using cloud-based computing. To replicate this success, it is inevitable that health IT migrates to the cloud.

Next-Generation Applications

The diversity and demand for next-generation applications continue to grow. Telehealth, unified communications, personalized medicine and “omics”, advanced analytics and patient engagement are the leading edge of this revolution. Applications like these typically require:

• Data Acquisition. They must acquire and retain clinical, operational and administrative data from a variety of sources. The scale and scope of these data sets is ever-increasing.
• Workflow Integration. They must be integrated into the workflow of end-users to achieve robust adoption and optimal use. Increasingly this means bi-directional, real-time integration with primary end-user systems like EHRs.
• Manipulating Large Data Sets. In addition to being able to acquire and retain large data sets, applications increasingly rely on advanced “big data” analytics which in turn requires substantial computing power.
• Rapid Response (Low Latency). End-users, be they providers or patients, have been conditioned by experiences in their everyday lives to expect rapid response from applications and websites. Sub-second responses and low latency are “table stakes” for applications to succeed.

These requirements present real challenges in the current IT environment and it seems likely that they, and others that emerge later, will be increasingly demanding. From an infrastructure perspective, the road to the future will require ever increasing amounts of data storage and computing power and the ability to deliver applications at scale over large geographic areas with very low latency.

Only in the Cloud

The escalating demands of this next generation of applications present real challenges in the current healthcare IT environment which is still dominated by “on premise” deployments in private data centers. Historically, health systems took comfort in owning and maintaining their own data centers in the belief that this level of control led to a more secure, stable and affordable environment that could meet enterprise computing needs. The emergence of powerful public cloud options from private sector companies like Amazon, Google and Microsoft have turned all of this on its head. These options are more secure, stable, proven and affordable than traditional healthcare data centers.

They are also far better at meeting the needs of the HIT 2.0 applications. As “The Cloud” has evolved from “someone else’s hard drive in the sky” to a set of powerful services, the design of applications has shifted to rely more on these services as fundamental building blocks. In other words, an application is not simply stored in the cloud, it is built using the services provided by the cloud. And, since public cloud offerings are evolving rapidly to produce ever-more sophisticated application support, the gap between what can be done in the public cloud and “on-prem” grows wider by the day.

The Big Migration

Thus begins a big migration from traditional owned data centers to the public cloud. This transition will take time and bring some challenges. Which applications can and should migrate? Which applications can remain as they are? How do we manage in a world where the health system (or digital health company) shares responsibility with a third-party like Amazon or Google for security, reliability and scalability? What are the implications of major EHR providers like Epic and Cerner who are migrating customers to their own cloud? And, as healthcare becomes more global, how does HIT manage compliance with different regimes like HITRUST in the U.S. and GDPR in the E.U.?

These challenges are real. Some are beginning to sort themselves. Others remain to be addressed. Given the enormous power and promise of cloud-based HIT and the diminishing ability of traditional “on-prem” hosting to meet the needs of health 2.0 applications, they are unlikely to remain barriers. Indeed, the move to cloud-based health IT is truly inevitable.

About the Author: Dave Levin, M.D., is a co-founder and chief medical officer for Datica, where he focuses on bringing healthcare to the cloud. Dave is a nationally recognized speaker, author and the former CMIO for the Cleveland Clinic. He has served in a variety of leadership and advisory roles for health IT companies, health systems and investors. You can follow him @DaveLevinMD or email [email protected].

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