Special Feature
Part of a ZDNet Special Feature: The Industry Cloud: Why It's Next

How industry cloud technology is changing healthcare

Learn how cloud services are powering healthcare's digital transformation.

How joined-up systems can create better healthcare services Forget AI and VR; if the NHS wants to use tech to improve healthcare, it needs to start with something else.

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Healthcare delivery organizations are still worried about security, but not so much that hospital CIOs and CTOs are avoiding cloud technology. 
 
In a recent research report on cloud services in the healthcare sector, Gartner analyst Gregg Pessin reports that, "Healthcare CIOs are becoming more comfortable with the public cloud as an option than in the past, and have begun to adopt cloud-based solutions where the benefits are clear and the risks are acceptable."
 
The idea of the cloud as an extension of internal infrastructure has helped healthcare CIOs understand the best uses of cloud technology and increased adoption rates in the sector.
 
The healthcare sector is under tremendous pressure to operate in real time and to provide easy access to data in multiple locations. Cloud services will help healthcare delivery organizations accomplish this transformation.
 
We talk with hospital leaders and technology executives to understand how the healthcare industry is using cloud computing to modernize business practices.

SEE: What is digital health? Everything you need to know about the future of healthcare (ZDNet)

Strategies for working with healthcare companies

Gartner organizes cloud computing companies into four tiers:

  1. Large cloud service providers (CSPs): Amazon, Microsoft Azure, Google, and IBM
  2. Smaller CSPs that leverage the large players by adding specialized services to their offerings: Atmosera, Green House Data, Healthcare Blocks, and Virtustream (a Dell Technologies Business)
  3. Vertical market players that provide electronic health records (EHR) hosting: Atlantic.Net, Netgain Technology, NTT Data, and HIPPA Vault 
  4. PaaS offerings from 'integrated delivery networks,' which are large multi-hospital systems selling products initially developed for their own use: Datica and UKCloud Health

There is a role for both large providers and smaller ones to help the healthcare sector make the digital transition. Large cloud computing providers have superior computing power, but not the industry expertise and dedicated support to work with healthcare clients, according to Gartner analysts Gregor Petri and Anurag Gupta. This creates a significant opportunity for managed service provider partners. Smaller cloud computing providers can work with Amazon and Microsoft to build and deliver services while establishing direct relationships with healthcare stakeholders.
 
Smaller providers also can help with implementation and ongoing management of cloud-based applications. In addition, these providers can use HIPAA expertise to satisfy the regulatory requirements that healthcare providers must meet. 

Using the cloud to test new solutions

For Phil Misiowiec, the Chief Technology Officer of Healthcare Blocks, most of his clients already have a cloud strategy in place when they contact him. Systems being deployed to the Healthcare Blocks platform fall into one of three buckets, Misiowiec said:

  1. New products developed by healthcare startups, either a service for patients or a value-add service for healthcare providers or insurers
  2. New products or pilots developed by mid-to-large healthcare organizations, who are evaluating a cloud strategy
  3. Legacy systems being cloud-enabled by being ported entirely to the cloud or deployed in a hybrid manner

Security, regulatory compliance, and cost are the most common concerns among Misiowiec's clients. "Smaller organizations tend to focus on the last one, whereas more mature organizations focus on the first two," he said. "Organizations also fear runaway costs, based on the complexity of infrastructure-as-a-service vendors' pricing models."

Healthcare Blocks is a HIPAA-compliant application hosting platform used by healthcare technology startups, hospitals, and labs. The company is an AWS partner.  

Moving a business-critical application into the cloud

Novant Health's recent cloud migration is an example of a legacy system being cloud-enabled. Earlier this year, Novant moved its Epic electronic health record system to the cloud after three months of planning and six months of implementation. Novant uses Virtustream as an infrastructure as a service provider, while the internal IT team manages the EHR application. 

SEE: Electronic health records: A cheat sheet for professionals (TechRepublic)
 
Based in North Carolina, Novant serves patients in four states at 640 locations, including hospitals, clinics, and physician practices. James Kluttz is a VP and chief technology officer at Novant and A.J. Patefield, MD, is an SVP and the chief medical information officer. Kluttz said that he and Patefield worked together very closely on the recent cloud migration. Collaboration is a standard operating procedure for the two colleagues to ensure technology projects support the overall medical and business strategies. 
 
Patefield said this approach means sharing the risk of changing how the hospital's most mission-critical system works.
 
"When James says, 'I'm going to move this to the cloud,' we go back and forth on timelines and testing," Patefield said. "I can then go back to the doctors and assure them that James has taken into account the clinical risks and potential impact." 

Novant has a clinical informatics group in addition to a robust EHR governance group that includes healthcare specialists from all over the hospital: Doctors, nurses, respiratory therapists, and pharmacists.
 
"We have 16 guiding principles that we use in making decisions around the system," Patefield said. "Every change that impacts what a nurse does goes before a leadership group before it is implemented."

Before moving the Epic EHR to the cloud, the hospital updated the system once a year. Now that Novant's installation is in the cloud, it's much easier for the IT team to support Epic's new quarterly update schedule. 

Building partnerships to develop healthcare solutions

Imprivata is partnering with a big cloud player -- Microsoft -- to create a solution to fit the unique needs of the healthcare industry. Imprivata provides identity management to hospitals. Imprivata's appliance sits within a company's network domain and connects to all the services within a hospital's IT infrastructure.

When a doctor or nurse taps a badge, Imprivata checks permissions in Active Directory as well as in healthcare applications that are not connected to Active Directory, such as software unique to the cardiology or radiology department.
  
"If you don't have those accounts linked, there can be orphan accounts in the PACS system or the cardiology system, and a person who doesn't have an Active Directory account can still have access to that system," said  Imprivata CTO Wes Wright. "Our software makes sure that a particular identity has access to the data that it's supposed to have access to."
 
Imprivata's identify management expertise also has helped doctors manage the new rules around opioids. The US Drug Enforcement Administration requires two-factor authentication when a physician writes a prescription for an opioid. Imprivata has embedded this process into the electronic health record workflow.
 
"We try to make the tech as transparent as possible for the provider and to remove as many clicks as possible," he said.  
 
In April 2019 Imprivata announced a partnership with Microsoft to expand the services included in a single sign-on process. In addition to giving doctors and nurses access to healthcare information systems, Healthcare Seamless SSO allows badge-tap access to Office 365 and any application connected to Microsoft Azure Active Directory. This eliminates the need for users to type usernames and passwords each time they need to access a particular application. 

"Much of the Office 365 stuff wasn't being used because it was hard to get to," Wright said. "With this partnership, a single badge tap can get them into their line of business applications and the 3,000 applications that Microsoft has in the Azure marketplace."

Wright said that the hyperscale cloud vendors benefit from an economy of scale that individual health systems can't match. "Microsoft spends $10 billion a year in cloud ops security, and there is no way that a healthcare organization can commit that much money to security," he said.

Using the cloud in healthcare to power a digital transformation

Hospitals and physician practices are still in the early stages of the digital transformation into "real-time health systems." Gartner analyst Gregg Pessin predicts that these "real-time healthcare delivery organizations" will expand the use of automation, analytics, location and condition sensing, event-driven technologies, interoperability, and mobility. This means that the public cloud will play a more significant role in delivering enterprise IT services.
 
Misiowiec of Healthcare Blocks sees the cloud as an important tool in the industry's transformation as healthcare moves "outside the hospital walls."
 
"Cloud services support the security, auditing, and operational efficiency requirements needed by telemedicine apps, patient engagement tools, and IoT devices," he said. "Cloud services are more cost effective and efficient than using on-premise or local data centers." 

Kluttz of Novant said that moving the EHR to the cloud will position healthcare providers to start using artificial intelligence and machine learning to guide patient care.
 
"As our business model changes, we can continue to grow as an organization and respond much more quickly than we did in the past," Kluttz said.

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