Health Care’s Shift to the Cloud via the Hybrid Cloud, Part 1

The changing healthcare scene is dragging hospital systems into the cloud to enable the interoperability necessary for the industry to send electronic medial records (EMRs) and other data to outside systems such as registries that enable bundled payments.

Because health insurance companies and Medicare only pay for patient episodes rather than for each subsequent treatment regardless of whether they’re medically necessary, hospitals must follow each treatment and take responsibility for them all. This gives hospitals incentive to get treatments right the first time.

DevOps.com paints the landscape behind the healthcare industry’s DevOps-enabled move to the hybrid cloud together with illustrations of how DevOps speeds that transition.

The Old World Order in Health Care

The Old World order for health care dictated that each hospital maintain its own isolated, protected, siloed and closed systems and patient health records, which in the not-too-distant past were maintained entirely in paper documents and charts. “That closed system was a file cabinet,” said Mayank Thanawala, CTO of HealthLoop, a provider of a cloud-based platform to automate follow-up medical care.

Patients likely would have outpatient visits with their doctors at the local clinic adjacent to the hospital. Interoperability between the hospital systems and the clinic systems amounted to hospital staff faxing over the patient record or chart or sending it over via Sneakernet.

A transition still occurring to move all that into EMRs/EHRs (electronic health records), although in a similar model as paper, with closed systems tied to the hospital and local clinics. “These are mostly not cloud systems but are rather on premises with largely client-server topologies,” Thanawala said.

Pain Points Driving Health Care’s Shift to the Cloud

In the old billing model, the hospital or physician billed the patient’s insurance or Medicare for each individual visit and procedure, treating them as separate, disconnected events even when the patient had the same treatment twice for a single need. “Insurance companies and specifically Medicare are now saying, ‘Hospitals, we don’t really care about all these complications, we care about the overall cost. If your patient had to go to the emergency room and had to have you perform the same surgery over again, that’s on you. We’re only paying for that initial surgery,’” Thanawala said.

The result is that the hospital must know whether the patient had additional care or the same care twice for the same need, where they had the procedure or treatment and what that was. A closed system, electronic or paper cannot address these requirements. “That is driving the need for interoperability between systems across different organizations, which is driving the shift to the cloud to handle that need,” Thanawala noted.

Delays in the Industry’s Shift to the Cloud

There is a breadth and complexity to health care that requires a great deal of cloud infrastructure, which is creating delays in the industry’s move to the cloud. Health care and HIPAA regulations demand tight, auditable security, which is easier to achieve with the current on-premises systems. “There’s not a lot of confidence in cloud security. It’s getting better, but hospital CIOs have great responsibility and want to be the kings of their domains where security and control are concerned,” Thanawala said.

At the same time, and because it can be problematic for hospitals to update workflow technologies, the cloud must support legacy connections such as HL7 that are not going away. “HL7 is designed to work within a network. Once you talk about cloud systems accessing HL7, you are talking about site-to-site VPNs for security and developing to embedded older technologies such as versions 8 or 9 of Internet Explorer,” he said.

The fact that the data so heavily affects people’s lives, including life-or-death situations, makes the proper scalability, security, stability, uptime and privacy, as well as all the other goals of the cloud and DevOps, doubly important. “It adds another level of scrutiny and pressure to the move to the cloud,” Thanawala said.

Take, for example, auditing, which touches every piece of healthcare data with such intensity. “From a systems perspective, you have to start thinking about auditing systems and tracking all transactions seven years back, which puts a lot of pressure on logging systems and databases,” he noted.

As for uptime, if a healthcare system goes down, how does it affect life-or-death situations in that moment?

How Health Care’s Transition to the Hybrid Cloud is Unique

“The hybrid cloud gives the hospital CIO the ability to maintain control over what they need to control and still look to the cloud to enable the integration and interoperability with outside systems,” Thanawala said. This is important because of the many factors that make transitioning to the cloud unique in the healthcare industry, including:

Users in hospitals blame their systems—systems the CIO is responsible for—for any number of challenges and errors.
Healthcare facilities don’t really have to scale in the cloud quickly, because in health care there already is a defined patient population and facilities won’t have a large number of new users signing up that it can’t handle.
Service providers must convince hospital CIOs that collaborating with cloud technologies, including opening up VPNs and ports where necessary, is worth the risk.