Over the last 19 years, I have served as the chief information officer (CIO) for hospitals and health systems across the United States, primarily in the west. Over that time, I have had hundreds of vendors approach me, trying to sell me remote hosted solutions. First it was dubbed an "ASP," then "software as a service," now the buzzword is "cloud." Regardless of what we called it, I was hesitant - except in the most unique of circumstances - to undertake this type of engagement. I am here to explain why I was cautious of this technology, and how I think healthcare will begin to embrace cloud over the next several years.
Connectivity Can Limit Cloud Feasibility
A primary limiter of cloud computing in healthcare has been connectivity. For cloud computing to work in healthcare, an organization requires always-on, fully redundant access to the application. Connectivity that requires any type of manual intervention to failover, at the network level or at the application level, is unacceptable. This is typically a non-issue for facilities located in large metropolitan areas, especially those on the east or west coasts. However, facilities located in the suburbs, or in areas with large geographical dispersion, this type of connectivity may be too costly, or often-time not available at all.
To complicate matters, many large tertiary-care facilities have affiliations with smaller, community-based hospitals. If an organization chooses to undertake a cloud-based strategy, the same always-on, fully-redundant connectivity requirements of the large center must be replicated at each of the smaller, community hospitals. Again, even for these smaller facilities, which are often located in the suburbs or rural areas, access to medical data is critical.
Risk Stratification and Private Clouds as a Method to Reduce Risk
Healthcare CIOs have traditionally risk-stratified the variety of applications being used, with those Tier-0 applications typically being managed in-house as a method to reduce the risk of unavailability. Over the last several years, as the availability to truly redundant connectivity has become more affordable, those institutions in larger metro-areas have begun to reconsider this strategy. Furthermore, large integrated delivery networks (IDNs) have been evaluating fault-tolerant methods to ensure always-on connectivity to remote hospitals and clinics. As these technologies become more prevalent, the viability of utilizing cloud applications becomes more of a reality.
Commonly, healthcare CIOs will begin their cloud journey by placing non-critical, Tier-3 or Tier-4 applications in the cloud, and evaluating the ability of their infrastructure design to provide always-on access to the application. This strategy allows the CIO to identify weaknesses in the design in a minimally disruptive manner. Only after success in this area will more critical applications be considered for the move to the cloud.
Another risk reduction strategy CIOs employ on their journey to the cloud, is to utilize a private-cloud model. With a private-cloud, the healthcare organization is able to control all aspects of application delivery, from the most basic physical connectivity to quality-of-service (QoS) metrics of specific types of traffic. In many cases, such as Mercy Technology Solution's private cloud, this provides a more secure, highly-available solution than a public cloud could offer.
Strategies Moving Forward
As healthcare organizations begin to embrace the cloud over the next several years, NetApp's solutions will play an essential role in the ability to effectively manage the data relied upon by hundreds-of-thousands of clinicians each day. With the advances in Clustered DataONTAP, the ability to manage data seamlessly between private, public, and hybrid cloud architectures will further reduce the risks that healthcare CIO's look to minimize.
Health systems with multiple locations can enhance their data protection and the always-on availability of data through use of MetroCluster, a clustering technology that allows for instant failover of data from one location to another, as far as 124 miles away, with no disruption of operations. Institutions embracing a private-cloud model over a public-cloud model can create fully fault-tolerant infrastructures through the use of this technology.
Technology in healthcare does appear to be antiquated in many ways when compared against the solutions employed in other industries around the world. Primarily, this is due to the risk-adverse nature of the healthcare culture, which CIOs in the industry must honor. New technology advancements in the industry, including capabilities being offered by NetApp, are now able to help reduce risk, rather than simply move risk factors from one area of operation to another.
Spencer Hamons, CHCIO, FACHE
Spencer Hamons is the Central Region’s Chief Information Officer for NetApp Healthcare. Spencer came to NetApp after nearly 20 years as a healthcare CIO and COO. Immediately prior to coming to NetApp, Spencer worked for Taos Health Systems as COO and CIO, and even served as Interim CEO. In addition to his 20 years’ experience in the health IT field, and holds Master’s and Bachelor’s degrees in business leadership from Colorado State University. He is a Fellow in the American College of Healthcare Executives (FACHE), and has earned certification as a Certified Healthcare CIO (CHCIO) through the College of Healthcare Information Management Executives (CHIME), one of only 193 CHCIOs in the United States. Prior to moving into the health IT field, Spencer was a Combat Medic in the United States Army.
[Photo by NEC Corporation of America with Creative Commons license]