HIMSS: Public Health and HIE – Cloud-Based Services

As featured on Government Health IT

By Noam Arzt, PhD, FHIMSS

NIST defines cloud computing as “…a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction.” What does that really mean?

Cloud computing allows for computing services and capacity to expand (or shrink) according to users’ needs with little impact on the users’ experience since services are configured on special, network-accessible platforms whose true, physical configuration is maintained behind-the-scenes. What was once Application Service Provider (ASP) solutions — where an application was run by users on an external service provider’s platform — has grown to a more sophisticated set of services where organizations or individuals can purchase a flexible quantity of shared computing services and not worry about its provisioning, operation, or availability.

As more and more healthcare providers acquire and deploy EHR systems over the next few years, an increasing proportion of those deployments will be cloud-based, especially among smaller providers. This offers a safer, more reliable, more resilient deployment option so long as network connectivity remains in place and the cloud service provider maintains health data in a secure manner (for more on this see EHNAC. Often, these installations are operated by the EHR system vendors themselves (rather than third party, “generic” cloud providers like Amazon or Linode) who provide their Software as a Service (SaaS). Cloud-based deployments provide more location-independent access, and also provide additional disaster recovery and business continuity superior to many small, stand-alone deployments.

What does this mean for public health? Public health agencies should (where permitted by State law) consider cloud-based computing as a potential solution for their own application needs. Total cost of ownership (TCO) for public health applications deployed in this manner may be quite competitive with traditional, in-house operations. When it comes to health information exchange — which may be a new capability for many agencies — consider a cloud-based solution to support interoperability with data trading partners, either through a State, regional, or local HIE project or from a vendor.

As more providers use cloud-based models operated by EHR system vendors themselves, public health agencies need to be prepared to work with EHR system vendors who increasingly are serving as aggregators of EHR data from their clients. Interfaces to providers will increasingly be facilitated by these vendors with or without the intermediation of HIEs. Cloud computing offers a flexible, potentially cost-saving alternative to traditional computing services delivery.

Finally, I encourage everyone to check out the article on this topic by Les Lenert and David Sundwall in the March 2012 on-line edition of the American Journal of Public Health.

Noam H. Arzt, PhD, FHIMSS, is president and founder of HLN Consulting, LLC, San Diego, and does consulting in healthcare systems integration, especially in public health.