How cloud computing increases data security, saves money, eases burnout, and improves patient care
Is it time to get off the fence?
Long after the cloud has permeated consumer uses, many healthcare organizations are now also embracing the full potential of cloud technology. In 2014, the Healthcare Information and Management Systems Society (HIMSS) released the results of its inaugural survey on the state of the cloud in healthcare. The report was upbeat: 80 percent of the 150 healthcare leaders who responded stated that they currently used cloud services in some fashion. All in all, HIMSS concluded a “positive growth outlook for cloud services” in healthcare. More recently, a 2019 survey on cloud hosting for healthcare reinforces these findings. Nearly 77 percent of the 101 health information technology professionals reported they are either considering or currently using the cloud for IT services.
The HIMSS survey also showed a small percentage of respondents who expressed reservations about cloud technology, understandably naming security concerns as a sticking point. More recently, a 2018 survey of healthcare CIOs revealed 50 percent of its respondents cited “concerns about security as a primary worry when it comes to cloud migration.” The challenge is for cloud service providers (CSPs) and IT experts to reinforce the proven advantages of cloud security over on-premise security – but more on that later.
Hospitals have other reasons for holding back on greater levels of cloud migration, including some hesitancy about how to proceed. Healthcare leaders themselves recognize the contradiction: Nearly 60 percent of those who took the CIO survey mentioned above say cloud hosting is among their top 10 priorities, but only about 30 percent have a strategy in place. Similarly, only 42 percent of participants in the cloud hosting survey report having a cloud strategy in their organization. Moreover, of those who do have a strategy, only half have been in place for longer than two years.
In many ways, healthcare is straddling the fence concerning cloud technology. Roughly 65 percent of respondents to a 2017 HIMSS follow-up study say they currently use cloud or cloud services within their organization, including clinical application and data hosting, data recovery and backup, and the hosting of operational applications. Yet, though a majority of organizations use cloud technology in some form, many healthcare leaders are still hesitating to embrace it for others, including patient data storage. Ironically, increased data may be the reason that ultimately pushes hospitals to the cloud.
Tackle the issues that keep you up at night
It’s no longer a question of “if” healthcare organizations should fully embrace cloud technology, but when. Market forces in healthcare will all but mandate greater use of the cloud in order to achieve critical enterprise goals including security, availability, and the ability to scale. There’s a good reason why: cloud technology contributes to satisfying these goals.
In late 2018, J. P. Morgan conducted a survey of healthcare executives, asking them to name their biggest concerns for the coming year. Respondents cited these top three challenges: Revenue growth, rising expenses, and labor costs. A 2018 survey by Black Book Research had similar findings among hospital leaders, showing that two of the key areas in which they are focusing their IT investments are increasing hospital operational efficiency and growing the health system’s revenue. Clinician burnout is another growing issue for most healthcare systems, confirming a nearly universal challenge to recruit and retain qualified clinical staff.
While cloud technology is not a panacea, it’s clear that it could make a significant difference to organizations as they face the headwinds of today’s healthcare environment. A recent Forbes article calls cloud computing a transformation in healthcare: “This transition is being driven by two forces: the business imperative to cut costs and improve the quality of care.” The newest research confirms these sentiments, with 45 percent of responders in the cloud computing survey reporting “reducing IT costs” as the number one driver for implementing cloud technologies. Ready or not, healthcare leaders must use the cloud if they are truly going to transform the care delivery model and ensure their hospitals’ future.
Let’s look at how the cloud can help with a hospital’s most pressing challenges.
“I need to know that our clinical data and information are absolutely secure.”
More than ever, data security is top of mind for health leaders. However, they are still skeptical about cloud security. The fact is, today cloud services offer better security and privacy for health data and health systems than do many on-premises solutions, due to the following reasons:
Employees are the more likely risk, not the cloud
While high-profile data breaches (for ex., Target, Equifax, Uber) can be scary to read about, cloud technology is not actually the biggest cybersecurity risk—negligent employees are. In these celebrated cases (and others), the bad guys aren’t “hacking the cloud,” they’re hacking into databases in other ways: via documents sent to the wrong recipient, lost documents, or data left in an unsecured location or on unencrypted devices.
In most cases, increasing data safety is as much about educating employees as it is about securing the technology itself. As one industry leader puts it, “The security risk to an organization is more heightened from a lost device or stolen password than it is a cloud breach of patient information.”
Cloud vendors are better equipped with advanced security
Moreover, cloud service providers (CSPs) outperform traditional security approaches and technologies for several key reasons, including the cloud’s on-demand nature and CSPs’ ability to dedicate more advanced resources to security than a single hospital’s IT department might.
A recent KPMG report on healthcare and the cloud calls moving to the cloud an opportunity to significantly improve security, “as most cloud vendors have more robust cyber-security capabilities than hospitals could build themselves.”
Spurred by increased market requirements, in the past few years the more experienced CSPs have developed increasingly sophisticated tools and services to monitor and react quickly to potential security threats or attacks—tools that go far beyond what an internal IT staff could provide. The leading CSPs provide 24/7 monitoring, responding to emerging and changing threats nearly instantly; multi-layered security measures (including encryption); management protocols and policies (e.g. compliance and regulatory policies); and continuous security updates that are seamlessly deployed.
One indisputable advantage of cloud security: In the event of a disaster at the hospital, business recovery doesn’t depend on access to an on-premise data storage and server. Most healthcare organizations agree with this use of the cloud—over 84 percent are already using it for disaster recovery/backup.
Ensure due diligence with cloud vendors
Working with a trusted third-party CSP is key. With the right partners selected, organizations find their data and processes are much better protected than with their own security—and require fewer internal dedicated staff. All this requires that the CSP chosen has been carefully vetted for their risk management framework and security management processes, which become part of the service level agreement.
“I need more operational efficiency and flexibility.”
Capital expenses go down; operational expenses become flexible
Here’s the most obvious advantage: In contrast to on-premise solutions, cloud computing requires less upfront investments in hardware—or ongoing investment in staff to deploy and manage the hardware. This helps decrease capital expenses and at the same time level-out or reduce IT operational expenses. Imagine having more capacity in capital and operational budgets.
Resources can scale up or down quickly for changing needs
With cloud computing, hospitals can scale exactly the right type and size of computing resources needed to invest in an innovative idea, grow current operations for an expansion, or to react rapidly to a downturn. As many resources as needed can be quickly accessed, with faster and simpler deployment for staff.
In addition, cloud computing can eliminate guessing on infrastructure capacity and staffing needs. The pressure of predicting how much power, storage, and support are required for new deployments and expansions (How many more servers are needed? More IT staff?) is noticeably eased.
This doesn’t mean the end of planning! With “pay-as-you-go” flexibility, hospitals still need to monitor their resource consumption to ensure they have right-sized their needs and adjust accordingly. The advantage of cloud technology, however, is that adjustments can happen almost immediately.
Gain budgeting predictability
Cloud computing is offered on a subscription basis, not only avoiding the upfront investment in data centers and servers, but also making base costs more predictable. When the need to scale up or down arises, depending on operational fluctuations, an organization only pays for how much it consumes. The resources are ready on demand.
Take advantage of seamless upgrades and innovation
Another benefit of cloud technology is access to ongoing upgrades. As part of a subscription service, these upgrades are automatically “pushed” out—no need for installation within on-premise equipment or a separate purchase. It’s a much easier, less disruptive way to deploy new technology improvements and features for patients and staff.
“I need to retain valuable clinical staff.”
Labor management is an ongoing challenge for most hospitals, and it’s not going to get easier in the coming years. A tight labor market is partially to blame. Simple demographics are another factor, as the cohort of baby-boomer-aged clinical staff is at or readying for retirement, with fewer replacement professionals available to take over.
The burnout problem
New surveys regularly appear to reaffirm the dire situation of clinician burnout. A 2018 survey from the New England Journal of Medicine (NEJM) Catalyst showed that 83 percent of respondents—clinicians, clinical leaders, healthcare executives—call physician burnout a “serious” or “moderate” problem in their organization, with 78 percent saying nurse burnout concerns are “serious” or “moderate.”
The causes of burnout, though complex and varied, are also well documented. The added burden of clerical interactions with EHR data is a top culprit. A 2018 J.P. Morgan report based on a survey of healthcare executives states that “a contributing cause to burnout is daily practice which emphasizes time spent on electronic medical record entries and less on patient care.” Nothing new here; most healthcare leaders and EHR vendors are well aware of this issue and are working to overcome it.
The depressing effect of inefficient, disrupted workflows
Another quite significant solution (mentioned by 46 percent of the NEJM survey respondents) is improving workflows.
A Harvard Global Health Institute report on burnout puts it this way: Challenges and obstacles physicians experience take a range of forms, including “poor workflow, distracting and unhelpful alerts, and inefficient and burdensome documentation processes.” A clinical leader at Virginia Mason Medical Center agrees, saying inefficient workflows contribute significantly to burnout as they add wasted time and extra steps to an already overloaded day, including an inordinate amount of time spent physically tracking down other care team members or the correct information source.
“Cloud technology takes efficiency and responsiveness to a new level.”
Cloud technology adds speed, reliability, and capacity
The cloud can help. Many workflow solutions are already available from non-cloud vendors. They help streamline clinical workflows, allowing clinicians faster, easier access to the information they need. A few more advanced vendors add interoperability with EHRs to simplify workflows even more. But cloud technology takes efficiency and responsiveness to a new level.
For example, the concept of “server downtime” for technology almost becomes a thing of the past. It’s now an industry standard for organizations to receive a guaranteed uptime of 99.999 percent from their cloud service providers, which translates into about five minutes of annual downtime. No vendor would last long if it were failing to meet that standard.
In addition, with cloud technology the process of adding upgrades to clinical solutions becomes far less burdensome. When upgrades come from the cloud, they can be provisioned quickly and delivered remotely—no need for vendors to come onsite and disrupt staff and their workflows while new features are installed in on-premise equipment.
Perhaps most important is the sheer speed of cloud response. Direct interconnections between data and the end-user reduces access to milliseconds. Communications among a care team can happen with a single click, and the transfer of patient data occurs instantly and securely.
“I need to strengthen patient care and experience.”
Faster data transfer facilitates care team collaboration, easing communication among clinicians, but of course that means it also improves patient care. One CIO endorses cloud technology by emphasizing that “state of the art patient care requires state of the art data in real time.” Clearly, cloud technologies allow hospitals to support both clinician workflow and also patient care.
Improved patient care also positively affects the patient experience. A recent study by Deloitte examined the association between patient experience scores and a broad range of hospital clinical quality measures (both process of care measures as well as clinical outcomes).
The study found that hospitals with higher patient-reported experience ratings have better process of care quality scores, and hospitals with higher experience ratings have better scores for some (though not all) clinical outcomes.
The importance of data analytics for patient care
Looking into the not-too-distant future, the incredible accumulation of healthcare data is going to make moving to cloud technology less of an option and more of a requirement. The increased amounts of data a health system must gather and maintain have critical implications for demonstrating value-based care as well as its companion mandate, gaining and maintaining reimbursement sources. Organizations increasing the use of data analytics to improve patient outcomes will need huge amounts of storage space, real-time access to the data, and more sophisticated analytical capabilities—all made easier and faster through cloud technology.
Cloud-native or cloud-based? Don’t be fooled.
BEWARE! Some legacy technology solutions that are simply operated in the cloud may be called “cloud services” by their vendors. These are often legacy on-premise software solutions being rebranded as “cloud-based.” But they are not true cloud computing solutions, according to the definition established by the National Institute of Standards and Technology (NIST). It’s important to understand the differences to make informed decisions on what solution will work best for your organization.
Redundancy and uptime:
Cloud-native software is more stable and provides auto-failover protections and much greater data redundancy. If one cloud-native server suffers an outage, another can seamlessly step in.
Cloud-native applications have been specifically designed for the cloud, and are not “cloud-washed.” The differences are critical.
Cloud-native software is multi-tenant, with resources dynamically assigned and scaled according to demand. When an issue occurs, the resolution is released simultaneously to everyone. On the other hand, cloud-based vendors are single-tenant, so resolutions may be delayed as resources are prioritized for other customers ahead in the queue.
Immediate, seamless updates:
Cloud-native software deploys new features immediately, without a disruption in service. There’s no gearing up for quarterly updates that cause scheduled shutdowns—as happens with non-cloud-native platforms.
Cloud-native platforms can scale automatically, either upward or downward, based on demand, without any degradation in performance. Cloud-washed applications are more likely to crash when deployed because of strain on resource workloads.
With cloud-native software, a spike in high use doesn’t require reconfiguring infrastructure or adding servers. Expanded resources are available immediately and the organization only pays for what it needs, when it needs it (“measured use”).
Cloud technology as an imperative for success
According to one recent report, hospitals plan to spend more than $5 billion on cloud computing by 2025. The healthcare industry may have been hesitant to pick up on the cloud technology trend, due to any number of reasons—cost concerns, lack of strategy, or lingering questions about security. But that is changing.
A recent article in Healthcare IT News observed a “notable shift in healthcare clouds from simple data storage to using the technology to lower costs, gain efficiencies and even move on to tasks such as personalizing patient care.” At the staff level, clinicians are looking for increased patient safety, improved workflows, and faster collaboration with their care teams—all of which can be made easier through use of cloud services.
Moving to the cloud provides the flexibility and resources to address healthcare leaders’ most pressing challenges in today’s tremendously fluid environment. As crises pop up on almost a daily basis, following an operational plan that is both agile and flexible is hard to imagine without the use of cloud technology.
Ninety-one percent of CIOs in a recent Black Book survey agree that cloud computing allows more agility in enterprise operations. One industry leader sets out the challenge this way: “As hospitals become cloud-enabled, it’s time to start moving faster toward the complete automation of care, treatments, and analyses of patient health…from a system that’s largely reactive to a system that’s completely proactive.” The benefits are significant for hospitals, staff, and patients alike.
“As hospitals become cloud-enabled, it’s time to start moving faster toward the complete automation of care, treatments, and analyses of patient health…from a system that’s largely reactive to a system that’s completely proactive.”