The announcement of Salesforce.com investing and coordinating development efforts with Practice Fusion has brought talk of “cloud computing” to the fore. Salesforce has been known as a leader in cloud computing, and moving healthcare IT to that “cloud” has raised questions by a number of observers. What, exactly, is “cloud computing?” Is it appropriate for health IT? What are the security issues and risks?
“Cloud computing” is a term described as a style of computing in which on-demand resources are provided as a service over the Internet. Software-as-a-service (SaaS) is a type of cloud computing, where users do not need to install or maintain any software themselves – simple Internet access and a browser are all that is needed. Users do not need to have knowledge of, expertise in, or control over the technology infrastructure in the “cloud” that supports them – the Internet site (e.g. Practice Fusion) provides a unified dashboard to the user, and works out the technical issues of presenting that data in the background.
Is this approach appropriate to health data? One of the greatest advantages of a “cloud” approach is that the network, server and security headaches that exist for locally-installed, legacy client/server systems is eliminated. Cost and poor usability have been cited as the biggest obstacles to adoption of health IT – especially Electronic Health Records (EHR) systems – and has resulted in problematically-low EHR adoption rates. Eliminating this cost, and the IT maintenance burdens that are often beyond the reach of small medical practices, clearly removes these significant roadblocks to EHR adoption.
What about safety? There are several issues around safety of health data which should be separately considered.
- Data safety in the event of disaster-recovery is better when the data is hosted, in a “cloud.” With local data installation, and certainly with paper records, a local disaster (building fire, tornado, hurricane, etc.) can wipe out local data. The only point of failure in a cloud-based approach is loss of internet access. Redundancy of internet access (hard lines, wireless, cell-phone) is recommended to minimize this risk.
- Security of the data from the standpoint of malicious hacks. Compared to locally-housed resources, “cloud” services typically improves security because SaaS providers (like Practice Fusion) are able to devote resources to solving security issues that many customers cannot afford. This has been the subject of a recent Practice Fusion blog post. By implementing high-level encryption across connections, as well as housing the data in a dis-aggregated and encrypted structure, the Practice Fusion “cloud” implements all the security requirements resulting from HHS “meaningful use” criteria.
- Privacy of data. Access to medical data is tightly controlled, and Practice Fusion has devoted much attention to this. Especially in an environment where a patient’s EHR data might be shared between practices taking care of that patient, and where EHR data is shared with a patient-centered Personal Health Record (see here for a discussion of these terms), diligent attention to privacy and permissions must be at the root of a “cloud”-hosted EHR or PHR system.
The approach to EHRs and PHRs that has been charted by Practice Fusion, and is significantly enhanced by Salesforce.com’s expertise and resources, is a tremendously positive step for everyone. Elimination of barriers to EHR adoption, while at the same time ensuring security and privacy of protected health information, are all positive results of using the “cloud” approach. They will move us all toward the true intent of “Meaningful Use” of EHRs – the basis of the federal stimulus around the emerging national health IT policy.
Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward, CA has functioned without paper charts since 2002.