Tag: Cloud-based EHR

What Happens Next? 2.0 Edition

Those of us who worry about the government creeping into all our lives can now stop fussing and fighting, cry it all out, and move on to implementing the Affordable Care Act (ACA).

But first, we need two core competencies: the ability to integrate health information across providers AND (soon thereafter) the ability to separate signal from noise.

Both of these competencies will require a propagation of the cloud. Let me explain why.

Our work in the health care (EHR) marketplace remains the same as if the ACA had been reversed…and it’s the same work we SHOULD have done years ago. That is, to treat the information that gets generated during the provision of care as if the consumer was actually paying for it. Because, in fact, they ARE paying for it and always have been—but the disintermediation by both third-party payers and the government has allowed us, as providers of health care services, to get pretty sloppy with the information that gets created in the name of client care.

While they are becoming more empowered, consumers haven’t throttled us during those instances when they must submit to a second test because the first result got fumbled somewhere in the care chain. Now, as each state goes for the federal dollars provided to them in the Affordable Care Act (ACA), they’ll feel greater pressure to…well…not lose information, and be able to provide it to any appropriate care giver who needs it. All while still trying to balance their budgets.

Continue reading…

Cloud Only is Dead for Health

A lot of people are intrigued with using “cloud” applications and storage for personal health data. This week we’re seeing what I think is the final nail in the coffin of “cloud only” for anything important. You gotta have offline backups: two huge cloud vendors – Amazon and now Google – have demonstrated that even they can go down, leaving their users absolutely powerless.

Cloud applications diagram from Wikipedia

Cloud computing (Wikipedia) is hugely attractive to software developers and businesses. As shown in this diagram from Wikipedia, the idea is that you do your computing using storage or tools that are on some computer somewhere out there “in the cloud.” You don’t know or care where, because somebody out there takes care of things. As your business or database grows, “they” take care of it.

And it’s real – it works.

But when “they” screw up, you could be screwed.

Last month Amazon Web Services went down for a couple of days. PC Magazine posted a good summary, and many of us learned that well known companies like Hootsuite and Foursquare don’t actually own the computers that deliver their product: they rent services from Amazon Web Services (AWS).

So when AWS went down, there was nothing they could do to help their customers.Continue reading…

Health Care in the Cloud: A ‘Case Study of What Not To Do’

Amazon Web Services (AWS), “the cloud” for many, experienced a serious interruption in service beginning on April 21st. The problem lingered for at least 6 days. Many websites that relied on Amazon services went down or saw their performance degraded during the event.

The AWS failure disproportionately affected startups like Foursquare, Quora and Reddit, companies that are “focused on moving fast in pursuit of growth, and less apt to pay for extensive backup and recovery services.”

One of the affected companies was a health care startup. What follows is a transcription (including typos) of an AWS Discussion Forum that this company initiated 24 hours after the outage began. The company’s contributions are in italics.

Life of our patients is at stake—I am desperately asking you to contact

Sorry I could not get through in any other way. We are a monitoring company and are monitoring hundreds of cardiac patients at home. We are unable to see their ECG signals since 21st of April. Can you please contact us? Or please let me know how can I contact you more ditectly. Thank you.Continue reading…

Health Information Security and the Cloud

Back in 2005, Hurricane Katrina smashed into the Gulf Coast community of Waveland, Mississippi. Among the many losses were the community’s medical files. The storm instantly wiped out more than 10,000 of Waveland Medical Center’s patient medical records.

“For the past year, we have had to rely on our memories and notecards to keep track of patient care while treating patients outside or in a tent, battling against power outages, and working without heat in the cold and without air conditioning in the summer,” said Roberta Chilimiagras, M.D., WMC’s owner, in the days after the storm.

Patients fleeing the Gulf Coast area often sought treatment elsewhere. In Houston, Melinda Amedee presented at the MD Anderson Cancer Center, saying that she had been scheduled to have a tumor removed from her kidney at a New Orleans hospital. As Time magazine reported, her case posed a serious challenge to the doctors in Houston, who had no medical records and no way of contacting her Louisiana kidney specialist.

This example – extreme as it is – highlights a critical, and often overlooked, component of the privacy and security of patient information. Health information security can be thought of as a three-legged stool—Confidentiality, Integrity, and Availability. It’s widely accepted that health information must be kept confidential. But what good is all that information if doctors and their patients can’t get to it at the critical moments? I’d argue that on a day-to-day basis, patient access to, and input on, what is in their health records is an aspect of privacy and security that deserves greater attention.Continue reading…