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Tag: Cloud Computing

The Importance of Data and Care Coordination

This house believes that society benefits when we share information online! This was the topic of debate before the Economist magazine’s Ideas Economy: Information 2012 conference here in San Francisco on Tuesday afternoon. Tom Standage, digital editor for the Economist, moderated this lively battle of wits.

Defending the motion was John Perry Barlow, former Grateful Dead lyricist and co-founder of the Electronic Frontier Foundation. “This is a little like defending sex!” he started off by saying.

I am paraphrasing here but he went on to say, ‘The Internet is an environment where what is great about human beings can manifest itself…collectively we are much smarter than any individual. Just as my mitochondria are unaware of my thoughts, we are largely unaware of our collective genius.’

I could not agree more.

Opposing the motion was Andrew Keen, Internet entrepreneur and author of “Cult of the Amateur.”

Again, paraphrasing, ‘Repressive governments and private companies who make the 1% look poor, are also benefitting. Most of the information is being stolen,’ Keen said. ‘Today everything has to be social.’

Keen rails against our intimate selves being taken from us and traded on by bazzilionaires, with not much coming back to we, the sharers. ‘Barlow would not be who he is, if he not had his years of very aloneness,’ said Keen, paraphrased.

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Healthcare Needs a Quaking Aspen

For the majority of my career I have been obsessed with creating technologies to modernize our largely dysfunctional U.S. healthcare system.  To me, it is very clear that the emergence of cloud computing has finally created the opportunity to truly address this daunting problem. Cloud-based solutions are the only viable option for effectively getting providers, patients and other key stakeholders online so that the necessary efficiencies find their way into the system.

To the rest of healthcare IT, however, it is not so clear, as witnessed by the lack of truly cloud-based companies in the marketplace.

Most of the large, established players in this industry continue to rely on the outdated client/server or older technologies, such as MUMPS.  Some of these companies’ products trace their roots as far back as 1969.  These companies and their software were built before the world wide web, before Facebook, the iPhone and iPad, salesforce.com – and even email, for God’s sake!  There also exists a tremendous amount of confusion related to the morass of small, bootstrapped EMR companies, which number in the hundreds.  People do not understand the difference between buying a monolithic single-purpose app to utilizing a robust, cloud-based platform approach.

This lack of understanding has made me realize that we need a better way to explain what the cloud has the power to do, and what true cloud-based technology even is. Easier said than done!

I was recently afforded a breakthrough, though unfortunately at the expense of an ancient treasure.  Allow me to explain:

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Heady Times for Health Care in the Cloud

In 1990, when I got my first health care job driving ambulances, not a soul in the New Orleans EMS department had a cellphone. Not even the head of the service. The mayor, his chief of staff and the police chief each had one. That was about it. These phones weighed like 15 pounds and were hardwired to a car battery. And we ambulance drivers documented our care on “run sheets” found on metal clipboards but, since so few people bothered to read them, we also wrote key vital signs and other metrics on a three-inch-wide piece of white tape smacked across the patient’s abdomen.

Today, everyone in New Orleans — and everywhere else — has a cellphone. These cellphones have the computing power to find, and add to, and direct everything that anyone would need to know about a patient anywhere in the world… but they don’t do it! Today’s “do-everything” cellphones are the size of your wallet, yet most ambulance crew run sheets are still paper, found on metal clipboards. And most good patient data is still found on those three-inch-wide pieces of tape.

Why? I’ll give you one good reason and one bad one.

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EMR Uptake Encouraging but Interoperability Needs Work

As those of us who work in health care prepare to analyze Stage 2 Meaningful Use rules – which are due any day now – it will be helpful to consider new data commissioned by the Optum Institute and conducted by Harris. The research finds that hospitals are progressing with adoption of electronic medical records (EMRs) but that the adoption is not creating the type of provider connectivity we need to support a more collaborative and aligned healthcare system.

To be sure, the survey of 301 U.S. hospital chief information officers has some very encouraging findings. In particular, the research finds that nearly nine out of 10 hospitals surveyed (87 percent) now have EMR systems in place – up significantly since 2011, when the Health Information and Management Systems Society (HIMSS) reported that only slightly more than half of CIOs had a fully operational electronic health record in at least one facility in their organization.

In addition, the survey finds that 70 percent of CIOs report their systems have attested to meaningful use 1 criteria (MU1) and three quarters anticipated being able to meet expected meaningful use 2 (MU2) criteria by 2014.

However, the survey also identifies six critical technology concerns facing hospital CIOs:

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Who will be the Salesforce.com of Healthcare IT?


Last week was the massive Salesforce.com user conference Dreamforce (massive in that there were more attendees at Dreamforce then this year’s HIMSS!). We’ve been reviewing more than a few articles and writings written by those who attended the event. In the few short years of its existence (~13yrs) Salesforce.com has become one of the leading Customer Relationship Management (CRM) vendors in the market and basically pushed the previous leader Siebel to the brink and into the arms of Oracle. Salesforce is arguably the leader in the Software as a Service (SaaS) market and thus someone to pay close attention to on all things “Cloud Computing.”

So what makes Salesforce.com so compelling and what are some parallels to the healthcare sector?

Similar Market Demographics: From the beginning Salesforce has always been structured as a SaaS and targeted the hard to reach and highly distributed sales forces of companies of all sizes. Actually, they first targeted the small to medium business (SMB) market and once successful there, went after Siebel in big enterprises. In healthcare, the vast majority of care is provided by small, 1-3 physician practices that are highly distributed across the country – perfect target for a hosted SaaS offering.

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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…

Seeding the Cloud

The newest new future of computing is floating your way.  Lie back on the grass and enjoy. It is The Cloud. Not the corporate Cloud that is the trademarked provider of Wi-Fi services in Europe.  But the broader Cloud that  is the internet. The World Wide Web. The electronic blanket that invisibly but none-the-less completely shrouds us all. The cloud.

We are exhorted to upload it to the cloud.  Store it in the cloud. Share it through the cloud. Download it from the cloud.

Your photo albums and your diaries and your work product and your deepest darkest secrets are slowly migrating from your computer to for-profit warehouses that promise safekeeping for your life’s work and memories. Even our medical records are going to wind up in the cloud. And because they are in the cloud, they are theoretically available to me or to those I authorize to viewse them – anywhere in the world. Instant access. Anywhere. Safety. Security. Total redundancy and backup.

What else is in the cloud? The apps that power our smart phones. The programs that power our computers. Our phone calls. Our video streams. The social media that passes for communication. All are drawn from and sent back out through the cloud.

And as long as you have great wi-fi service or  five bars on your cell phone,  you will always have access to your stuff, Right?

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Welcome to the Cloud Clan

I’m watching ads during the ballgame (I watched the kick-off and the ads—the rest, not so much) and who should be declaring itself a “cloud solution” but Microsoft?!

See the ads here and here, in case you don’t own a TV or computer or newspaper.

OK, I’ve gotta admit my gut reaction was: Microsoft in the cloud? Seriously? But my next thought was…YES! FINALLY! I’m watching evolution unfold before my very eyes, and it’s oh so comforting to see others walking upright on two feet, using modern tools, and cooking their food.

What am I talking about? Well, let me explain. Gather round kids for a quick tour of the museum of ancient computing history. There will be time for a bathroom break later.

Here in the lobby is a giant diorama like you see in other ancient history museums. (For a larger version, click here.)Continue reading…