Cloud Computing Solutions in Healthcare

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Table of Contents

Introduction
Findings
Conclusion
References

Introduction

This report focuses on the strategy of a heath care institution in adopting cloud computing. It reviews available information about their enterprise and its business environment factors influence the organization’s strategy of cloud computing. The report evaluates the strategy’s suitability in relation to the observable results and the expected outcomes for the organization in relation to its business strategy.

Providence is placed in position 3 among the health care providers with a non-profit business strategy in the US. It has divisions in Alaska, California, Montana, Oregon, and Washington, with a collection of 73,000 care givers who are all employees of the organization (Providence, 2014).

Its services cover a diverse range, including acute care, physician clinics, long-term, and assisted living, as well as palliative and hospice care (Providence, 2014). Patients can also receive home health, supporting housing, and education from the organization.

The organization has 34 hospitals, 475 physician clinics, and 19 hospices (Providence, 2014). It also has 22 long-term care facilities and 693 supportive housing units. All these are available selectively at 14 locations in the five states, where Providence has a presence (Providence, 2014).

For the cloud computing strategy, Providence Health & Services (PH&S) partners with Codonis and together, the two organizations manage the Multiscale Health Network (MHN) (Fishman, 2013). Codonis is an organization that creates a world-class life sciences computing platform to accelerate research, improve efficiency of health care providers, and ensure that the transition to next-generation personalised medicine eases (Codonis, 2014).

According to Williams (2008), medical systems are mostly problematic because their primary aim is patient care. For most deployments, security is an assumption or an ignored concept altogether. An apparent loss of trust between clients, patients and service providers occurs when there are data leakages (Perna, 2011).

The concerns by PH&S are rational because several cases of data leakage from medical facilities have already been documented. For example, Moisse (2011) reports that Stanford Hospital lost 20,000 ER patient records, while Caldwell and Early (2009) report that an Australian pathology laboratory lost patient data that eventually led to the loss of trust among the parties involved.

Assumptions

This report assumes the following scenarios.

PH&S deploys its cloud computing infrastructure centrally rather than independently for each of its operations.
The organization’s partnership with Codonis is mutual.
MHN was specifically customised to fit PH&S organization needs.
The use of OpenStack within MHN is without modifications that alter the performance of OpenStack.

Findings

Scalability

PH&S is already a recipient of medical informatics and bioinformatics researchers who make explorations that aim to discover innovative solutions within the medical field (Deng, Petkovic, Nalin, & Baroni, 2011). The two fields, medical informatics and bioinformatics, require the use of computational power, data storage facilities, and supercomputing resources. In addition, they thrive in environments that encourage data sharing with collaborators around the world.

With the cloud computing infrastructure in place, PH&S is able to not only connect to other medical facilities around the world for collaboration, but it is also able to share idle resources from other computing systems linked to the cloud (Fishman, 2013). PH&S provides electronic intensive care unit (eICU) services in Alaska and other states to offer remote patient care for community and rural hospitals (Wicklund, 2009).

The eICU program enhances medical services for each of the partner hospitals by allowing them to access the right patient treatment at the right time (Wicklund, 2009). It provides two-way services for patients and doctors from Providence and the local hospital to make remote monitoring on patient’s vital signs. The eICU also provides remote medications, test results, X-rays, and other data. It relies on a robust infrastructure that is able to scale up or down, according to the needs of the program and the connected rural or community hospitals (Wicklund, 2009).

Reduced costs of management

The organisation has a health delivery network that spans five states in the United States. Its use of traditional data centres with physical servers became too costly as the organization had to scale up frequently. PH&S has an overall management strategy of reducing costs of delivering health services in the five states that it covers (Providence, 2014).

The organization is already facing a challenge of dealing with the cost of human resources, given that it has about 73,000 employees (Providence, 2014). As a result of the cost constraints, it is only able to spend on major projects when their budgets are within the allocated funds in its operating expenditure budget. It cannot sacrifice additional funds to spend on capital investments. On the other hand, it cannot ignore the increasing needs of computing power and data management as many health care services and components are digitised.

The cloud computing infrastructure allows the organisation as a service provider to pay for its rental services that it receives from the cloud computing provider by using its operating expenditure funds, which is a huge cost saving avenue for the organization.

Existence of cloud infrastructure

The availability of fast broadband services around the organization’s facilities the organization’s cloud computing strategy. At the same time, it reduces the need to have powerful computers and computing gadgets, as the cloud interface may also help to redistribute processing resources to the areas of need. For PH&S, the existence of the broadband service and promise by various vendors to deliver customised solutions for the organization eases the choice of moving to the cloud (Fishman, 2013).

Ease of use

Other than just continue with its conventional processes of information capture and then upload stored information into the cloud interface, PH&S was also looking at the option of transforming the entire patient record input to make it web-based (Fishman, 2013).

This would essentially transform many handheld devices such as tablets into data entry tools that practitioners would use whenever they are to capture patient information and add it to the existing database that would already be on the cloud (Rackspace Support, 2014).

Other characteristics

With the cloud computing system, the organisation is able to capture massive amounts of data from a range of equipment being used in its consultation offices, laboratories, and management offices (Fishman, 2013). The system stores, curates, supports, and enables the analysis of the collected data for use by scientists, medical practitioners, managers, and designated patients in the organization (Rackspace Support, 2014).

With data storage blocks virtualised in the system and with private access to these blocks, the organization is able to rely on OpenStack to manage the communication and data sharing of different organizational departments without jeopardizing the security of the information being shared (Hussein & Arafat, 2013).

The private nature also ensures that the public, through other public infrastructures that may connect to the system, do not have unrestricted access. Nevertheless, much of the implementation of the MHN only happens within the PH&S and only part of the service is virtualised (Fishman, 2013).

Electronic health record management at the organization has improved as a result of the cloud computing implementation. The organization spends less time on the management of its physical infrastructures, especially on issues that deal with software update as the service now happens automatically with the cloud service. Consequently, IT management at the organization has been simplified.

The actual number of personnel needed to maintain the infrastructure reduced because the cloud computing system was a joint partnership with another organization, Codonis, whose speciality is the provision of computational infrastructure of health services. PH&S, therefore, has more human resources to deploy to its key performance areas that directly transform personal health care and people’s lives (Providence, 2014). PH&S as an organization recognises security as a mandatory part of any system development strategy that seeks to ease work processes and service delivery in the organization (Fishman, 2013).

The choice of cloud computing as a technology came after the board of management was successfully convinced that the solution would reduce the required hardware input in comparison to a typical physical deployment of a computer data management infrastructure (Providence, 2014). The organisation opted for a joint partnership with Codonis, rather than rely on a public cloud solution that would be more scalable and easy to acquire and full of management challenges (Fishman, 2013).

The resultant MHN meets the cloud computing needs of the organization, under the help of the Codonis. Above all, it is under the control of Providence, in addition to being customised for the organization’s needs (Fishman, 2013). MHN was able to set up and use a storage platform of a block nature, which was followed by the acquisition of OpenStack (Fishman, 2013). The block nature of the storage system helps Multiscale to execute critical functions like providing the server and the use of the database to access and store files (Yacov, Horowitz, Guo, Andrijcic & Bogdanor, 2014).

Expressed concerns

Medical records often contain identification information for patients and their financial details that relate to their preferred form of paying for their medical bills. In PH&S case, there exist medical records for patients that have information dating back to a decade ago (Fishman, 2013).

This information is stored in a single database entry that links to other databases maintained by the organization. A breach of the main database that contains identification information for patients would allow anyone who gets access to that information to access the patient’s other records at any other storage area within PH&S systems due to the relational nature of the database (Fishman, 2013).

A breach of security at this scale would need the unauthorised intruder to be physically present at the organization’s facilities to access one of its computers. However, in the case of cloud storage, the intruder could be anywhere in the world and would only need to be connected to the cloud interface to access the privileged information (Reali, Femminella, Nunzi, & Valocchi, 2014).

In fact, the biggest concern expressed by PH&S was whether employees, more so the administrators of the third-party company providing the cloud computing interface would be able to access and manipulate PH&S data that is put in the cloud (Fishman, 2013).

Human resource challenges still persist because cloud computing, like other technologies, is evolving. It demands a review of people skills to happen periodically. It also calls for a persistent look out for advances in the technology and appropriate applications (Deng et al., 2011).

Analysis and Discussion

Based on the objectives of the organization, it would be expected that PH&S would invest in cloud computing to enhance its competitive advantage. Without sufficient resources to facilitate work efficiency for the researchers, the institution would not be able to enhance its status as a centre for bioinformatics.

Scalability of the cloud allows organizations to remain agile in response such that it can easily change its strategic positioning to match emerging organization needs (Perna, 2011). For example, the cloud computing infrastructure ensures that the eICU program does not suffer outages, as its redundancy is assured. Unlike other forms of distributed computing, cloud computing provides users with on-demand self-service, broad network access, resource pooling, rapid elasticity, and measured service.

All these properties are quantifiable, such that it is easy for the management to not only evaluate the cost of the investment against its returns, but also evaluate the efficacy of the cloud computing system based on the demands of the organization (Badger, Grance, Patt-Corner, & Voas, 2012).

On the other hand, cloud computing at first only required the virtualization of the existing servers and then additional needs would be scaled up virtually, rather than physically. The cost of renting services is lower compared with the cost of acquiring hardware and then running the services in-house.

Evidence for this statement is provided by Rackspace a cloud computing solutions provider, which supports the open stack software and network. Rackspace Support (2014) offers infrastructure as a service through a platform virtualization environment so that client organizations do not have to purchase servers, software, and data centre space or network equipment (Rackspace Support, 2014).

The first cost saving arises out of the reduced marginal cost of expansion that would be incurred with every additional hardware or software purchase for the physical system. A second avenue for cost reduction happens due to burst-ability (Rackspace Support, 2014).

The cloud computing infrastructure scales according to demand, such that an increase in the demand leads to more economies of scale for all users, while a decrease in demand does not cause clients to incur costs for unwanted services (Rackspace Support, 2014).

Organizations can either be innovators or imitators when it comes to the adoption of Information Technology features. The findings of this study show that PH&S is an imitator because it relies on experience and information on cloud computing from other organizations and industry trends.

In looking at the situation from the theory of planned behaviour perspective, PH&S is pursuing cloud computing strategy because it wants to realize its organizational objectives in the most efficient way (Fishman, 2013). Management is convinced that the cloud solution is the most robust for the enterprise’s present situation.

As the findings on challenges facing PH&S show, much of the strategic alignment of the cloud computing solution focuses on risk aversion. Meanwhile the key motivating factor for adoption is reduction of cost and increase in organization’s agility.

Therefore, an overall strategy of PH&S is to use its strengths to minimize weaknesses inherent in the healthcare enterprise adoption of cloud computing. Though there are identified risks, the organization does not explicitly pursue risk prevention or minimization strategies.

The Task-Technology Fit Theory explains that specific characteristics of a technology and the intended usage of the technology determine its suitability and performance when humans are using it (Dahnil et al., 2014). This theory can help to shed light on the aptness of cloud computing strategy at PH&S. The organization delivers health care in different states, and its main value proposition is to provide personalized professional care to communities at an affordable rate. To achieve the objective, the organization has to keep costs low, and a way to do this is by limiting its investments on non-core business practices and needs.

A good way for achieving the objective is by outsourcing, though that cannot happen under the main business strategy because it would erode the value proposition of the organization. Cloud computing is mainly taking place in the backend; therefore, fits well into the strategy orientation of the organization, which is to use strengths to minimize weaknesses and threats to efficient service delivery.

It is not clear as to whether PH&S has already received payoffs of its investment, but indications are that the organization will obtain a significant return on its cloud computing investment (Fishman, 2013). One of the reasons for this verdict is the on-going improvement in competitive advantages of the firm due to increased computational and record management efficiencies.

The separation of the cloud computing deployment and the core running of the organization will ensure that while the pursuit of the IT solution fits into the overall objective of improving services and reach to communities, the organization does not succumb to rigidities of implementing the new solution, which could stifle core strategy areas. Here, PH&S strategic alignment is to run the cloud computing implementation as a separate division and can therefore check on its contributions to core services periodically (Fishman, 2013).

Conclusion

Cloud computing strategy at the organization is suitable because it relies on the formation of a partnership with an organization that already has enough experience on the technology. The strategic choice to use a privately management system that would allow the organization to retain control, but still expose it to all opportunities provided by the technology offers cost reducing features and does not require extensive use of internal organization resources because it is implemented by a third party. Lastly, the PH&S open source cloud strategy eliminates recurrent licensing costs.

References

Badger, L., Grance, T., R, P.-C., & Voas, J. (2012). Cloud computing synopsis and recommendations. NIST Special Publication 800-146.

Caldwell, A., & Earley, D. (2009). Patients’ medical records leaked online by pathology lab Sullivan Nicolaides. Web.

Codonis. (2014). Bridging life sciences and health care. Codonis. Web.

Dahnil, M. I., Marzuki, K. M., Langgat, J., & Fabeil, N. F. (2014). Factors influencing SMEs adoption of social media marketing. Procedia – Social and Behavioral Science, 148, 119-126.

Deng, M., Petkovic, M., Nalin, M., & Baroni, I. (2011). A home healthcare system in the cloud: Addressing security and privacy challenges. IEEE International Conference, (pp. 549-556).

Fishman, D. M. (2013). Case study on OpenStack cloud in health care. Mirantis. Web.

Hussein, S. E., & Arafat, H. (2013). An open cloud model for expanding healthcare infrastructure. International Journal of Advanced Computer Science and Applications, 4(9), 84-91.

Moisse, K. (2011). Stanford hospital patient records leaked online. ABC News. Web.

Perna, G. (2011). A hazy outlook for cloud computing. Healthcare Informatics. Web.

Providence. (2014). Creating healthier communities, together. Providence Health & Services. Web.

Rackspace Support. (2014). Moving your infrastructure to the cloud: How to maximize benefits and avoid pitfalls. Rackspace. Web.

Reali, G., Femminella, M., Nunzi, E., & Valocchi, D. (2014). ARES: Advanced networking for distributing genomic data. Institute for Information Infrastructure Protection.

Seagate Cloud News. (2013). OpenStack case study: Healthcare. Web.

Wicklund, E. (2009). Philips VISICU brings eICU services to Alsaka. Healthcare IT news. Web.

Williams, T. (2008). When trust defies common security sense. Health Informatics Journal, 14(3), 211-221.

Yacov, Y. H., Horowitz, B. M., Guo, Z., Andrijcic, E., & Bogdanor, J. (2014). Assessing systemic risk to cloud computing technology as complex interconnected systems of systems. Center for Risk Management of Engineering Systems. University of Virginia.

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