Health IT Summit: Cloud, data proliferation, interoperability all impacting storage

CAMBRIDGE, MASS.—Storage is coming down in price but it may be premature to move healthcare data to the cloud. That was the consensus during a May 7 panel discussion on managing patient data during the Boston Health IT Summit hosted by the Institute for Health Technology Transformation.

The cloud strategy on the imaging side is starting to bear fruit, said Chuck Podesta, senior VP and CIO, Fletcher Allen Health Care, in Vermont. “When you think about 14 different hospitals within an ACO [accountable care organization] having access to information, a VPN doesn’t make a lot of sense. Moving to the cloud is probably the solution.” The organization did a study for a data center scheduled to be built and found lots of growth the first five years but then shrinkage of the center itself for years six through 10. “A lot of that is based on moving to the cloud. Our HIE is looking to make it part of their product set. For the members of our HIE, it makes a lot of sense to move that to the cloud for large datasets once you’re assured of security as much as you can be.”

Micky Tripathi, PhD, president and CEO of Massachusetts eHealth Initiative, shared Podesta’s concerns. His organization started off with a data warehouse but now gets live feeds from eight different organizations. Originally, they produced static measures for organizations once a quarter. “What happened is, once they signed a contract, this is a very dynamic environment, so they became a Pioneer ACO and wanted to use the warehouse increasingly for performance measurement. How do we keep that storage growing in a way that meets the needs of the overall size and magnitude of the data and is sensitive to increasing performance demands?”

It becomes a cultural question, said Jeffrey Brown, CIO of Lawrence Memorial Hospital in Lawrence, Mass. “The notion of moving to the cloud is very complicated. Our organization housed, owned and operated all its own IT systems for years.” Moving to the cloud requires a robust security program, he said. “Nothing scares you more as a CIO than when you start looking at NIST [National institute of Standards and Technology] 800 controls and there are more than 200 around security and process. The cloud becomes a real risk to an organization. I have a three-year plan to move to the cloud and a large part of that plan is education.”

Security is a major concern, agreed Cara Babachicos, CIO of community hospitals and nonacute care, Partners Healthcare, in Boston. “Servers multiple like rabbits. We have two data centers and are about to build a third so I don’t see this getting any easier. I see us replicating data more and more and having to do it on the fly.” The organization frequently does replication of data so they don’t have “to hit the source system with a complicated process,” she said.

Partners also is looking at data storage with different security levels, she said. “Materials management data might not be the same as clinical documentation.” Appropriate security is “a big deal and the industry overall needs a lot of assistance.”

Babachicos said she also doesn’t think organizations should stream all data in the same way. She cited the need to know the cost to care for a patient across the care continuum. For example, a hip replacement patient is an inpatient, could stay at a rehabilitation hospital or skilled nursing facility and then go to outpatient rehab. “We should know what it costs to do business and make better care decisions. To capture data just to capture data is a burden and is useless.”

When it comes to making such decisions, Brown said he is “always baffled when people are just stalled. We can’t move forward without data and systems. I worry about our three-year vision and cost model on big data.” Brown said his organization was about to move the needle with just paper for a referral management program. Employees wrote on a spreadsheet where clinicians were sending patients. “We noticed significant movement in keeping low local referral patterns and we did it without technology—no tracking system or robust communication system. So, when people ask what can be done without data and systems, in my area, a lot.”

Despite the possibilities that still exist with paper, system advances could make “smart data” a real possibility in the near future, said Babachicos. For example, there are certain indicators of sepsis in the record. “We can’t analyze records line by line but with a smart way to pull that information out, that’s the stuff that makes a difference in patient care. We want to capture data in the transaction record so it can be pulled out and activated when necessary.”

“There needs to be more conscious awareness of what really needs to be shared,” said Rodney Hamilton, MD, CMIO of Informatics Corporation of America, headquartered in Nashville, Tenn. “There’s a level of information that probably really matters and should be shared. The challenge of that is, as a physician, in the heat of the moment, I sometimes want fine, granular details. It really matters in some cases.” But, usually a summary level is what clinicians really need. Duplication of data includes the HIE copy, the origination copy inside the service provider moving the message and a copy of the message at the destination. “We’re seeing that proliferation of data all throughout medicine.”