Cloud Computing & Clinical Apps: Beyond Storage
Compared with other industries, cloud-based clinical application development has been rather slow. However, as algorithms and computing power ramp up, healthcare providers are finding more choices and expanding capabilities among cloud apps.
More than words
“The ability to do large computations with analyses was difficult before [cloud computing allowed it],” says Jeffrey T. Leek, PhD, MS, assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. Leek and his colleagues use an internally developed open-source cloud computing pipeline called Myrna for calculating differential gene expression in large RNA-sequencing datasets.
According to Leek, the cloud enables academic researchers conducting molecular biology studies and hospital clinicians taking blood samples from patients to run an application to correlate outcomes and predict how a patient might react to a particular treatment.
Healthcare systems should take note of this kind of heavy duty data-crunching because it enables vast amounts of processing at a lower cost. RNA-sequencing requires a large amount of computational power and running an analysis for a single RNA sequence on one laptop could take up to three weeks to complete on a local computer network, says Leek. In contrast, renting multiple computers for cloud computation services for $65, Leek can get results back in an hour and 45 minutes, he says.
“If you imagine three weeks for every experiment, you’re paying for the convenience of getting results back in less than two hours,” says Leek.
Cloud computing in the clinical healthcare setting will help provide similar computation-intensive solutions for clinicians dealing with massive data files instead of processing on local computers, he says.
Three practices, one cloud
One group of independent physician practices is using cloud computing to assist clinical decision support and consultation for radiation oncology images. “The cloud gives the opportunity for practices to share everything they know while not worrying about customized program systems,” says Ed Purkiss, director of technology at three Scottsdale, Ariz.-based independent medical practices: Breastnet (mammography), Arizona Breast Cancer Specialists (radiation oncology) and Arizona Institute for Breast Health Foundation (which gives free second opinions of breast cancer studies). The practices formed a natural collaboration because each represents different aspects of oncology treatment, Purkiss says.
The cloud has been running computation executions for nine months among the practices, including a mammography imaging practice. Storage is provided by DICOM Grid and Iron Medical, and Varian software houses patient history. In the cloud, clinicians can perform radiation treatment planning by contouring of images generated via Eclipsys and Velocity programs, Purkiss says. Processors in the cloud system then convert the augmented pictures into a format that can be read by a linear accelerator, which tells the irradiation device where and how much radiation to deliver to a patient.
A woman can get a mammogram at Breastnet, and the images are sent to the cloud along with annotations made by the radiologist. Users at Arizona Breast Cancer Specialists can instantly access images and the patient’s clinical data, and operate software such as contouring in the cloud via a mobile device, rather than on a traditional stationary computer.
“The full sweep of taking a picture of a breast, re-analyzing it among doctors and finally treating the breast makes an interesting narrative of how the cloud is being used to make doctors much more effective,” says Purkiss. “The timeliness and accuracy are greatly enhanced.”
In addition, “data and execution allow collaboration even though the practices are separate entities,” says Purkiss. “At the end of the day, it’s all about the patient and this gives the doctors the tools to provide good healthcare.”
A tool for ACO transition
Sharp Community Medical Group (SCMG) in San Diego is currently evaluating a cloud computing application—Collaborative Care Solution, from IBM and ActiveHealth Management—to connect the independent practice association of 640 clinicians to assist clinical decision support.
SCMG is moving toward accountable care organization (ACO) agreements with commercial payors, says John Jenrette, MD, CEO of SCMG. The medical group has been installing NextGen and Allscripts EMR technology in SCMG’s individual practice association (IPA) and one of SCMG’s subgroups—and while the EMR may be good for care, says Jenrette, it can be difficult at times to retrieve important clinical information.
Jenrette hopes the cloud computing application can provide actionable clinical intelligence that sits on top of the EMR’s data collection.
The application was implemented in August, and Jenrette doesn’t expect SCMG to finish its validation review of the application until the beginning of 2011. Currently, SCMG is beginning to implement changes in workflow to use a digital dashboard that will collect the aggregate data and provide real-time analysis of clinical throughput.
Clinicians will be able to open the dashboard and review their roster of patients and see gaps in care—for example, if someone hasn’t picked up medication or followed up for care of their diabetes, says Jenrette. SCMG management will be able to view data across the entire patient population to check such items as compliance issues, MRI utilization rates and standard clinical metrics.
“We see this replacing current internally built data warehouses over time,” says Jenrette, who sees the cloud-based dashboard as an important tool for a medical home model.
On a broader scale, “if we can use the cloud to move healthcare systems out of their siloed mentality and to make care community-focused, with patients integrating [their data] into PHRs, we can engage in better care by sharing more clinical data among providers and between patients and providers, Jenrette says. “In the long run, medical information belongs to the patient and our long term approach should be patient-centric.”
As other industries have known for a while, when it comes to large-scale collaboration, the cloud model shines. Now healthcare is seeing the potential to reduce costs by reducing hardware purchases. Cloud computing may just be in the right place and the right time, as clinicians move to share more data to boost patient care.
| Put It in Writing |
| Although cloud computing can expedite information exchange, healthcare providers need to pay attention to compliance with regulations regarding data security. Amy K. Fehn, JD, partner at Wachler & Associates, PC, a healthcare law firm in Royal Oak, Mich., specializing in HIPAA compliance and compliance programs, outlined some considerations for professionals contemplating hooking up with remotely-hosted software. A vendor should be familiar with HIPAA security regulations and understand them, says Fehn. “Set forth methodologies that will be used for encryption. Organizations might want to get indemnification provisions, so if there is a breach, they will be protected.” Modifications to HITECH’s privacy and security standards made in July extend the definition of business associates beyond covered entities to vendors, she says. If a business associate subcontracts with another business associate, that subcontracted business associate is also required to comply with privacy and security rules. “Make sure you’re familiar with the security rule and enter into agreements that state the security will be in accordance with HITECH standards,” says Fehn. If a cloud provider site goes down, organizations must ensure they can still access data to function as a business, she says. This requires a disaster recovery plan specific to organizations, depending on their geography and potential hazards. “Organizations need to be sure they can still run their practice if the remote cloud system is down,” says Fehn. Organizations should make sure the data are not lost by the vendor or rendered inaccessible either because of bankruptcy/transfer of ownership or a disaster that brings the vendor’s system down. “Just as you don’t want the only copy of your information to be kept onsite, you wouldn’t want the only copy to be kept with a single cloud vendor,” says Fehn. “Cloud computing is a great solution for disaster recovery if a disaster strikes the provider’s location, but if the only copy of the information lies with the cloud vendor, you have the same concerns with regard to a disaster at their facility [or any other cause of interruption in service].” She suggests organizations have some low-tech tools available—clinical information on paper and a backup generator—in case an interruption in service knocks out access to the cloud. |