1. Six questions every health
industry executive should ask
about cloud computing
Health industry executives need to evaluate what cloud
computing can do for their organizations. Asking the right
questions is the place to start.
By Dadong Wan, Andrew Greenway, Jeanne G. Harris and Allan E. Alter
3. No leader today in business or This prospect is creating significant
government can afford to ignore optimism about the long-term potential
cloud computing.1 Many global of cloud computing in the health sector.
organizations—including Citigroup However, alongside the optimism,
and Starbucks—are already using it cloud computing also raises some
to analyze data, provide applications difficult questions, quite apart from
to employees and run special projects.2 the overarching concerns over the
Media giants are reported to be security agenda. While cloud can
working on a cloud-like service that undoubtedly bring significant benefits,
will enable content to be delivered the technology’s disruptive and pervasive
dynamically in multiple formats and impact makes it hard to evaluate its
on a variety of devices.3 And more longer-term costs and risks. Further-
cloud services will soon be available, more, the significance and effects of
as established IT and telecom providers the cloud will differ widely between
such as Microsoft, IBM, Accenture, different industries and even different
Fujitsu, KDDI, China Mobile and companies in the same industry. Faced
SingTel join cloud pioneers like Google, with such uncertainty, it is all too easy
Amazon and Salesforce.com.4 for leaders to succumb to “analysis
paralysis” or leave all the decisions
Many aspects of the health sector to the IT department. But cloud
are well-suited to the flexibility computing is too important for such
and collaboration enabled by cloud a hands-off approach.
services. These include the industry’s
vast and fragmented ecosystem, with To help health industry decision-makers
participants ranging from patients make the right choices about cloud
and insurance companies to hospitals, computing, Accenture has identified
physicians and testing laboratories all six key questions that we think
with a mission-critical need to share they should ask about this still-new
health records quickly and accurately. paradigm. By focusing on these questions,
However, this sharing must also be executives can focus their attention
carried out securely and confidentially. on the right set of key issues, and start
Concerns over these issues represent to identify the real opportunities and
the stumbling block that has hampered risks for their own organization.
adoption of cloud technologies to
date. Given the sensitivities around
data security and privacy and the fact
that privacy and consent policies vary
in every state, region, and country,
it seems likely that the first wave of
cloud implementations in the health
industry may consist largely of private
clouds set up and run by specific
countries and/or groups of providers.
Once these are proven, they may then
move into public infrastructure, enabling
increasing levels of collaboration and
integration with other clouds.
3
4. Healthcare is a highly complex and Improving care quality as a Patient Centered Medical Home
fragmented industry. It is unique in This requirement is a potential driver (PCMH) model or Accountable Care
that it must support a widespread, for cloud computing adoption, especially Organization (ACO).
diverse professional user population given the billions of dollars in federal
(i.e., clinicians) with patients in life- incentives in the US for quality Reducing costs
critical situations. The industry is outcomes and the “meaningful use” The potential to reduce costs throughout
currently facing growing economic agenda, which aims to expand the use the health industry ecosystem is a key
and regulatory pressures that make of electronic health records systems rationale for the adoption of cloud
its IT infrastructure ripe for radical as well as provide the basis for computing. This benefit would extend
change. In combination, these two exchange across and between providers, to all healthcare organizations, regardless
factors suggest that organizations regardless of which information of size and area of specialization. In
in the health industry should take a platforms they are using. Electronic making IT investment decisions, health
closer look at the potential benefits of health records (EHRs) are expected to organizations will take account of
cloud computing (see definition box). be in widespread use by 2014. cost savings and returns on investment
to optimize current and future spending.
The top priorities of the health industry In addition, consumer-oriented cloud With many of the new Health Information
include improving the quality of applications have the potential to Exchange (HIE) models such as PCMH
patient care, reducing cost, increasing improve healthcare communications and ACO, the infrastructure and design
access, and ensuring data privacy and patients’ ability to manage their are in place but usage has yet to take
and security. Widespread adoption own diseases and make healthy life- off. Until greater adoption occurs
of cloud computing would have style choices. The cloud platform also among providers in a state or region,
significant implications for each of lends itself well to new models requiring a limited cloud infrastructure with
these strategic areas. ubiquitous access from multiple ability to quickly scale may represent
providers to a single patient, such the ideal platform.
4
5. What is “cloud computing?”
Cloud computing is an emerging computing paradigm that has
the potential to change how business works. Accenture defines
cloud computing as “the dynamic provisioning of IT capabilities
(hardware, software or services) from third parties over a network."
A variety of factors are converging to make cloud computing
eminently possible—and its promise of rapid, pay-as-you-go
scalability is very attractive to many CIOs under pressure to do
more with less. In fact, Accenture sees cloud computing as an
important step forward in the continuing industrialization of IT—
and thus capable of ultimately playing a role in enabling
high performance.
Increasing access the greatest deterrent to embracing existing online personal health
In today’s health system, whether or cloud computing. Provisions such as record applications such as Microsoft
not someone can receive the right the US Federal (the US Department of HealthVault and Google Health are
care—as well as what kind of care one Health and Human Service’s Health specifically designed to offer a level
might receive—depends heavily on the Insurance Portability and Accountability of security that is appropriate to the
physical location where that person Act, or HIPAA), European Union and industry’s requirements.
lives. As more health data moves into other national or local data protection
the cloud and telehealth technologies regulations must be met. As well, the
become more widely adopted, all US Patriot Act raises concerns over
parties, including patients themselves, on-shoring of data from overseas.
will be able to access health information
and services from anywhere using any However, the data security issue
device. The result will be better access could ultimately play in favor of
to health care and data, especially in cloud computing. By centralizing
remote and emerging areas. and standardizing the handling
of patient data across the health
Ensuring data security ecosystem, adoption of the cloud
could enable stronger security and
As we have already pointed out, risks
authentication to be imposed by
around data privacy, security and safety,
software as a service (SaaS) providers,
and state-specific policy rules are
thereby actually improving the
among the top concerns raised about
protection and integrity of data.
the adoption of cloud computing. As a
And, in terms of patient privacy,
result, these issues currently represent
5
6. A technology whose time has Figure 1. 32% of healthcare respondents are using cloud applications
come for health organizations 80
While these are still early days for the 70
adoption of cloud computing in health,
60
and efforts to alleviate concerns over 53%
security are continuing, there are 50
41%
already clear signs that the industry 40 37%
35%
is starting to appreciate the benefits. 32% 32%
30 29%
While healthcare companies are by 24%
20 19%
nature a relatively conservative group
of businesses, recent research shows 10
that they are increasingly turning to 0
cloud services to boost their efficiency Education Energy Financial Govern- Health- Legal/ Manufac- Retail Tech-
Services ment care Professional turing nology
and effectiveness. Services
Using cloud-based solutions Not using the cloud
As Figure 1 shows, a study released in
Source: Mimecast, Cloud Adoption Survey Results, February 4, 20105
early 2010 found that almost a third
of health industry respondents are
already using cloud applications, an
adoption rate that compares well with
many other sectors.
It is also clear that the early adopters’
experience with cloud computing has
been sufficiently positive to assuage
health companies’ fears and encourage
rising take-up in the future. The same
survey found that almost three-quarters
of health industry respondents already
Figure 2. 73% of healthcare respondents plan to move more
using cloud-based services are planning applications to the cloud
to move more applications to the cloud
(see Figure 2). Education 88%
Energy 50%
These findings suggest that a further
driver for cloud adoption is emerging 68%
Financial Services
in the health industry. As more
participants in the health ecosystem Government 75%
move to cloud computing, those that
Healthcare 73%
hang back may find themselves at a
competitive disadvantage in terms of 81%
Legal and Professional Services
cost and effectiveness, as well as being
less able to collaborate seamlessly with Manufacturing 48%
other players than the cloud-enabled
companies. This prospect indicates Retail 78%
that health companies should not only 75%
Technology
consider cloud computing, but should
do so as a matter of strategic urgency. 0 20 40 60 80 100
We will now go on to explore the six Moving additional applications to the cloud Not moving additional applications
key questions that we believe every
Source: Mimecast, Cloud Adoption Survey Results, February 4, 20105
health industry executive should ask
when evaluating the potential
adoption of cloud computing.
6
7. Health and cloud computing:
mapping industry needs to
technology capabilities
There are several reasons why the health industry’s unique blend
of requirements is so suited to cloud computing solutions:
• It can lead to easier update and higher quality patient data—a
feature especially important in health care, where fragmented,
redundant, and inconsistent data is rampant today.
• SaaS-based electronic medical record (EMR) solutions are
a natural fit for small physician practices to which most
physicians belong because of their affordability, ease of use,
and small requirement for ongoing technical support.
• The exoskeleton nature of the cloud makes it relatively easy to
inter-connect disparate systems from different health organizations,
and provide an elastic infrastructure that can start inexpensively
and quickly scale as adoption increases. Thus, it provide an
ideal architectural alternative for Health Information Exchanges
(HIEs). There are promising advances across a broad spectrum of
patient-facing and telemedicine/telehealth applications. There
is also growing attention on providing direct, continuous
engagement between patients and providers through “in the
cloud” relationships that include advanced continuous home
and portable monitoring.
• Cloud computing-based health applications such as Microsoft
HealthVault and Google Health can help create a new market
of consumer-oriented healthcare applications, enabling better
consumer lifestyle choices and more active consumer participation
in choosing a course of treatment for serious health problems.
Sources: Gartner, Factiva [from Accenture ‘Cloud Computing in Healthcare’ deck, date Feb 19 2010, slide 3]
7
8. 1. What is cloud computing, • Rapid acquisition and deployment device or personal computer with a
and how does it work? of systems and applications browser. As with most utilities,
• Lower ongoing operating costs
organizations pay by the kind and
At its most basic level, cloud computing amount of services they use, plus any
allows all participants in the health • Improved data sharing among additional fees. (Some cloud services
industry ecosystem—from patients to different organizations such as social networks and Web mail
employees to IT staff—wherever they are available at no cost, but these
are, to obtain computing capabilities For businesspeople, cloud computing are intended for individuals rather
through the Internet. At the other can seem almost too good to be true: than organizations.)
end of the Internet connection are plenty of computing power to tap into,
computing “clouds,” which are essentially and no expensive IT infrastructure to The absence of a data center on-site
supersized data centers containing buy or maintain. For once, experience doesn’t mean cloud computing is not
tens of thousands of servers hosting shows that the truth can match the real. Here’s how it works. The clouds,
web applications. Cloud services ranging hype, provided the cloud is adopted the remote data centers, are designed
from raw computing capacity to and managed properly. Cloud computing so that processing power can be added
complete business processes can be lets organizations bypass the expense simply by attaching more servers;
purchased through web interfaces and and bother of buying, installing, everything is virtualized so that soft-
turned on and off as they are needed. operating, maintaining and upgrading ware can be run on any available server
the networks and computers found with excess capacity. And because
This structure means the characteristics in data centers. Instead of licensing everything is hosted in the cloud, users
of cloud services include: software, users tap into a service when can run processes, build applications
• Little or no capital investment it’s needed for as long as it’s needed. and do more without loading each and
All that is required is a broadband every tool onto their computers.
• Variable pricing based on consumption:
Internet connection, and a mobile
buyers pay by the drink
8
9. Pathwork Diagnostics: tapping into
the computing power of the cloud
Pathwork Diagnostics, a molecular diagnostics company, develops
high-value diagnostic tests to help oncologists diagnose hard-to-
identify cancer tumors. Pathwork uses proprietary machine learning
algorithms to analyze large libraries of tumor specimen profiles—
a computation process that can take months using a mid-size high
performance computing resource. So it opted for cloud computing.
“Our challenge was a perfect fit for cloud computing,” says Ljubomir
Buturovic, chief scientist at Sunnyvale, California-based Pathwork.
“We needed access to more computing capacity than we could
possibly maintain internally—but only at certain peak times. When
we develop and deliver a product for clinical validation, we’ll have
weeks where we need access to almost unlimited capacity.”
Source: ‘Health Companies in the Cloud’, CMIO Magazine; http://www.cmio.net/index.php?option=com_
articles&view=article&id=16941:future-forecast-cloud-computing-brightens-healthcares-dark-
skies&division=cmio
The basic technologies are well- these solutions may move out into 2. What benefits can clouds
established and can be duplicated public infrastructure, enabling bring to my organization?
by any organization. This makes it increasing levels of collaboration
possible for organizations to build and integration with other clouds. The three top benefits that cloud
“private clouds,” ring-fenced infra- In the long term, building and managing computing can potentially deliver
structure that uses cloud computing a secure and flexible infrastructure to a health organization are
technologies but is only shared by cloud using a combination of “private” improvements in cost, flexibility
approved organizations. Major public and “public” services will be an important and speed to market.
clouds require additional technologies building block if health companies are
so they can support many millions to harness the enormous benefits that Cost
of users around the world without cloud computing can provide. The relatively low price of cloud
becoming sluggish.6 services is a big part of their
This definition barely scratches the attractiveness. For example, a large
As we have already pointed out, the surface of the technical complexities pharmaceutical company is reported
sensitivities around data security and of cloud computing. But for health to have paid Amazon Web Services
privacy make it likely that the first industry leaders, it highlights the only US$89 to analyze data on a drug
wave of cloud implementations in the crucial point: with cloud computing, under development. To do the job
health industry may consist largely the provision of IT power becomes themselves, its researchers would have
of private clouds set up and run by someone else’s problem. had to buy 25 servers.7 Add to that the
specific countries and/or groups of savings from eliminating the cost of
organizations. Over time, as these servers, software licenses, maintenance
initial forays into cloud computing fees, data center space, electricity and
prove their functionality and robustness, IT labor—together with the benefits
9
10. Figure 3. Initial opportunities for using clouds
New businesses
Business continuity (storage)
Batch and data intensive applications
Software development and testing
Desktop productivity
Ease of
Peak load demands
Implemen- Geographic expansion
tation
Sensitive applications
Legacy
Value to the Enterprise
Source: Accenture Institute for High Performance
of replacing a large up-front capital Clouds can be summoned quickly when Speed
expense with a low, variable, pay- needed, expand by assigning more Clouds, paradoxically, can both
for-use operating expense—and the servers to a job, and then shrink or decentralize technical innovation
financial appeal of cloud computing disappear when no longer needed. This and impose centralized control on
becomes even clearer. flexibility makes clouds ideally suited IT resources. With the advent of the
to sporadic, seasonal or temporary cloud, the barrier to entry for providing
These benefits are paramount in work, for finishing tasks at lightning an innovative IT service has never been
the case of non-profit organizations speed and processing vast amounts of lower. Any programmer could create a
participating in US federal programs, data, and for software development software service using free or low-cost
such as Regional Extension Centers and testing projects—all of which are development tools and quickly make it
to assist small-practice physicians common requirements in the health available to all departments, potentially
focusing on the medically underserved. industry. Clouds can also supplement making each business unit and the
Many of the tools, platforms and conventional systems when demand organization as a whole much more
infrastructure necessary to support for computing exceeds supply. And agile and responsive. Clouds are also
these service organizations, and since they are an operational expense, a fast and easy way for organizations
even the small-practice physicians cloud services can often bypass the to impose a standard set of applications
themselves, are not achievable in capital-expense approval process, or processes. They only need pay for a
a short timeframe with significant and thus be quicker to procure than cloud service and then require employees
up-front capital. conventional systems. In the pharma- to go online and use it. These benefits
ceutical company’s case, using clouds are attracting other sectors to adopt
Flexibility shaved three months off the IT budget cloud-based approaches. In public
Clouds offer extraordinarily flexible and approval process. When translated services, cloud applications and
resources too, and are scalable because to faster time to market, that represents mashups are becoming mainstream,
of their underlying technical design. US$1 billion in opportunity costs avoided.
10
11. together with new publicly available 2. The push for greater data sharing 5. Increasing reliance on remote
data sets such as NYC BigApps and and collaboration among health monitoring of health data entered
platforms such as iApps. organizations, including innovations by the patient, care taker or through
such as real-time biosurveillance by automated medical equipment.
Industry advancements public health entities. To be efficient
On top of these three principal benefits, and deliver better patient outcomes, Cloud computing has the characteristics
we believe that organizations in the the health industry will need to foster to support all these changes—Internet-
health industry have unique opportunities closer and more inclusive teamwork based, flexible, pay-as-you-go, low
to use cloud computing to deliver between different organizations and capital investment, lower operating
significant advances. In particular, a patients, underpinned by better sharing costs—while maximizing the benefits
number of strong industry trends will of patient information. to health organizations and patients.
drive adoption of—and subsequent 3. Using data to assist clinical decision- As these characteristics suggest, a
benefits from—cloud computing in making through evidenced-based further important aspect of cloud
many new areas. These trends include: approaches, such as drug interaction computing is that its benefits are
alerts and intervention reminders, and available to organizations of all sizes
1. Increasing use of Internet-based
using large data sets across exchanges throughout the health ecosystem. This
computing across the health industry
for comparative effectiveness research means it fosters collaboration and
and by patients, and the resulting
and population health reporting. sharing not just between the biggest
explosion in health-related information,
players, but in a way that is inclusive
including digitized health data (MRI 4. Patients’ growing desire for of non-profit and smaller specialist
scans, Ultrasound images, positron information at anytime and anywhere, and niche organizations. Since an
emission tomography, endoscopy pictures, accessed through multiple mobile devices. organization pays only for the services
mammograms, and digital radiography)
it uses, and no long-term contracts are
and user-generated content such as
blogs, wikis, and online social networks.
11
12. needed, cloud computing is affordable applications, services and offerings But health executives evaluating the
even for small physician practices, that were previously too difficult or potential savings from adopting cloud
which represent around 49 percent expensive for the organization to offer. computing should not take most
of office-based physicians in the US. The accompanying information panel promises and projections of cloud savings
summarizes some instances of new at face value. The articles about
Given that adoption of clouds in the cloud-enabled service offerings. companies that have saved money
industry is still at an embryonic stage, rarely explain how these savings were
it is too early to make a completely 3. Can I depend on clouds to calculated. Some apparently rigorous
accurate assessment of their potential save my organization money? analyses of cloud savings have been
for the health industry. Leaders should criticized as unrealistic.11 Furthermore,
begin by looking for specific benefits CIOs across many industries say they while most organizations that use
for their own organization–ways to are finding real savings from cloud clouds say they are saving money as
reduce costs, improve processes and computing. Accenture estimates its expected, not all are doing so. In one
more. They should also watch out for own IT organization could save up study of software-as-a-service users,
situations where clouds do not make to 50 percent of its hosting costs only about half of the respondents
sense. For example, migrating a annually by transferring most of its reported a positive return on investment
complex legacy system to a cloud applications to infrastructure clouds.9 from SaaS, while a quarter found
would require a costly redesign. Bechtel’s CIO benchmarked the the cost was greater than they had
Projects requiring a guaranteed company’s internal data center and budgeted.12 And while Accenture’s
response time should also be avoided, storage against those of Google, internal IT organization has moved
since guarantees are risky when data Amazon and Salesforce.com, concluding several internal applications to the
has to be accessed via the Internet.8 he could greatly reduce his per unit cloud, in a number of cases it has
Executives are likely to find the greatest costs by creating an internal cloud.10 actively chosen not to do so, on the
benefit by envisioning new processes,
12
13. Using the cloud to expand the
service portfolio
There are several examples of health industry organizations
already using cloud computing to support new services.
These include:
• Many physicians in US are starting to use free or pay-as-you-
go cloud-based, electronic health record services for recording
and sharing patient information, such as Patient Fusion, Microsoft
Health Vault and Google Health.
• The UK National Health Service has developed a secure, private
cloud-based service for storing patient medical images for easy
access across different parts of the organization.
• A US dental software company has developed a cloud-based
application in response to the dental industry’s need for a HIPAA-
compliant method of sending, managing, and storing patients’
electronic Protected Health Information (ePHI) among care
providers. It runs on the public cloud and uses encrypted
communication, access, and storage security measures.
• MedCommons, a health records services provider in the US,
gives patients direct access to their medical information (via web
browser) and allows an easy way to share this information with
healthcare providers.
• The Office of the National Coordinator in the US itself has
deployed a custom set of cloud tools based on salesforce.com
to help the 20+ Regional Extension Center program awardees
to manage provider outreach and assistance in their EHR
implementation programs.
13
14. NY Presbyterian: bringing the
benefits of the cloud to patients
Working together for over a year, NY Presbyterian (NYP) and Microsoft
have co-developed a platform called MyNYP.org. MyNYP.org is a
consumer-facing personal health record (PHR) solution for NYP customers
that combines attributes of Microsoft’s two leading healthcare solutions,
consumer-facing HealthVault (which is a cloud-based platform) and
provider-facing Amalga (which is not). In addition to using Amalga,
Microsoft’s Unified Intelligence System (UIS), to aggregate and present
patient data to physicians, NYP is also using Amalga to aggregate and
push such information into a customer’s/patient’s MyNYP.org PHR
account. In doing so, NYP is enabling consumers to access and export
all of their NYP clinical records into their personally controlled
HealthVault (HV) account. This provides the consumer with the gold
standard of clinical health data, combined with the portability and
data management capabilities of HV. Based on the NYP experience,
Microsoft now offers a product called HealthVault Community Connect.
Source: NYP; Drawn from: http://chilmarkresearch.com/2009/04/06/healthvault-ny-presbyterian-clos-
ing-the-loop-on-care/ (précised on page 1 of Accenture’s “Health Companies in the Cloud” document)
grounds that the cost of hosting the they need to work with the finance 4. How will clouds affect the
system internally, either in an optimized department to develop a consistent way my organization operates
U.S.-based data center or one of its and acceptable approach to measuring
in the future?
Indian facilities, was less than that of the costs and return from clouds. Only
an external cloud service. then can they reach a reliable estimate Companies that have built massive
of the savings. In addition, the following clouds are already transforming
Such instances suggest that health factors will be critical to realizing the the nature of competition. Google’s
industry executives need to take a greatest possible benefits: advertising-supported search engine
close look for themselves into the cost and tools and Amazon’s online retail
• Adopting common standards that
implications of cloud computing. Their operations are all made possible by
make sharing easier
investigations should include seeking the computing clouds created by those
rigorous ROI case studies based on • Using standard, “fit-for-purpose” companies. Elsewhere, cloud-based
actual cloud usage, rather than estimates service levels as much as possible, consumer applications such as Facebook
of anticipated savings. Hardware, after depending on the requirements of and iPhone applets are driving innovation
all, is a relatively small component each specific application in unpredictable ways. In the next few
of data center costs. They also need • Applying security and data privacy years, health industry organizations
to uncover the hidden management, restrictions appropriately and, again, will also start to achieve similarly
transition, and usage costs that reveal standardizing on the number of sweeping change by leveraging cloud
themselves only when organizations different levels as much as possible computing. Here are some examples
start to work with the technology. of the developments we are likely
• Overcoming any departmental
Furthermore, they should examine to see:
“ownership” issues so as much work
the costs of using each kind of cloud as possible can be moved to the cloud
service separately, since the pricing
and cost involved in using different • Taking care to maintain flexibility
kinds of cloud services all vary. And around procurement and avoid getting
too tied into specific suppliers
14
15. 1. The development of a health industry 5. A migration away from face-to-face assessment to understand how clouds
information ecosystem, with electronic to continuous interaction between can help them. In particular, strategists
personal medical records at the heart, patients and physicians, towards must investigate what new services
located in a secure, confidential cloud- remote monitoring and information should be pursued using cloud computing,
based environment. sharing supported by cloud computing while CIOs must track the evolution
2. Increasing digitization of health applications. of the technology and the market
information to provide a comprehensive 6. The advent of cloud-based order for cloud services, to ensure their
patient medical record including entry applications to enable a physician organizations’ strategic ambitions
medical notes, images, test results, to order services quickly and simply do not outrun the capabilities of
and self-diagnostic information. from health industry providers such the technology.
3. Increasing integration of mobile as laboratories, hospitals and drug
suppliers. 5. What about security, privacy
devices and cloud-based applications
to support wellness programs such as 7. Medical decision support systems
and other risks around data?
exercise, diet, self-testing and remote to assist physicians’ clinical decision- Compared to the mainstream commercial
health monitoring. making by providing evidence-based sector, health industry leaders face
knowledge in the context of patient- significantly higher sensitivity around
4. Increasing use of community
specific data. data security and privacy, reflecting
applications (Facebook, Twitter, Youtube,
the deeply personal nature of the
PatientsLikeMe) to inform patients
As with the benefits, it is still too early information they hold and process.
and to support communication and
to gauge fully all the ways in which This means they need to scrutinize
networking across health communities.
the cloud will change how the health their decisions around cloud looking
The World Health Organization (WHO)
industry will operate. Decision-makers through a more powerful lens, taking
used tools such as this to inform the
will need to perform a thorough account of a wide array of industry-
world about Swine Flu.
specific factors:
15
16. 1. Political and regulatory: it may not carries a lot of risk and cost. Against an organization maximizes benefits
be acceptable to have patient health this background, the move to cloud and minimizes risks, executives must
information held and processing computing actually presents a positive do the following:
performed outside the country. opportunity to drive more consistency
2. Tough standards: given the extremely and automation in security and data Ask hard questions and demand
sensitive nature of patient health privacy, thereby providing a catalyst data-based analyses regarding
information and variations in state for combining higher security with cost savings.
and regional regulations, concerns lower costs. Don’t assume automatic and substantive
around security, data privacy and cost savings. Carry out an ROI analysis.
reliability may impose even tougher Our view is that organizations should Consider conversion and ongoing costs
restrictions on how much flexibility is adopt a very practical approach to as well as savings. Don’t be intimidated
feasible when accessing, storing and security and data privacy in the cloud. by the jargon. Experiment or pilot on
processing data in the cloud. Most health data can be tagged with low-hanging fruit such as workgroup
different levels of sensitivity, from low applications, or on a non-mission critical,
3. Organizational issues: management level (published widely and no restrictions) non-integrated application. Then be
will need to overcome any cultural to ultra-sensitive patient data. In the ready to scale once you’ve proven the
barriers or resistance to sharing same way, organizations can design benefits are worth it.
information, services and IT across their cloud infrastructure to have
health care organizations. appropriate levels of security built in,
Establish a clear governance
4. Procurement processes: designed through a managed combination of
structure for cloud computing.
to maintain fair competition between both private and public clouds. So,
Many organizations have rules and
different suppliers, organizations’ for example, low-level data may
structures in place that govern how
procurement policies may restrict well be suitable to go onto a public
IT decisions are shared between
their flexibility and leeway to use cloud cloud infrastructure service with
departmental leaders and IT executives.
services. simple password access, whereas ultra-
Use them (and if they don’t exist,
sensitive data may need to go onto
create them) to decide who inside
Various surveys have confirmed that dedicated secure servers housed in
and outside the IT organization should
security and data privacy remain prime local data centers with strong
be engaged in decisions on cloud
concerns for cloud implementers in authentication required for access.
computing, and what decision-making
the health industry. The fear of their There will be several different levels
rights and responsibilities they have.
patient data being “out in the cloud” is of security between these two extremes.
the single greatest hurdle that health As we noted earlier in this paper, a key
Keep cloud efforts on track.
industry leaders must overcome to enabler for health companies to realize
build trust and gain the benefits from the full potential benefits of cloud Make sure cloud computing receives
cloud computing. CIOs are concerned computing may be to create and manage the focused thinking, planning and
that their data could be stolen by a secure and flexible hybrid infrastructure follow-up it requires. Use the answers
hackers, mixed with data from their cloud combining both private and to these six questions to identify and
cloud providers’ other customers, or public services, with each function address immediate business needs that
released by mistake. Any of these allocated to the appropriate type of lend themselves to cloud computing and
incidents would expose organizations service (see information panel). longer-term opportunities for clouds,
to public embarrassment and to develop a plan for using public and
lawsuits, as well as the time and 6. What are my next steps? perhaps private clouds, and to gain the
expense of cleaning data and undoing capabilities the plan requires. Make
Cloud computing is too important to sure the organization understands and
other damage.13
the future of any organization to be responds appropriately to the impact
left entirely to technologists. While clouds are having on their operations.
Many health organizations today have
the heavy lifting of the migration from
very specific challenges in areas of
conventional to cloud computing is Set the standards for success.
security and data privacy. Their existing
likely to fall on the shoulders of the
IT estates consist of highly fragmented Provide the necessary oversight to the
CIO, other senior executives should be
landscapes of security and data privacy IT organization. Make sure that goals
closely involved and indeed will have
approaches and policies taken across and deliverables are well understood,
important roles to play. To make sure
different departments. This in turn and that projects are well aligned
16
17. The hybrid approach: balancing
security and ease of access
Adopting a cloud computing strategy that seamlessly integrates
public and private cloud capabilities with legacy IT can enable a
health organization to align its data security with the sensitivity
of specific types of information, and well as bringing additional
benefits and increasing the opportunities for success. This hybrid
approach means an organization can meet the conflicting
requirements for data privacy, security, lower costs, improved
services and higher efficiency by:
• Avoiding the fragmentation and dilution of efforts that hinder
efficiency, reliability, data privacy and security across depart-
ments.
• Enabling new integrated “patient-centric” processes that are
gaining importance in health services.
• Sharing departmental peaks in data processing across the cloud
to reduce overall capacity requirements and costs.
• Standardizing new and current services for multiple groups,
saving development and maintenance costs and speeding
provision time.
• Providing a platform that allows very quick development of
new applications and services, ideal for short term needs.
• Facilitating real-time competition among service providers.
17
18. Managing the transition: the need
for a balanced approach
To navigate a successful transition to a cloud computing
environment, health companies will need to take a balanced
approach that reflects their own specific characteristics and
needs. For example, hospitals already have a significant investment
in IT that they will need to manage, while small physician practices
will probably be more focused on moving to lower and more
flexible service costs. In health organizations of all kinds, one
of the key challenges for the IT function throughout the transition
and beyond will be deciding what to hold onto and what to let
go. Large healthcare organizations are likely to pursue a blended
and pragmatic approach for several years to come, supplying
some hardware and software requirements themselves and
purchasing others.
with business needs. Clarify how the well. So when selecting cloud providers, market. The low development cost,
value from cloud computing is to be carefully consider whether they have short development cycle, and quick
determined: which quantitative and the potential to be a desirable partner return on cloud services are irresistible.
qualitative benefits are sought? And in the future. Even after they are This means future IT advances and
consider what else constitutes success chosen, evaluate your partners on innovations are much more likely to
besides value achieved and projects their financial stability, as well as their be based on clouds than conventional
completed: skills developed, partner- ability to improve functionality and computing. For health companies,
ships established, risks addressed. service levels, to integrate data across the critical issue isn’t whether cloud
different technology platforms and computing will become a fundamental
Provide the necessary support. cloud services, and to deliver on technology in the next decade. It is
Besides financial resources and technical their promises. how they will make money and generate
talent, support other activities that will benefits for patients from the capabilities
underpin the success of cloud initiatives. It will take time for organizations it offers.
For example, organizations may benefit to achieve the transition to cloud
from a community of practice or a computing. Executives are still As we have stressed throughout
cloud program office to develop the grappling with its risks and possibilities, his paper, cloud services will evolve
skills and share the experiences of and the cost of writing off current IT over time. Managing the new cloud
people engaged in cloud projects. investments. Still, a transition to a capabilities in tandem with all the
hybrid of cloud and conventional existing legacy systems in a coherent
Buy cautiously, appraise frequently. computing is under way. The capabilities and consistent way will be critical to
and potential savings from clouds realizing the benefits and managing
It’s too early to predict who the major
are too great to ignore. In addition, the risks.
cloud providers will be in a few years,
software developers and venture
what capabilities they will deliver,
capitalists will be drawn to this new
when they will deliver them, and how
18
19. About the authors
Dadong Wan is leading much of our management executive. He also has Allan E. Alter is a research fellow
work to think through implications of deep management consulting experience, with the Accenture Institute for High
emerging technologies (including cloud with particular focus on helping clients Performance, and is based in Boston.
computing) for our health industry improve business processes. He was formerly an editor with such
clients. Based in Chicago, he is a andrew.greenway@accenture.com publications as CIO Magazine and
senior research scientist at Accenture CIO Insight.
Technology Labs and has deep experience Jeanne G. Harris is an executive allan.e.alter@accenture.com
in designing and implementing next research fellow with the Accenture
generation innovative IT solutions. Institute for High Performance, and is
dadong.wan@accenture.com based in Chicago. She is the co-author,
with Thomas H. Davenport, of Competing
Andrew Greenway is responsible for on Analytics: The New Science of
leading Accenture’s cloud computing Winning (Harvard Business Press,
program, and is based in London. He 2007) and, with Davenport and Robert
has extensive experience leading large Morison, of Analytics at Work: Smarter
IT organizations and major IT projects. Decisions, Better Results (Harvard
He has experience as a senior marketing Business Press, 2010).
executive and as a supply chain jeanne.g.harris@accenture.com
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