Sil­ver lin­ing

Cloud com­put­ing brings sav­ings, risks

Modern Healthcare - - From The C-suite - Shubho Chat­ter­jee Shubho Chat­ter­jee is chief in­for­ma­tion of­fi­cer of Mi­ami (Fla.) Jewish Health Sys­tems.

Cloud com­put­ing is an In­ter­net­based us­age of com­puter ap­pli­ca­tions and ser­vices whereby var­i­ous com­put­ing re­sources, such as com­puter ap­pli­ca­tions, web­sites and data cen­ters, are shared in a pub­lic util­ity model. It is a par­a­digm shift in com­put­ing start­ing with mi­gra­tion from the main­frame to the client server, to the In­ter­net, and to mod­els such as soft­ware as a ser­vice, or SaaS; plat­form as a ser­vice, or PaaS; and in­fra­struc­ture as a ser­vice, or IaaS.

The SaaS model al­lows li­censed use of a re­motely hosted ap­pli­ca­tion. The PaaS model is an en­vi­ron­ment for ap­pli­ca­tion devel­op­ment, test­ing, de­ploy­ment, host­ing, stor­age, in­te­gra­tion with other Web ser­vices, and other util­i­ties. The IaaS model pro­vides ac­cess to hard­ware, DC space, soft­ware and op­er­at­ing sys­tems, re­mote desk­top and ap­pli­ca­tions and net­work man­age­ment.

At Mi­ami Jewish Health Sys­tems, we mi­grated our en­ter­prisewide ap­pli­ca­tions to a cloud model. The over­all in­for­ma­tion technology strat­egy was ex­am­ined from three busi­ness levers: busi­ness growth, op­er­a­tional ef­fi­ciency im­prove­ment and im­proved qual­ity of pa­tient care.

The ma­jor com­po­nents in the strat­egy were: sim­pli­fy­ing IT ser­vice de­liv­ery and main­te­nance, re­duc­ing costs, re­liev­ing crit­i­cal hu­man tal­ent from main­te­nance work, re­duc­ing re­source re­quire­ments for ma­jor soft­ware up­grades, and bet­ter man­ag­ing the plat­form and in­fra­struc­ture of the sup­ported ap­pli­ca­tions. Be­sides these op­er­a­tional ef­fi­cien­cies, these strate­gies also prom­ise to in­di­rectly boost busi­ness growth and qual­ity of care as the sys­tem can rede­ploy scant or­ga­ni­za­tional and tech­ni­cal re­sources to higher value-added projects.

Cloud com­put­ing should re­duce the to­tal cost of the sys­tem—the larger the hard­ware foot­print, the larger the po­ten­tial for sav­ings. Cloud com­put­ing should elim­i­nate re­dun­dant hard­ware from the data cen­ter, re­duc­ing main­te­nance and cool­ing costs. It should free up skilled tech­ni­cal re­sources to be re­de­ployed as busi­ness an­a­lysts to proac­tively as­sess and pri­or­i­tize IT projects for top busi­ness goals.

An en­ter­prise con­tent man­age­ment sys­tem, a cor­po­rate web­site, the en­ter­prise med­i­cal record plat­form and the hu­man re­sources in­for­ma­tion sys­tem have been mi­grated from a client-server to a PaaS cloud en­vi­ron­ment. A time-and-sched­ul­ing man­age­ment sys­tem will be mi­grated to SaaS in the near fu­ture, while a busi­ness in­tel­li­gence SaaS plat­form is be­ing planned for in­te­gra­tion with the elec­tronic health-record plat­form in the same PaaS en­vi­ron­ment and lo­ca­tion as the EHR plat­form. Per­for­mance de­pends on In­ter­net con­nec­tiv­ity, and an In­ter­net out­age can af­fect busi­ness. Risk is mit­i­gated with In­ter­net re­dun­dancy—an im­me­di­ate switchover oc­curs if a pri­mary link fails. Con­tracts must in­clude clear ser­vice-level pro­vi­sions to com­pen­sate for down­times, with clear mon­e­tary penal­ties and rec­om­pense for sys­tem non­avail­abil­ity. The client should in­sist that ven­dors pro­vide sys­tem up­time re­ports. Con­tracts also should in­clude dis­as­ter man­age­ment and backup clauses and pro­ce­dures.

An out­age also can come from in­suf­fi­cient In­ter­net band­width ca­pac­ity, so this must be planned for and sup­ple­mented with an ef­fi­cient in­ter­nal net­work to en­sure that users get the best pos­si­ble qual­ity out of the sys­tem.

A rig­or­ous cost-ben­e­fit anal­y­sis should be un­der­taken at the out­set for each mi­gra­tion. Some cost pa­ram­e­ters to be con­sid­ered in­clude: the pro­jected costs in re­plac­ing hard­ware, pro­jected sav­ings in la­bor and soft­ware li­cens­ing costs, sav­ings in pe­riph­eral costs (such as backup tapes) and sav­ings from not need­ing a dis­as­ter backup “hot site.”

Health sys­tems must clearly com­mu­ni­cate their ex­pec­ta­tions to ven­dors for both the sys­tem mi­gra­tion phase and for the term of the con­tract. Those man­ag­ing a mi­gra­tion to a cloud en­vi­ron­ment also must com­mu­ni­cate well to stake­hold­ers and users, and en­sure proper train­ing.

Both the client and the ven­dor must plan to en­sure max­i­mum safety of in­for­ma­tion.

The adop­tion of cloud com­put­ing in health­care has prom­ises for de­liv­er­ing ef­fi­ciency in IT op­er­a­tions im­prove­ment. When cou­pled with ju­di­cious due dili­gence in ven­dor sys­tems eval­u­a­tion, plan­ning and im­ple­men­ta­tion, it can re­sult in faster de­liv­ery of qual­ity IT ser­vices and im­proved pa­tient care.

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