Franciscan Health

Charles E. Christian

I’ve been working in Health Information Technology (HIT) for almost four decades. Over that time, I have participated in many decisions concerning the best approach for deploying technology to meet the data and analytical platform requirements of healthcare organizations.

With technology moving at an extreme pace of change, it’s almost impossible to keep up with what’s new, what works well, etc. I’m reminded of an old story that I heard about technology in the past: Picture a horse pulling a cart and attached at the back of the cart is a bungee cord with a concrete block tied to it. As the horse moves along, the tension on the bungee cord increases and when the tension is high enough, the concrete block leaps forward. However, there’s never enough kinetic energy built up in the bungee cord to get the concrete block into the back of the cart.

This is how it feels in today’s technology world. The technology and platforms move forward (the horse and the cart); there is tension between where you are and where you want to be (the bungee cord); and, you guessed it, we’re the concrete block that never really gets to experience the current technology. When tension gets us moving, the technology has moved on.

Healthcare HIT executives have been following the progress of cloud platforms, cloud computing, cloud services, etc. for some time -- many of us with an eye toward adopting that technology.

However, in healthcare we must deal with many factors that create tension before we can make the leap. One of those, at least for me, was security and a little thing called HIPAA (Healthcare Insurance Portability and Accessibility Act). In the first versions of HIPAA, data security was the sole responsibility of the healthcare organization. With no shared responsibility, only a few brave souls were willing to risk moving this level of data (including PHI) to a platform they could not physically protect. With recent changes to HIPAA, however, in the case of an actual breach, the risk is now shared and/or owned depending on such factors as where the breach occurred, the Business Associated Agreements, and data security architectures. Because of this, many in the healthcare space are more willing to place their enterprise systems in a cloud-based architecture.

In many cases, healthcare organizations that seek to take advantage of the newer enterprise solutions really don’t have a choice about moving to a cloud-based platform. Anyone who has deployed ServiceNow, Salesforce, WorkDay, Nuance, Office365, and a host of others are implementing those using the application vendor’s cloud-based platform.

There is no other option. There are some distinct advantages of moving to these platforms as well as some distinct disadvantages. I will not cover those in any detail here as there are a great many pro-and-con articles written already, and from various viewpoints.

However, one of the bigger questions I find myself discussing with other HIT professionals is: Should we be getting out of the data center business by moving the technology infrastructure to one or more of the cloud architectures/platforms?

Based upon these conversations and continued research, it doesn’t appear there is one single platform that meets all our infrastructure requirements. Most healthcare organizations are running many different solutions to meet their specific and diverse feature/function sets amidst diverse infrastructure requirements -- many of which have not been designed/written/coded to take advantage of a pure cloud platform environment.

So, healthcare executives are trying to determine the best place to move/host/run their legacy applications. Well, what I’ve found is a “Six-Sigma” solution -- it depends.

• It depends if you can find a SaaS (software-as-a-service) vendor to move to.

• It depends if your current solution vendor offers its own cloud-based service platform.

• It depends whether you are looking to some level of managed services on top of the cloud-based solution to augment your team’s expertise, or unload the platform support and maintenance duties.

I’ve found that many organizations don’t understand the different “flavors” of cloud platforms and their associated service offerings. Some of these can take advantage of the cloud fabric, while others are better at platform-as-a-service or infrastructure-as-a-service. Education is very important for decision makers, therefore, to ensure they have a thorough and accurate understanding of the various service offerings. At Franciscan we are working on a form of matrix decision-making tool (similar to a RACI document) to help us make a more informed decision.

We must do whatever we can as healthcare technology decision-makers to make the best choices for our organizations, and ultimately our patients and employees. We can’t let the urge to simply keep up with technology “cloud” our judgement.

Think back to the cart and the concrete block. We in the world of technology will not be able to land in the back of the cart; but with enough research and partnership, we can all land a lot closer.