Healthcare in the Clouds

1,358 views

Published on

Published in: Technology, Business
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,358
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Healthcare in the Clouds

  1. 1. HEALTHCARE IN THE CLOUDS Gail Wilcox CSIX Cloud Computing SIG September 10, 2010
  2. 2. SCOPEAssumptions ConstraintsAudience has basic cloud computing Addresses only EHR cloud technologyknowledgeMost “health records” are still paper HITECH separate from other CMSbased incentive programsEligible health caregivers will use only Does not cover Electronic Medicalcertified Electronic Health Records Records (EMRs) and Personal Health Records (PHR) ** **PHR contains information regarding an individual’s medical history, e.g., vaccination history, lab test results, allergies, medications, surgeries, family history. Google Health and Microsoft HealthVault are the two best-known PHR services. Property of CSIX Cloud Computing SIG 9/10/2010, Page 2
  3. 3. Healthcare in the Clouds Overview • Foundation • Technology • Vendors • Summary Property of CSIX Cloud Computing SIG 9/10/2010, Page 3
  4. 4. Healthcare in the Clouds Foundation Setting the Stage Property of CSIX Cloud Computing SIG 9/10/2010, Page 4
  5. 5. Property of CSIX Cloud Computing SIG 5
  6. 6. American Recovery and Reinvestment Act (ARRA)of 2009• Signed into law February 17, 2009• Economic stimulus package intended to create jobs and promote investment and consumer spending during the recession• Set forth $789 billion in economic recovery programs Property of CSIX Cloud Computing SIG 9/10/2010, Page 6
  7. 7. Health Information Technology forEconomic and Clinical Health (HITECH) Act• Part of ARRA• Sets requirements for being compatible with the security and privacy regulations of the Privacy Rule• ARRA allocates $19 billion for health providers and hospitals who demonstrate Meaningful Use of electronic health records (EHRs)• Established programs under Medicare and Medicaid to provide incentive payments for the Meaningful Use of certified EHR technology Property of CSIX Cloud Computing SIG 9/10/2010, Page 7
  8. 8. Healthcare Overhaul Legislation• Patient Protection and Affordable Care Act (PPACA)• Signed into law March 23, 2010• Most expansive social legislation enacted in decades Property of CSIX Cloud Computing SIG 9/10/2010, Page 8
  9. 9. PPACA Vision• To transform America’s healthcare system in an effort to improve – Quality – Safety – Efficiency of care Property of CSIX Cloud Computing SIG 9/10/2010, Page 9
  10. 10. Differences Between EMR and EHRElectronic Medical Record (EMR) Electronic Health Record (EHR)A collection of patient information from A collection of patient information fromone organization, e.g., hospital, family many sources, including hospitals, familypractice or community care facility physicians, pharmacies and laboratoriesA record of a single period or episode of A record of lifelong interactions withtreatment or care healthcare providersEMRs are the foundation of an EHR An EHR is composed of many EMRs EHR EMR EMR EMR EMR EMR Property of CSIX Cloud Computing SIG 9/10/2010, Page 10
  11. 11. Meaningful Use‘ Partnership• Office of the Secretary for the U.S. Department of Health and Human Services• Address privacy and security protections under HITECH Act – Centers for Medicare and Medicaid Services (CMS) – Office of the National Coordinator for Health Information Technology (ONC) – Office for Civil Rights (OCR) Property of CSIX Cloud Computing SIG 9/10/2010, Page 11
  12. 12. Meaningful Use Partnership• CMS and ONC developed standards, implementation specifications, and certification criteria for EHR technology• ONC is the main resource/driver to the entire health system – Charged with coordination of the adoption of HIT – Promotes nationwide HIE to improve health care • Regional offices• Office for Civil Rights – Health Insurance Portability and Accountability Act (HIPAA) Property of CSIX Cloud Computing SIG 9/10/2010, Page 12
  13. 13. Health Information Exchange (HIE)• HIE is the transmission of healthcare-related data among facilities, health information organizations and government agencies according to national standards• The purpose of HIE development is to improve healthcare delivery and information gathering• To meet ‘meaningful use’ requirements, HIE technology must enable reliable and secure transfer of data among diverse systems and also facilitate access and retrieval data Property of CSIX Cloud Computing SIG 9/10/2010, Page 13
  14. 14. The Nationwide Health Information Network (NHIN)• NHIN is a set of standards, services and policies that enable secure health information exchange over the Internet – Will provide a foundation for the exchange of health IT across diverse entities, within communities and across the country, helping to achieve the goals of the HITECH Act – Enable health information to follow the consumer and be available for clinical decision making Property of CSIX Cloud Computing SIG 9/10/2010, Page 14
  15. 15. CMS Incentive Program• CMS released the incentive payment program final rule on July 13, 2010 (definitions in place)• The programs begin in 2011• Five-year period to adoption• Incentive program will provide incentive (bonus) payments to eligible professionals and eligible hospitals as they adopt, implement, upgrade or demonstrate ‘meaningful use’ of certified EHR technology Property of CSIX Cloud Computing SIG 9/10/2010, Page 15
  16. 16. ‘Meaningful Use’ Medicare Eligible Provider EHR Incentives Example AdoptionYear Goal Incentive Totals* Penalties2011 • To electronically capture health record $44,000 - 2011 None data in coded format $44,000 - 2012 • To report health information • To use that information to track clinical conditions2013 • To guide and support care $39,000 - 2013 None processes and care coordination $24,000 - 20142015 • To achieve and improve performance and $0 - 2015 1% cut in Medicare support care processes and key health forward payments system outcomes2016 2% cut in Medicare payments2017+ 3% - 5% pending overall adoption rate Property of CSIX Cloud Computing SIG 9/10/2010, Page 16 * Plus 10% for Health Professional Shortage Areas
  17. 17. Meeting ‘Meaningful Use’ Objectives Term describing dedicated, regular use of an EHR to carry out about two dozen activities VENDORS PROVIDERS Assured system theyEnsure systems deliver ‘Meaningful acquire will supportthe required capabilities Use’ achievement Property of CSIX Cloud Computing SIG 9/10/2010, Page 17
  18. 18. Meaningful Use Activity Grouping Charting Order entry (e.g., meds, labs, radiology tests, referrals)Communicating with patients 23 – 25and third parties Clinical decision Activities support Quality and performance reporting Protecting patient confidential HIPAA information Property of CSIX Cloud Computing SIG 9/10/2010, Page 18
  19. 19. Healthcare in the Clouds Technology Concerns Property of CSIX Cloud Computing SIG 9/10/2010, Page 19
  20. 20. Cloud Computing Healthcare Definition• The term "cloud computing" describes the practice of storing all data, software, and hardware off-site, with the system accessible to hospitals, patients and providers via a web browser-based login• Hospitals could share infrastructure and reduce costs with vast numbers of systems linked together• Vendors could introduce new pay-as-you-go models based on use of CPU hours, or gigabits consumed and transferred Property of CSIX Cloud Computing SIG 9/10/2010, Page 20
  21. 21. Why Choose Cloud-Based EHR Models• Let expensive hardware installation, data storage, and application hosting be someone elses headache• EHR system is immediately available to any Internet-connected computer in the world• Overall healthcare and operation costs decrease• Meet government EHR transformation requirement• Allows patients to become more involved in their healthcare Property of CSIX Cloud Computing SIG 9/10/2010, Page 21
  22. 22. Electronic Health Record in the Cloud THE DARK SIDE Property of CSIX Cloud Computing SIG 22
  23. 23. Bertman’s Ten Reasons Why Cloud EHR is Bad • Trusting the service provider – Come to grips with no physical file to touch – Someone else has control over file • Not knowing where data is stored – Broken into chunks and stored in multiple locations • Not knowing exactly who has access – Read SLA carefully (care givers, cloud IT personnel, etc.) – Patient anonymity Property of CSIX Cloud Computing SIG 9/10/2010, Page 23
  24. 24. Bertman’s Ten Reasons Why Cloud EHR is Bad • Cloud service companies can change or disappear – GE Healthcare 30 day notice • Cloud medical record storage is not cheap – $300-$800 per month versus less expensive client- server software • Privacy rights not readily understood – Cloud services companies control and monitor at will – How much information caregivers and patients can see Property of CSIX Cloud Computing SIG 9/10/2010, Page 24
  25. 25. Bertman’s Ten Reasons Why Cloud EHR is Bad • Ad-based cloud services present new issues – Caregiver influenced by ads that are tracked, targeted and monitored carefully – Compromise patient privacy/quality of care • Inherent slowness of web-based systems cause problems – Multiple screens – Problems finishing patient notes Property of CSIX Cloud Computing SIG 9/10/2010, Page 25
  26. 26. Bertman’s Ten Reasons Why Cloud EHR is Bad • Subject to poor Internet Service quality – Service and power outages, acts of God – Patient care can be compromised • Cloud EHR systems are prime targets for hackers – Sensitive information (health, financial) Property of CSIX Cloud Computing SIG 9/10/2010, Page 26
  27. 27. Black Hat Security Conference Lessons Learned• Cloud offers less legal protection• Client does not own the hardware• Strong policies and user education required• Do not trust machine instances• Rethink your assumption Property of CSIX Cloud Computing SIG 9/10/2010, Page 27
  28. 28. Cloud Developer Challenges• Cannot rely on homogenous computing environments• Web-based software must account for different operating systems and hardware• Cloud computing strength is scalability – must function under enormous bandwidth loads and millions of simultaneous users Property of CSIX Cloud Computing SIG 9/10/2010, Page 28
  29. 29. Hospital Cloud Challenges• As hospitals make more use of cloud resources, expenses can rise exponentially• One desired capability is to link ultra-secure private clouds with cheaper public offerings – an EHR system that could pipe into a data transfer alternative during peak usage hours Property of CSIX Cloud Computing SIG 9/10/2010, Page 29
  30. 30. Healthcare in the Clouds Vendor Highlights Property of CSIX Cloud Computing SIG 9/10/2010, Page 30
  31. 31. EHIT Vendor Exponential Growth• Growth from mergers, acquisitions, partnering and new start-ups (Yes, even Walmart)• Careful what you buy – Perform due diligence – Seek out the wisdom of early adopters – Make sure vendor is CCHIT compliant – Seek guidance from ONC local regional office – Choose wisely based on business and clinical needs Property of CSIX Cloud Computing SIG 9/10/2010, Page 31
  32. 32. Certification Commission for Health Information Technology (CCHIT)• Independent, nonprofit 5011(c)3 organization• Federally recognized certifying body• Certification is a requirement of state eHealth programs and private sector pay-for- performance programs• Over 250 products certified Property of CSIX Cloud Computing SIG 9/10/2010, Page 32
  33. 33. Property of CSIX Cloud Computing SIG 9/10/2010, Page 33
  34. 34. Why Doctors Flock to Practice Fusion?• Completely web-based, with live phone support, and it is free• Live in FiveTM program allows users to be up and using the EHR in less than five minutes• No software to install, sales contracts to sign, consultants to pay or hardware to buy• Users do not have to be a technology expert• Just sign up and start charting Property of CSIX Cloud Computing SIG 9/10/2010, Page 34
  35. 35. Salesforce Meets Practice Fusion• In 2009 Salesforce invests almost $10 million• Salesforce will get a minority stake of the ad-based revenues• Salesforce’s “cloud-computing” model makes sense for doctors’ offices, which are typically small businesses without much of an IT staff• Practice Fusion already uses that model• Under the deal, Practice Fusion’s product will reside on Salesforce’s cloud Property of CSIX Cloud Computing SIG 9/10/2010, Page 35
  36. 36. EHR Screen Shot Property of CSIX Cloud Computing SIG 9/10/2010, Page 36
  37. 37. Property of CSIX Cloud Computing SIG 9/10/2010, Page 37
  38. 38. Epic Systems and Apple Mobile Phone-based EHR Application• Haiku is available on Apple’s AppStore• Haiku works on both the iPhone and iPod touch• Conducted a trial at Stanford Hospital and Clinics Property of CSIX Cloud Computing SIG 9/10/2010, Page 38
  39. 39. HAIKU Provides authorized clinical users of Epic’s EHR with secure access to: • clinic schedules • hospital patient lists • health summaries • test results • notes Supports: • dictation • in basket access Screenshot shows the patient’s problem list, contact info, photo and points to an allergies listProperty of CSIX Cloud Computing SIG 9/10/2010, Page 39
  40. 40. Healthcare in the Clouds Summary• Meet ‘Meaningful Use’ requirements• Stay current on government regulations• Determine if cloud technology is right• Vendor selection• Embrace change• Understand special needs in healthcare – Security – Certification Property of CSIX Cloud Computing SIG 9/10/2010, Page 40
  41. 41. HEALTHCARE IN THE CLOUDS Questions?Comments?

×