Six questions every health
industry executive should ask
about cloud computing
Health industry executives need to evaluate...
2
No leader today in business or              This prospect is creating significant
government can afford to ignore          ...
Healthcare is a highly complex and          Improving care quality                      as a Patient Centered Medical Home...
What is “cloud computing?”
Cloud computing is an emerging computing paradigm that has
the potential to change how business...
A technology whose time has                 Figure 1. 32% of healthcare respondents are using cloud applications
come for ...
Health and cloud computing:
mapping industry needs to
technology capabilities
There are several reasons why the health ind...
1. What is cloud computing,                 • Rapid acquisition and deployment        device or personal computer with a
a...
Pathwork Diagnostics: tapping into
the computing power of the cloud
Pathwork Diagnostics, a molecular diagnostics company,...
Figure 3. Initial opportunities for using clouds



                                                                      ...
together with new publicly available        2. The push for greater data sharing         5. Increasing reliance on remote
...
needed, cloud computing is affordable       applications, services and offerings       But health executives evaluating th...
Using the cloud to expand the
service portfolio
There are several examples of health industry organizations
already using ...
NY Presbyterian: bringing the
benefits of the cloud to patients
Working together for over a year, NY Presbyterian (NYP) and...
1. The development of a health industry     5. A migration away from face-to-face        assessment to understand how clou...
1. Political and regulatory: it may not     carries a lot of risk and cost. Against        an organization maximizes benefi...
The hybrid approach: balancing
security and ease of access
Adopting a cloud computing strategy that seamlessly integrates
...
Managing the transition: the need
for a balanced approach
To navigate a successful transition to a cloud computing
environ...
About the authors
Dadong Wan is leading much of our                 management executive. He also has                  All...
About the Accenture Institute              About Accenture
for High Performance                       Accenture is a globa...
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Accenture Cloud Healthcare Po V

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Transcript of "Accenture Cloud Healthcare Po V"

  1. 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
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  3. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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 References 1 “What the Enterprise Needs to Know About 3 Ethan Smith, “Disney Touts a Way to Ditch 8 What the Enterprise Needs to Know About Cloud Computing,” Accenture Technology the DVD,” Wall Street Journal, October 21, 2009. Cloud Computing. Labs, October 2009; “Gartner Identifies the Top 10 Strategic Technologies for 2010,” 4 Ben Worthen and Justin Scheck, “Tech 9 “Pressure Performance: 2009 IT Report,” Gartner, Inc. press release, October 20, 2009; Giants Ramp Up Their Online Offerings,” Accenture CIO Organization, November 2009. “2009 ” (“Cloud Wall Street Journal, June 22, 2009; “Cloud Computing in 2009 Forum dossier”), Chinese Services/SaaS: What Telcos Are Doing,” IDC 10 “CTO Roundtable: Cloud Computing,” Institute of Electronics Cloud Computing Technology Assessment, October 2009; “China Communications of the ACM, Volume 52, Experts Association, http://server.it168.com; Mobile Enters Sphere of Cloud Computing,” Number 8 (2009), Pages 50-56 http://queue. “The Cloud Wars: $100+ billion at stake,” Interfax, November 17, 2009; Bernard Golden, acm.org; Gray Hall, “Bechtel Harnesses the Merrill Lynch, May 7, 2008; Avenade 2009 “The State of Cloud Computing in Japan,” Cloud: Case Study of an Enterprise Cloud,” Global Survey of Cloud Computing, http:// CIO.com, November 5, 2009; “SingTel to Cloudstoragestrategy.com. www.avanade.com; Laurianne McLaughlin, Help Establish Singapore as a Regional Cloud “Cloud Computing Survey: IT Leaders See Big Computing Hub,” SingTel press release, July 11 “Cloud Coockoo Land Computing,” Promise, Have Big Security Questions,” CIO 14, 2009; Chris Preimesberger, “Fujitsu dotfuturemanifesto.blogspot.com; Andy Greenberg, Magazine, October 21, 2008. Launches Cloud Services in North America,” “Deflating the Cloud,” Forbes.com, April 15, 2009 eWeek.com, December 8, 2009. 2 Eric Auchard, “Salesforce.com Signs 12 “SaaS Returns Bolster Cloud Computing’s Citigroup Deal,” Reuters.com, November 5 Taken from Accenture “Cloud Computing in Promise,” Computer Economics, March 2009. 15, 2007; “Salesforce.com Powers Starbucks Healthcare” deck, date Feb 19 2010, slide 6 Campaign to Mobilize Americans in National 13 CIO Cloud Computing Survey,” CIO Service,” Salesforce.com press release, January 6 Luiz André Barroso and Urs Hölzle, The Magazine, June 2009; “Clouds Beyond 21, 2009, http://www.salesforce.com; Ron Datacenter as a Computer: An Introduction the Hype: Positioning for the New Era of Condon, “The Opportunities and Risks of Cloud to the Design of Warehouse-Scale Machines Enterprise IT,” presentation by Frank Gens, Computing Services,” SearchSecurity.co.uk, (Morgan & Claypool Publishers, 2009). International Data Corp. to the Society for February 23, 2009. Information Management Boston chapter, 7 Condon, ibid. June 11, 2009; McLaughlin, ibid., Avenade study, ibid. 19
  20. 20. About the Accenture Institute About Accenture for High Performance Accenture is a global management The Accenture Institute for High consulting, technology services and Performance creates strategic insights outsourcing company, with more than into key management issues and 181,000 people serving clients in macroeconomic and political trends more than 120 countries. Combining through original research and analysis. unparalleled experience, comprehensive Its management researchers combine capabilities across all industries and world-class reputations with Accenture’s business functions, and extensive extensive consulting, technology and research on the world’s most successful outsourcing experience to conduct companies, Accenture collaborates innovative research and analysis into with clients to help them become how organizations become and remain high-performance businesses and high-performance businesses. governments. The company generated net revenues of US$21.58 billion for the fiscal year ended Aug. 31, 2009. Its home page is www.accenture.com. Copyright © 2010 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture.

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