This document discusses cloud computing and its applications in healthcare. It begins with an overview of cloud computing, defining it as on-demand network access to configurable computing resources. It then discusses how cloud computing has benefited healthcare through electronic health records (EHRs). Specifically, it notes that cloud-based, patient-centric EHRs allow for improved quality, safety, speed and access to care while reducing costs. The document concludes with a demonstration of a cloud-based, patient-centric EHR system.

1. Cloud Computing
Richard D. Roblee, DDS, MS
Fayetteville, Arkansas
DrRoblee@DrDroblee.com
Disclosure:
•No clinical images have been altered
•No outside compensation for presentation
•Founder/Chairman – TeamLINKS/UShealthrecord.com 1

2. Interdisciplinary Dentistry : 25 Years of Evolution
Early Interdisciplinary
Circa
Mid-
1980’s
•Early common knowledge
•Structured collaboration
•Common goals 2

3. 3

4. 4

5. Interdisciplinary Dentistry : 25 Years of Evolution
Early Interdisciplinary
Circa
Mid-
1980’s
Interdisciplinary
•Early common knowledge
•Common goals
•Structured collaboration
•Working common knowledge
“Think alike”
•Common values and goals
•Seamless collaboration through
cloud-based patient-centric records5

6. Patient: E.M. Age - 47

10. Patient: E.M. Age - 47

11. 2 weeks post-opSurgery – Aligner 18/36

12. Aligner 37/37
Initial

14. Initial
Progress - refinement

15. Initial
Final
Final

18. CBCT Airway Analysis
Initial Final

20. Cloud Computing
20

21. What is Cloud Computing?
21

22. What is Cloud Computing?
Cloud computing is a model for
enabling ubiquitous, convenient,
on-demand network access to a
shared pool of configurable
computing resources (e.g.,
networks, servers, storage,
applications, and services) that
can be rapidly provisioned and
released with minimal
management effort or service
provider interaction.
22

23. What is Cloud Computing?
Cloud computing is a model for
enabling ubiquitous, convenient,
on-demand network access to a
shared pool of configurable
computing resources (e.g.,
networks, servers, storage,
applications, and services) that
can be rapidly provisioned and
released with minimal
management effort or service
provider interaction.
23

24. What is Cloud Computing?
•Agility
•On-demand self-service
•Centralization
•Broad network access
•Device independence
•Resource pooling
•Rapid elasticity/scalability
•Measured service
Essential Characteristics:
24

25. What is Cloud Computing?
Software as a Service (SaaS)
•Salesforce.com, Gmail, PayPal, TeamLINKS
Platform as a Service (PaaS)
•Microsoft Azure, Google App Engine
Infrastructure as a Service (IaaS)
• IBM, HP, Rackspace, Amazon
Service Models:
25

26. What is Cloud Computing?
•Lower initial and ongoing costs
•The data can be accessed from
anywhere
•Increased Agility/Scalability
•Information is securely stored
•Updates are performed automatically
•Users can purchase a less-expensive
computer
Benefits:
26

27. What is Cloud Computing?
•Private Cloud
•Community Cloud
•Public Cloud
•Hybrid Cloud
Cloud Computing types:
27

28. Cloud Security?
28

29. Cloud Computing
29

30. What is Dental Informatics?
Wikipedia
 Dental informatics is considered a specialty of health informatics
 Health informatics is a discipline at the intersection of information science,
computer science, and health care
• It deals with the resources, devices, and methods required to optimize the
acquisition, storage, retrieval, and use of information in health and
biomedicine
• It is applied to the areas of nursing, clinical care, dentistry, pharmacy,
public health, occupational therapy, and (bio)medical research
 Health informatics tools include not only computers but also clinical
guidelines, formal medical terminologies, and information and
communication systems. 30

31. What is Teledentistry?
Teledentistry is the use of information technology and
telecommunications for dental care, consultation, education, and public
awareness in the same manner as telehealth and telemedicine.
Teledentistry can also be used to assist general dentists with specialty
work and improve services to underserved populations such as in rural or
less developed areas.
 WebEx
 Remote rendering
 Virtual Desktops
 PC-over-internet protocols (PCoIP)
 Cloud-based Patient-Centic EHR’s
Wikipedia31

32. Why is Cloud Computing important to Healthcare?
Some say we are at
the beginning of the
single largest
transformation of
any industry in U.S.
history
32

33. Why Provider-Centric Medical Records?
33

34. Key Definitions
 Electronic Medical Record (EMR)
o An electronic record of health-related information on an individual that can be
created, gathered, managed, and consulted by authorized clinicians and staff within
one health care organization (Provider-Centric)
 Electronic Health Record (EHR)
o An electronic record of health-related information on an individual that conforms to
nationally recognized interoperability standards and that can be created, managed,
and consulted by authorized clinicians and staff across more than one health care
organization (Patient-Centric)
 Personal Health Record (PHR)
o An electronic record of health-related information on an individual that conforms to
nationally recognized interoperability standards and that can be drawn from
multiple sources while being managed, shared, and controlled by the individual. 34

35. Key Definitions
 Universal Health Record (UHR)
o A new concept being discussed is the UHR or "universal health record", which would be
a patient-centered and patient-controlled body of information that could be shared in a
granular way with particular health care providers at the patient's discretion in support
of the patient's work with health care providers. This project would enlist open source
contributions and enhancements from developers, with particular emphasis on
supporting patient expectations of privacy and responsible patient control of protected
health information (PHI). It is anticipated that effective implementation of one or more
"open source" approaches to the UHR would benefit both providers and patients,
including providing more cost-effective solutions to currently difficult problems
including entry/verification/update of personal health data, enabling responsible
patient-controlled granular release of PHI, and supporting interoperability and effective
collaboration of patients and physicians across disparate EHR/PHR platforms
35

36. Background
 1989: Initiated Community-Based Health Record System for both Dental and Medical with a “Mayo Clinic”
Philosophy
 1994: Published textbook on Interdisciplinary Therapy
 1995: Began evolution from paper to electronic health records
 1997: Patient-Centric Cloud-Based Collaborative Health Record
 2000: Every patient provided a Cloud-Based Personal Health Record
 2003: Development Team won IBM’s Beacon Award for “Best Collaborative Solution”
 2004: The President of the United States signed Executive Order 13335 on April 27th, 2004 to form the Office
of the National Coordinator for Health Information Technology with the objective of providing electronic
health records to most Americans by 2014
 2012: Only Cloud-Based Dental Electronic Health Record to be certified for “Meaningful Use”
 2012: First Dental EHR to complete MU Reporting
 2013: Arkansas State Grant and interface with S.H.A.R.E (Arkansas H.I.E)
 2nd Quarter 2014: Release TeamLINKS Messenger for entry level HIPAA-Compliant collaboration via email or
text on any platform, tablet or Smartphone including iPhone App that seamlessly ties into TeamLINKS II
 2nd Quarter 2014: Meaningful Use 2 with TeamLINKS II release 3rd Quarter 2014
36

37. Cloud-Based Patient-Centric EHR
37

38. Cloud-Based Patient-Centric EHR
38

39. Provider-Centric Analog Medical Records
Ortho
Pedo
Prosth
MD
Pt Lab
Rx
Endo
Oral
Surg
Perio
DDS
39

40. Ortho
Pedo
Prosth
CE/SC
Pt Lab
Rx
Endo
Oral
Surg
Perio
DDS
WWW
TVC
TVCTVC
Interoperability
Interface Engine
Provider-Centric Electronic Medical Records
40

41. Provider A
Provider B
Visiting Dr
Patient
Virtual
Patient
Record
41

42. What is the EHR Incentive Program?
 Incentive payments to Medicare and Medicaid healthcare providers to
adopt a standardized electronic health records system
• $44,000 for Medicare providers
• $63,750 for Medicaid providers (Providers who do at least 30% Medicaid)
 Payments are based on healthcare providers meeting specific milestones
over a period of either five (Medicare) or six (Medicaid) years
 Milestones are based on providers using the EHR in a “meaningful way”
termed “Meaningful Use”
 Incentive payment funded with the ARRA (stimulus), not Affordable Care
Act, (partial/full repeal of “Obama care” would not affect the program)
42

43. Why Incentivize Electronic Health Records?
ImprovePatientCare:
Provideclinicaldecisiontoolsforhealthcareproviderssuchasautomaticdrug-
allergy/drug-druginteractionchecks
Promotecoordinationofcarebetweenallhealthcareproviders
Promoteinvolvementofpatientinhis/herhealthcare
Reducemedicalerrors
ReducetheCostofHealthcare:
Improveefficiencyofhealthcareprovidersandstaff
Reducenumberofduplicativetestsandprocedures
Improvepreventativeandearly-detectionratesforacuteandchronicdiseases
Reducemedicalerrors 43

44. Why Incentivize Electronic Health Records?
44

45. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
 Speed
 Access
 Cost
 Research for Future Medical Advances
45

46. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
o Always up to date
o Complete, accurate and searchable information, available at
point of diagnosis and care, allowing for more informed
decision making to enhance reliability of healthcare delivery
o Provides healthcare professionals with the best and latest
options
46

47. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
o Help prevent using wrong medications
o Reductions in adverse events
o Minimizes medical errors
• Up to 90% reduction
• Up to 98,000 people die in U.S. due to medical errors
o Medicine reconciliation
o Always up to date
47

48. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
 Speed
o Faster lab and testing results with subsequent faster
treatment
o No delays due to unnecessary or receptive procedures
o Earlier diagnosis and characterization of diseases
o Increased efficiencies allowing:
• More interaction
• More transfer of information
• Better monitoring of patient care 48

49. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
 Speed
 Access
o Patients can make appointments, refill prescriptions and
collaborate with healthcare professionals online
o Doctor can access health records from anywhere in world
49

50. Cloud-Based Patient-Centric EHR’s in Times of Chaos
50

51. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
 Speed
 Access
 Cost (H.C. up .9% in 2009 to 17.3% of GDP = $2.5 Trillion)
o Reduces unnecessary or repetitive tests and procedures
• Estimated 30% of healthcare spending is inappropriate
• Save as much as $300 billion per year
o Can reduce cost to health professionals
• Plus government incentives (Up to $66,000 for Medicaid providers
starting in 2011) 51

52. Benefits of a Cloud-Based Patient-Centric EHR
 Quality
 Safety
 Speed
 Access
 Cost
 Research for Future Medical Advances
o Creates an expansive database to de-identify personal
information and use best practices and evidence-based
medicine to improve current and future patient care
52

53. E-mail, Texting, and Security
53
• Security Rule §164.312 requires consideration of encryption of
data at rest and data in motion
– Security rule does not explicitly require encryption
– Risk Analysis may indicate need to encrypt over the Internet
– Professional communications must be encrypted over the Internet
• Guidance says plain E-mail with patients is fine
– Evaluate the risks and discuss with the individual
– Guidance says nothing about Texting
– May apply the same logic to Texting

54. HIPAA Violation Tiered Penalty Structure
54
 Tier 1: Did not know and, with reasonable diligence, would not have know
• $100 - $50,000 per violation
 Tier 2: Violation due to reasonable cause and not willful neglect
• $1000 - $50,000 per violation
 Tier 3: Violation due to willful neglect and corrected within 30 days of when known
or should have been known with reasonable diligence
• $10,000 - $50,000 per violation
 Tier 4: Violation due to willful neglect and NOT corrected within 30 days of
• when known or should have been known with reasonable diligence $50,000 per
violation
 Willful Neglect: Conscious, intentional failure or reckless indifference to the
obligation to comply
• $1.5 million maximum for all violations of a similar type in a calendar year

55. Cloud-Based Patient-Centric EHR Demo
55

56. Technology Adoption Life Cycle
Innovators
Early
Majority
Early
Adopters
Late
Majority
Laggards
Crossing the Chasm, Geoffrey A. Moore56

57. Cloud Computing
Richard D. Roblee, DDS, MS
Fayetteville, Arkansas
DrRoblee@DrDroblee.com 57