Rasu Shrestha

Health IT viewpoints: The cloud is the future

February 19, 2016
Health care is exploding at the seams with data, spilling outside the traditional four walls of the hospital and impacting the entire health care ecosystem. Industry consolidation and cost pressures are squeezing margins and pushing providers to find innovative, data-driven and cost-effective solutions. In this challenging environment, health care leaders are joining with software developers to explore a new, much larger space: the cloud.

Information overload
The exponential growth of data in recent years impacts health care as much, or more than, other areas of life. The complexities inside hospitals have increased as radiologists and clinicians have shifted from manila folders, traditional film and analog data to computerized imaging data sets, complex algorithms, pre and post-processing requirements and increasingly distributed needs.

Data management becomes even more complex as we look to manage various data types, such as video and 3-D imaging, PDFs and wave forms. Together, these intricate data sets combine to create upwards of 2.5 exabytes of data globally, every day.1 As we look to the future with genomic, next generation sequencing and live-streaming data, it’s expected that health care will see data grow even more — up to 50 times by 2020.2

This data deluge is making radiologists, clinicians and other health care professionals rethink the way they interact with patients and patient information. The rationale behind this is clear, as recent survey data show that up to 35 percent of patient cases are under- or misdiagnosed in part due to a lack of access to images, data and records. This makes improving health care data management and analytics an imperative.

The health care industry — radiology departments specifically — is data rich, and insight poor. Everyone is searching for ways to convert the data pools available at their fingertips into meaningful, actionable insights. Cloud computing will offer health care systems and radiology departments of the future the tools they need to manage data much more intelligently.

Evren Eryurek

Why the cloud matters
One of the greatest challenges health care systems face today is connecting the dots between disparate data to derive meaningful insights. The cloud can help answer this challenge — essentially freeing data from its traditional silos of machines, hospital departments and physically separate locations.

Radiologists can spend up to 2.5 hours per day preparing for case reviews.4 The cloud will be able to help these doctors do the same preparation in minutes. In certain circumstances, a radiologist’s tendency may be to review a series of images in a row, focusing on individual snapshots and data points.

Now, powered by cloud-based collaboration and tools, radiologists can better view the patient as a whole — not only to help drive toward better disease management, but also to drive down costs and increase efficiencies. Cloud innovations will offer clinicians, departments and entire health care ecosystems opportunities for advances in clinical, financial and operational outcomes. One of the health care cloud’s key features is flexibility, which will help reduce costs, and enables better clinical and operational outcomes. One study points to increasing interoperability of medical systems saving health care ecosystems $30 billion per year.5

Cloud strategy
As health care providers and radiology departments move to the cloud, here are a few important considerations:
• The main goal in adopting the use of a cloud should be to derive value out of insightful analytics that could impact care processes and outcomes.
• “Cloud-onomics” — the economics of leveraging the cloud — must be front and center throughout the process of cloud adoption.
• Usability, context and workflow are important factors to consider when embracing the cloud.
• Cloud and data governance is important. The aim is to make it easier for radiologists and clinicians to do the right things, backed by technology-enabled enforcement.
• Interoperability and security standards — including HIPAA privacy compliance — are crucial as providers begin the cloud adoption process. It’s very important that all possible measures have been taken to ensure patient privacy, while also allowing systems to talk across departments.
• Cloud computing brings a new elasticity with huge server farms like those used by social media outlets. Computing power will no longer be defined by what providers own on-site, like desktop devices, medical devices or servers. It will be scalable — up or down — depending on current needs.
• It’s critical to map out a robust, thorough cloud development strategy to ensure its use is properly executed at all levels. By implementing a comprehensive cloud strategy, health care providers can completely transform the way they treat patients.

Next up in the cloud
The cloud may soon become one of the greatest health care innovation enablers of the 21st century, transforming health care in ways not yet even imagined. Developers, hospitals, academic institutions and manufacturers will come together to solve problems related to improved patient care across disease areas and care pathways, departments, hospitals and freestanding clinics.

Through the cloud, clinicians and developers alike can unearth data and put it back together like a puzzle. Currently, clinicians spend significant time sifting through cases for comparisons. In the future, cloud-based apps will use computational power to access thousands, if not millions, of other cases to compare any one case at a certain time. Leveraging the cloud, clinicians will be able to focus on more intellectual, decision-making and communication activities.

These apps will compound algorithms on top of other algorithms, datasets with more datasets — all to help enable better outcomes for hospitals, clinicians and patients. App developers, like the academic institutions that already develop helpful algorithms each year, will be able to host their patient offerings on the cloud and access them from any place, any time.

Innovation in the cloud also opens up opportunities to decrease clinical miscommunications. Take, for example, patient handoffs. With the cloud and app solutions, a patient’s multi-disciplinary team can be quickly coordinated — through image sharing and contextualized collaboration — over time and location. A doctor working the night shift will be able to provide analysis and notes during a quick, 10-minute break. Then, a cancer care nurse can review those insights and notes the next morning. This will all be as simple as using social media.

Apps will help clinicians and patients get more value out of the images they have. One study shows that 85 percent of patients want access to their radiology images.6 Many clinicians know that a 3-D image is worth more than a thousand words when trying to help a patient understand his or her condition. Through the cloud and its apps, clinicians will be able to easily and quickly access those large, 3-D images while sitting alongside a patient explaining a tumor or other diagnoses. This highlights the amazing potential of the health care cloud — to change processes, workflows and care pathways, all to the ultimate benefit of patients.

As the health care industry faces a substantial flurry of data and environmental demands, providers need the cloud and its innovations to solve the problems of today and tomorrow. This work has already begun.

Rasu Shrestha, M.D., M.B.A., is the chief innovation officer for UPMC.
Evren Eryurek is the software chief technology officer at GE Healthcare.

1. http://martinhilbert.net/WorldInfoCapacity.html
2. CIO magazine. May 2013
3. “Types and Origins of Diagnostic Errors in Primary Care Settings,” Journal of American Medicine, 2013
4. Radiologists’ Burden of Inefficiency Using Conventional Imaging Workstations
5. http://www.westhealth.org/sites/default/files/The-Value-of-Medical-Device-Interoperability.pdf
6. CDW Analytics in Healthcare 2015 — 150Healthcare decision makers