Should providers embrace and adopt the “Cloud?”

Oct. 23, 2015 / By AJ Dandrea

Information technology planning in the 1990s and early 2000s involved forecasting capacity based upon detailed planning. Technologists would meet with business teams and supporting staff, and then whiteboard and spreadsheet the planned IT activity.

This effort resulted in vendor relationships, proposals and capital expenses, then waiting on equipment to arrive with the inevitable communication around delays due to backordered equipment and telephony circuits. No offense to my contemporaries of that time period, but as an industry we either under-provisioned, over-provisioned, or in rare cases, forecasted the right amount of capacity. The simple math is that 66 percent of the time, we technologists were not accurate in our ability to provide the services of infrastructure, capacity and performance. One could posit that predicting the weather had a higher probability of success than information technology planning.

How often did we have to reply, “Apologies, we do not currently have space for that” or “That wasn’t in the original scope of this system so we will have to place an order. Do you have this in your budget?” This lack of agility halted the innovation and technology adoption required for meaningful use initiatives, electronic medical record systems and reimbursement systems. The end result is tool fatigue where every effort requires an additional purchase and “another” tool.

Today, one of the first things I ask when considering the subject is “How many tools do you use on a daily basis for meaningful use, reimbursement and EMR activity?” Or “Do you have a strategy to reduce tool fatigue?” As difficult as tool fatigue is, we have the same challenge with vendor fatigue. If there is a tool for every effort, often there is a vendor for every tool. If the answer to ”How many tools…” is over a dozen, the scope of work to maintain that many successful relationships directly or indirectly supporting users is a big challenge.

What does tool fatigue have to do with the Cloud? Does the Cloud offer the answer in reducing tool fatigue? I think back to my provider years: What if we had made our vendors use the same platform, or what if we had endeavored to consolidate tools? Current users of these systems may even still want the decision makers to consider this challenge. According to Gartner Inc., the technical debt around these questions may be answered by their advice to, “develop only after public services have been integrated with private delivery.” ¹

In the early 2000s, as a director of information technology for a provider organization, I had an animus towards the Cloud. I didn’t trust the security model, or better yet, my constituents did not. The problems we had fifteen years ago have not changed. We require capacity in order to service our clients. As IT stewards, this capacity needs to be secure. In order to build trust, our clients (whether a patient, covered entity or business associate) want transparency and assurances in what we steward. These days I do not consider the Cloud in simple terms of infrastructure and capacity. I consider it in the context of platforms and the problems it solves.

There are easy solutions to Infrastructure as a Service (IaaS) and capacity challenges if adopting the Cloud. However, the true power of the Cloud is the ability to take advantage of a platform of services, commonly referred to Platform as a Service (PaaS). I agree with most industry experts that the Cloud enables agility and lessens the upfront cost of service development and ownership. Note, although security services are available in the Cloud PaaS offerings, the responsibility and ownership of controls would still primarily be with the Cloud consumer. As a provider you still need policies and procedures, standards, data use agreements and documentation to successfully audit and maintain HIPAA compliance with adoption of the Cloud. Think of it this way, that “integration into private delivery” involves multiple domains outside of information technology.

Should provider organizations embrace and adopt the Cloud?

The term “Cloud” can be somewhat nebulous. The types are Private Cloud, Public Cloud and Hybrid. Follow the breadcrumbs of your data through your current vendor partners and you may discover as a provider that you are indeed a consumer of one of these types of Cloud technology. If so, can you enable a strategy that solves more technology problems by using the Cloud?  

AJ Dandrea is operations manager of the cloud hosting organization at 3M Health Information Systems

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¹ Health Data Management (