Add one more to the growing list of healthcare providers moving their EHRs into the cloud. Coastal Orthopedics in Conway, South Carolina, consolidated its legacy electronic health records and practice management systems into the cloud and is seeing tangible results already.
To help with your planning, this Healthcare IT News Cloud Computing Buyers guide looks at the top four IaaS providers, Amazon, Microsoft, Google and IBM. A report from Synergy Research Group found that these platforms have over 60 percent of the public cloud market. (Amazon has the lion’s share with 33 percent share; the other three divide 27 percent of the market.) The market is far from stable, however; Microsoft and Google each achieved an annualized growth rate of 80 percent in the first quarter of 2017.
We also look at services from three companies who specialize in supporting healthcare providers with managed services: ClearData, CDW and VMware.
Shop carefully. “Read the fine print and really make sure you ask a lot of questions,” Snedaker says. “Don’t take a sales rep’s word for anything. Not to disparage sales reps, but if it’s not in the contract, it really doesn’t matter what the salesperson said.”
She also advises stress testing. “Get your team to think up all the very worst case scenarios they can think of and bounce them against the contract. Does it still hold up?“
Cloud computing has a clear advantage on the cost side. But healthcare IT managers know that cost is not the only priority. They have a special responsibility to deliver data reliably. And while cloud computing offers many advantages, it’s a big step and adequate planning is essential to ensure success.
As Snedaker says, “Take your time in understanding the solution before you drop your data off at someone else’s house.”
Amazon Web Services
Amazon was the pioneer in Infrastructure-as-a-Service, with the first public cloud offering in 2006 and it has built on that headstart. One reason it keeps that lead is pricing. Amazon Web Services (AWS) is very aggressive in pricing: it has already made two reductions just since the start of the year for storage and the Amazon Elastic Computer Cloud (EC2) which offers virtual computers for rent.
AWS also innovates at a fast pace. Many cloud platforms go weeks or months between service updates. AWS posts several service updates on its What’s New page almost every day.
To support healthcare providers, AWS recently removed the dedicated instance requirement from its HIPAA business associate agreement (BAA), and added 13 new services to the BAA since January 2017. The HIPAA eligible services that have been added this year include Amazon WorkSpaces, AWS Microsoft AD, and Amazon Cloud Directory.
It also created a new feature to simplify management of BA addendums. Using the AWS self-service Business Associate Addendum, a cloud account admin can instantly designate an AWS account as a “HIPAA Account” for use with PHI. Users can then sign in to AWS Artifact to confirm that the account is designated as a HIPAA Account, and review the terms of the BAA for that account.
One of AWS’s new directions is the AWS Healthcare Competency Partners program for vendors who are offering services through AWS. PracticeFusion, Infor and Phillips are among the partners.
Learn more about AWS
CDW Cloud Solutions
The same company that provides IT departments with a deep inventory of hardware, software and specialized medical equipment also offers cloud management services. This option will be especially appealing to HIT departments that find themselves stretched. CDW’s services include migration planning, project scoping and ongoing support. CDW’s managed IT services include proactive maintenance, monitoring, notifications and reporting.
CDW has six data centers hosting cloud infrastucture and it can provide more IaaS support through partnerships with AWS, Microsoft and others. The offering helps clients find the right mix of services to map against their client’s requirements. And CDW is not necessarily biased in favor of a cloud solution. It also operates and provides managed support for data center solutions.
Learn more about CDW Cloud Solutions
ClearDATA has only one focus: cloud computing for healthcare. It says that it employs a team that is trained in health IT operations and capable of supporting interoperability, patient engagement, data analytics and other health IT priorities. The environment is a HITRUST certified managed cloud infrastructure that adheres to HIPAA Privacy and Security Rules and the HITECH Act.
The company’s solutions include backup, disaster recovery, data privacy, business continuity services and security risk assessment and remediation services. They also offer support for BYOD security; secure email; collaboration tools; security Risk Assessment and Remediation Services; desktop-as-a-service and archive-as-a-service.
End-to-end deployment services are available, reducing the workload on a provider’s IT staff during migration and deployment, and speeding up the process of moving into the cloud.
Learn more about ClearData
Google Cloud Platform
Since the last time we wrote about its cloud platform, Google added more support for healthcare applications. At HIMSS17 in February, Google announced support for the HL7 FHIR Foundation to help advance development of data interoperability standards.
Google’s public network takes advantage of more than 100 global points of presence to reduce latency. To provide enterprise-grade connections with higher availability and lower latency than existing Internet connections, the company offers Google Cloud Interconnect and supports direct network peering for customers that can meet Google at one of many peering locations.
To enhance security, Google developed its own hardware, Titan, to authenticate legitimate access at the hardware level. Titan uses a hardware random number generator, performs cryptographic operations in the isolated memory, and has a dedicated on-chip secure process.
For application security, Google provides a Data Loss Prevention (DLP) API to find and redact sensitive data stored in your cloud environment. The API makes it possible to inject data-sensing intelligence into legacy applications or build predefined detectors into your new apps.
To reinforce support for HIPAA standards, Google is providing a guide to HIPAA Compliance on GCP which offers best practices for healthcare security on Google cloud. Google will enter into Business Associate Agreements with its customers and notes that it has a 700-person security engineering team and regular independent third-party audits to provide external verification. Among the standards for which it has been audited are SSAE16 / ISAE 3402 Type II, ISO 27001, ISO 27017 Cloud Security, ISO 27019 Cloud Privacy, FedRAMP ATO for the Google App Engine and PCDI DSS v 3.1.
Learn more about Google Cloud Platform
IBM Cloud provides a full range of infrastructure-as-a-service options starting with basic block storage, public virtual servers and bare metal servers that compete with the cloud-only vendors. Big Blue also provides a range of more advanced platforms that directly support application development in a number of areas including big health data, analytics, and cognitive capabilities.
Its Bluemix platform is based on an implementation of the Cloud Foundry, an open-source application development platform that supports Java, Python, Ruby, custom frameworks and a range of applications including MySQL, PostgreSQL and more. The IBM Cloud is integrated with the Watson Platform for Health, which provides solutions for collecting, normalizing, and analyzing data from diverse sources. Watson IoT Platform Connect supports device management and the new Blockchain-as-a-Service platform enables the creation of a dynamic distributed network that functions according to logic embedded to define assets and manage transactions.
Security includes end-to-end encryption, role-based access, event monitoring and alerting. The HIPAA-enabled cloud foundation is supported by IBM SoftLayer. Data governance tools are available for managing patient consent and identity masking.
Learn more about IBM Cloud
Microsoft Azure has supported healthcare through its cloud infrastructure platform since 2011. Today it has 40 data centers and the company says it now has over 25,000 health organizations on its cloud services in the U.S.
One of Microsoft’s selling points is flexibility. It claims that its architecture simplifies the process of moving resources out of data centers and onto Azure to meet peak demands, and that it maintains more data centers in more regions than any other cloud provider. It also has the benefit of supporting Microsoft Office applications through its Office 365 cloud platform, which is provided in a Software-as-a-Service offering.
Microsoft claims more security certifications than its competitors with ISO/IEC, CSA, CCM, ITAR, HITRUST, HIPAA/HITECH and CIS certifications. And more BAA-covered services with agreements available for Microsoft Office 365, Dynamics 365, Power BI, Azure, Intune and Microsoft Visual Studio Team Services. And it offers a site recovery program.
It also claims an advantage with a $1 billion annual budget for security research and development. The company’s cyber threat intelligence is based on over 450 billion authentications processed per month and 400 billion emails scanned. The company says this results in quick detection of emerging threats and delivery of responses.
Learn more about Microsoft Azure
VMware Cross Cloud Architecture
VMware is in a transition with its support for cloud infrastructure. It recently sold its VCloud Air service to OVH, one of the largest hosting providers in Europe. VMware, part of Dell Technologies, is now focused on providing Cross-Cloud Services to work through any cloud platform. The strategy is designed to provide a simplified operational management structure for IT managers who can use the same set of VMware tools they’ve used at their data centers in managing their cloud platforms.
VMware’s partners, who include AWS and Microsoft Azure, will run the VMware software stack in their cloud to provide a platform that supports a VCloud network.
VMware will manage the operational layer, including security, so customers can concentrate on managing their own application layer. The strategy will allow healthcare IT teams to extend into public cloud providers using the same tools and operational processes they use on premises in their data center.
Learn more about VMware Cross Cloud Architecture
Comparing cloud services: Understanding your options
Cloud solutions aren’t a one-size-fits all product. In fact, there some key technical and pricing details to consider. Below is a primer on the key elements of cloud architecture:
Block Level Storage: Raw disk space formatted to support a required file system, typically deployed in a SAN (storage area network) environment. Useful to support a specific application.
File Level Storage: Generally less expensive to maintain than Block Level Storage, files are stored in a hierarchical structure (ie, folders) such as Unix’s Network File Storage (NFS) or Windows Server Message Block (SMB).
Desktop as a Service: A virtualization service in which a cloud service provider supports desktop applications remotely.
Infrastructure-as-a-Service: A cloud platform that provides a hosted environment that can be used to deploy applications or data transfer. Examples are AWS, Google Cloud Platform, IBM Cloud and Microsoft Azure.
Hybrid cloud: A platform providing infrastucture-as-a-service that combines cloud services hosted at the client’s data center and remotely at the vendor’s data center.
Hyper-scalars: A cloud platform that can dynamically provide more computing resources as demand increases.
Latency: The delay between the time a data request is made and the data is delivered.
Platform-as-a-Service: A cloud environment that provides services to run specific applications, development kits, database tools, and application management tools. Examples are IBM BlueMix, Oracle Cloud Platform-as-a-Service and SalesForce App Cloud.
Public cloud: Hosted remotely at a vendor’s data center, a public cloud provides service to all of the vendor’s clients. Your applications and data will be hosted on servers shared by other enterprises.
Private cloud: Your enterprise is provided with a dedicated space providing cloud infrastructure that can be used for running your applications and data transferred. Your space is dedicated to your enterprise and is not shared with others.
Software-as-a-Service: Applications are provided remotely in a cloud environment that is maintained by the vendor. Examples are athenaClinicals, Salesforce Health Cloud, and PracticeFusion.
Throughput: The amount of data that a system can support in a specified time period.
Featured Decision Content
Cloud computing is still fairly new to healthcare and, as such, confusion and a few myths surround the technology. And many of those skewed perceptions are driven by simple misunderstandings, most notably about information security.
Healthcare did not lead the charge into the cloud. But it has been making up for lost time. The use of cloud platforms has grown substantially within healthcare provider organizations.