Riding the Cloud to Improve Patient Safety
After nearly 30 years as a practicing physician, I don't have a day go by in my practice where a patient would not benefit from more timely availability of records from other institutions. Now, however, thanks to cloud computing, the delays and inappropriate repetitive testing attributable to unavailable records may finally be coming to an end. The limitation is no longer the technology itself but simply the speed of adoption.
All caregivers are familiar with a variety of clinical scenarios where unavailable records hinder patient care and often pose unnecessary risks:
- The patient presenting to an emergency room at 2 a.m. who underwent a CT scan in an outside outpatient imaging center in the last week.
- The cancer patient who travels to a tertiary referral center to see an oncologist, only to find out that critical records essential for his evaluation have not arrived.
- The woman who undergoes a screening mammogram, but does not receive a report for a week or more as the provider waits for prior exams essential for comparison.
- The man who undergoes a lung biopsy for a pulmonary nodule because his old "films," which might have proved the nodule benign, are no longer available.
Scenarios like these are the source of avoidable morbidity, delay in care, wasteful costs, and excessive radiation from redundant diagnostic imaging.
As a physician (radiologist) and chairman of a company that provides medical imaging information systems, I have dreamed of the solution to this problem since my early days in medical school in the late 1970s.
What if a solution existed that would enable caregivers to share records in a timely, secure, and tracked manner? What if the solution provided interoperability among virtually all healthcare information systems? What if it enabled transmission of images and other records to patient homes, doctor's offices, or other remote locations? If upon receipt, the recipient could store records locally or securely on the Internet? What if a patient could send any computerized record directly from her own personal computing device to any provider? If any user could transport the received records by creating a CD/DVD (or USB-attached media) with embedded viewing software?
What if the receiving facility could automatically forward the received results to its own information system? What if a facility could automatically output images, reports, audio, and other records to the inbox of different proprietary EMRs located in doctors' offices in a community, without requiring virtual private networks or expensive interfaces? What if recipients could view the results without requiring installation of any software on their computing device—no application, no applets? What if these solutions were not just affordable, but considerably less expensive than current methods?
Sounds like a dream, doesn't it? Yet effective, safe, secure, and affordable solutions are already available that provide these benefits. In fact, multiple vendors and hundreds of U.S. healthcare providers have adopted cloud computing to share healthcare records with other healthcare providers and patients. Beyond healthcare, Microsoft now claims, "Twenty million businesses and over a billion people use ...cloud services...we're all in the Cloud."
What is cloud computing? SearchCloudComputing.com defines it as "a general term for anything that involves delivering hosted services over the Internet... A cloud service has three distinct characteristics that differentiate it from traditional hosting. It is sold on demand, typically by the minute or the hour; it is elastic—a user can have as much or as little of a service as they want at any given time; and the service is fully managed by the provider (the consumer needs nothing but a personal computer and Internet access)."
How is cloud computing being used in healthcare today? A solution used in my community allows providers to share medical records, including all types of images and associated reports, via the Internet. Healthcare providers pay per use, with no long-term costs. There is no hardware installation required, and the software set-up on the sender's end takes only a few minutes.
With this approach, the recipient may securely view results without downloading any application, or can quickly download an application and enroll as a sender. Records can be uploaded from any DICOM source or any PC that can print a record. When images and reports are received, the results can be viewed directly or forwarded to any DICOM viewing system. The entire process is secure, tracked, and cheaper than creating and delivering a CD.
What are the barriers to use of this cloud-based medical information exchange? In my experience the main barrier has been the adaptability of human users. Simply stated, the revolution has just begun, and conservative adopters are taking a wait-and-see attitude. Others are waiting for a critical mass of healthcare providers in their community to adopt similar technology. Still others are stuck in the old belief that information isolation may actually provide a competitive advantage.
For example, while most providers in our community have welcomed quick cloud-based delivery of medical images and reports, one institution recently refused free delivery in this manner. Why? At this time, they simply don't see the need. Perhaps they also are concerned that community-wide interoperability of healthcare information would result in increased healthcare consumerism. In other words, if patients know their records can be securely and easily shared between competing healthcare providers, perhaps they will be freer to move between providers based on competitive differences in price and service. While that may be a good thing for patients, taxpayers, and employers, some provincial providers view this type of competition as a bad thing.
The bottom line, however, is that cloud-based medical information exchange is here to stay. It's just a matter of time before the benefits are widely appreciated by healthcare providers and their patients.