With more than 800 active health IT applications to maintain, Bill Russell has no time for distractions. The senior vice president and CIO of St Joseph Health—a nonprofit integrated health-care network that includes 14 hospitals in California and Texas—has a lot on his plate. There’s even more since the system’s February 2013 affiliation with the network of Hoag Memorial Hospital Presbyterian to form the regional Covenant Health Network (Irvine, California), covering an area stretching from California’s Orange County to the High Desert.
Russell, a relative newcomer to health care, has IT expertise informed by 26 years of consulting in the telecommunications, banking, engineering, and manufacturing industries. He specialized in cloud consulting at the time of his leap into health care.
It’s surprising that it is not the sector’s regulatory and security concerns that differentiate health care from the world of business IT, in Russell’s opinion. “Every industry has stringent security requirements, and while the regulatory environment in health care is complex, to be sure, it is just as complex in other industries,” he says.
The differences, he believes, are data complexity and the proliferation of proprietary systems. “The complexity is enormous, compared with tracking investments, balances, production, and even supply-chain activities,” he notes. “In the coming years, health care will become very personalized, and this will increase the number of permutations and variations on the data.”
For this reason, he believes that health care should focus on data management that is specific to health care and not distinctly an IT function (which is where cloud-based applications enter). “For example, we need to understand that the care and maintenance of data centers, servers, storage, and—in some cases—networks are not distinctly health-care work, and we should move these items to the cloud,” he says.
Initial Cloud Moves
The easiest cloud technologies to implement are infrastructure-as-a-service, or IaaS, technologies, which cover the data center, servers, storage, network, and management platform associated with that equipment. “We view this as an opportunity to get out of the data-center–maintenance business,” he says. “This will save us several million dollars over the next three years.”
St Joseph Health also deploys a number of software-as-a-service (SaaS) technologies, including a cloud-based vendor-neutral archive (VNA) for medical images and a popular open-source analytics platform. In the next two years, it will roll out a cloud-based human-resources application.
“SaaS provides some interesting opportunities and challenges, as we move forward,” Russell says. “While the central storage of information such as PACS images is intriguing, you have to be aware of vendor and data lock-in. We expect to be able to access just about every piece of data we store in the cloud programmatically, through application programming interfaces (APIs): We don’t want to trade one trap for another. Proprietary clouds are what we are trying to avoid.”
For instance, if St Joseph Health wants to deliver PACS images to a patient portal, it doesn’t want to be locked into the vendor’s portal solution. “We want to be able to extract those images using APIs and deliver them in whatever portal we decide to use,” he explains. “We use a cloud-based VNA for storing and delivering our images to various platforms.”
To choose a cloud solution, ask the same questions asked of any application, Russell advises: Is it open? Does it have service-oriented architecture? Does it have APIs? How good are those APIs? How secure is it?
“We need our cloud providers to understand that when we put our data out there, they don’t own our data. They can’t trap our data,” he says. “We need to be able to get to discrete data elements at every stage of the development cycle. When we look for cloud providers, we are looking for characteristics found in service-oriented architecture.”
Time and again, Russell returns to the potential efficiencies that can be achieved using a cloud-based application. If a hosted cloud application doesn’t provide appropriate security and an architecture that maintains what he calls clear layers of abstraction, then Russell will build and maintain a private cloud to provide the platform for the application.
The Essential Shift
Building platforms that provide future flexibility through layers—not silos that trap information in proprietary information