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Christus Health

The Challenge Of Cloud Technology In Healthcare

For many years, healthcare technology and compliance leaders have been very skeptical about using cloud technology. The idea of allowing patient data to be stored in locations where we do not have complete control, has been regarded as an unacceptable security risk. It only takes one letter from the Office of Civil Rights (OCR) to make a healthcare organization recognize the hard realities of their responsibilities, no matter where their patient data may reside. The following are some different things to consider before leaping to a cloud service.

Today, as technology improves, a variety of opportunities have emerged for healthcare entities to take advantage of evolving cloud offerings. Many organizations are struggling with aging infrastructure and a lack of resources to maintain them. As a result, cloud offerings begin to look very enticing. With applications requiring constant upgrades, pressures are ever stronger on hard-pressed IT departments to do all the work that they need to. In the cloud, vendors have the ability to move more quickly to execute needed upgrades. Again a high value proposition in favor of cloud services.

There is a price paid for using new services. Before any organization starts down the path of utilizing cloud technology, they should become familiar with some of the terms, the differences in the offerings, and the overall requirements. The offerings range from applications hosting as a replacement for on premise data centers to a complete application and database management solution. Having knowledgeable staff who can analyze the risks, rewards, and return on investment of these offerings, is a critical requirement. A common question concerning many healthcare organizations is: Where does the application and the data reside? It can be surprising to learn they do not always reside together. Some solution providers utilize the cloud services of Amazon and Microsoft Azure. In such cases, the application and the data are housed within those services, but they may not reside in the same physical location.

Before any organization starts down the path of utilizing cloud technology, they should become familiar with its terms, offerings, and overall requirements


Does your organization conduct business in European markets? Those markets have different requirements for patient data use and confidentiality. Some vendors may have a mixed or hybrid approach such as having applications reside in their private data center, but having the data stored in a third party location. Is keeping your patient data within United States national boundaries important?

Many organizations have been apprehensive in the past regarding where their data was located, access to the data, and ensuring the security of the data. This is particularly true with patient health records. It is important to have the answers to these questions as cloud service providers are evaluated. Know in advance, what is most important and preferred by your organization.

Some vendors provide software as a service (SaaS). In these cases, the software is owned and maintained by the vendor, but the data can reside on your premise (though that is not required). These vendors will refer to their offerings as “cloud services” which are HIPAA compliant or certified. Be aware, this means nothing to the patient or Office of Civil Rights, if a breach occurs. Your organization retains fiduciary responsibility for protection of patient information.

Accessing the cloud has traditionally meant using the Internet. Utilizing the Internet to transmit and store patient data presents risks that need to be minimized. If you can have a direct network connection to the vendor’s data center instead of the open internet, the potential risk of Internet interruptions and threats of hacking can be mitigated.

Cloud services are governed by contracts and the terms and conditions need to be fully understood. Learn who has access, ownership, and the ability to use the data at any point. It is imperative that a clear contract termination, data ownership, and retrieval terms be clearly defined. If your organization does not pay attention to these basic elements, you may find that you have given away rights to your data, or worse, you may find your data held hostage at the end of contract.

The myth of cloud services being financially cheaper needs to be better understood. Moving to the cloud or relying on a SaaS may not yield the expected financial benefit. If your organization moves your information technology environment to the cloud, you are essentially outsourcing your data center to a third party. In effect, you will be trading capital costs for operating costs. The staffing expertise that your organization used to run your data center, now switches to expertise in cloud service management and data governance. The move to these services rarely represents total organizational cost savings.

The cloud can be a great tool for any healthcare organization. It will be a wise healthcare organization that ensures: (1) they have personnel who understand the different cloud strategies and implementation options; (2) these personnel can analyze the risks and benefits to provide the best recommendations and ongoing guidance; and (3) the best organizational decisions are taken while doing everything possible to protect the security and confidentiality of their patient information.

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The articles from these contributors are based on their personal expertise and viewpoints, and do not necessarily reflect the opinions of their employers or affiliated organizations.