August 2017, as barometers fell and the flood waters rose around Houston, Texas, healthcare administrators had plenty to think about. First and foremost was patient safety in an impending Category 4 hurricane. Then, they confronted operational challenges--how to maintain staffing needs and how to support stranded, overwhelmed, and exhausted medical teams. Availability of supplies in a just-in-time environment was compounded by the increasing needs of a population suffering injuries from the storm.
What they should not have had to worry about was access to electronic health records (EHR) that would streamline care and help ensure accurate diagnosis through comprehensive knowledge of patient histories. Unfortunately, some of Houston's largest health providers were not able to reach this fullness of care because local servers lost functionality. However, other facilities with cloud based storage did more than just weather the storm. They not only provided proactive, patient-centric care by opening multiple communication channels with high-risk individuals, they also equipped doctors with devices that accessed data, test results, and images even when electricity and wi-fi were down.
By having cloud based healthcare data storage systems already in place well before Hurricane Harvey, these providers were also able to step in and assist patients from those facilities whose records were, quite literally, under water.
The benefits of technology in healthcare are almost innumerable, but overall technology strategy cannot neglect considering the various healthcare data storage solutions. Even today, when healthcare data storage methods are evaluated, some decision makers balk at using cloud based services for applications that process or store information with personally identifiable information (PII) in them. This can be because of concerns over HIPAA compliant cloud storage. There is a fear among some that by migrating patient data to the healthcare cloud, they are at risk of violating electronic protected health information (ePHI) requirements by potentially opening doors to unauthorized access to sensitive data.
Cloud computing security addresses many worries that responsible health IT administrators may harbor. Well-designed security plans implemented with fidelity are personalized to individual client needs. HIPAA compliant end-to-end encryption at rest and in transit, hashing, and multi-factor authentication are standard security processes designed to keep data safe in the cloud. Decreasing dependence on paper records and medical devices that feed data directly into EHR cuts down on opportunities to acquire physical data.
Infrastructure aligned with federated access across devices and environments streamlines hierarchies of accessibility, while developments in intrusion detection prevention systems that learn user patterns of behavior and mark suspicious packets all add to a system-wide security plan built around protection of ePHI for improved HIPAA compliance. Additionally, the duplication of records that is automatically part of a distributed cloud solution frees organizations from being held hostage to demands of ransomware attacks that cost precious funding, patient and practitioner time, and costly public relations reputation management campaigns.
Using traditional methods like on-site servers is only complicated by the sheer abundance and exponential growth of ePHI. Physicians have increased their dependence on imaging data, and this strains the physical capabilities of traditional storage systems that were designed around warehousing structured data. Today's medical imaging options continue to produce greater, and more in-depth, views of the human body.
Consider that an individual patient record could have multiple MRIs, CAT scans, X-Rays, narratives from specialists, and even videos of certain procedures. The trend to gather unstructured data is projected to continue to increase even more as physicians strive to create a plan of care around all possible patient variables. Developments in telemedicine have made providing remote clinical healthcare easier every year. According to a 2018 Accenture survey, a quarter of customers have already experienced telemedicine, records of which continue to add bulk to a patient's file. From the same report, 90% of those surveyed are willing to share wearable health data with their doctor. That is a lot of information about one person!
Forward thinking administrators understand that applying predictive analytics is one way to improve patient outcomes. Progress in health data science opens doors for targeting care initiatives to high risk populations, addressing issues of unconscious bias, and optimizing patient flow and throughput numbers. Inadequate healthcare data storage challenges could affect their organization's ability to compete in tomorrow's data dependent landscape.
Utilizing healthcare cloud services to store and organize these massive amounts of data could be the answer for greater competitive advantage in this area. Because healthcare cloud solutions have the capacity to hold large amounts of unstructured data as objects, images can be meta-tagged and analyzed for actionable insight. Objects are not stored in a hierarchy, which makes retrieval faster. Also, any time the data is changed, a new version is stored for a comprehensive and traceable change history.
Long-term Storage, Cost, and Vendor Neutrality
While most people think about medical records storage requirements for HIPAA compliance in terms of encryption, access management, and physical security, it is also important to consider that client records are also stored for, in some states, up to 30 years. The trade publication HIPAA Journal states that even less sensitive materials such as Notice of Privacy Practices and Business Associate Agreements need to be stored at minimum for six years, with multiple copies if working with Centers for Medicare and Medicaid Services (CMS).
This volume of long-term storage has the potential to be costly and cumbersome from a management perspective. Cloud service providers offer scalability and savings. While most healthcare costs have been rising, cloud computing in the healthcare industry can be up to ten times less than on-site, private servers. Organizations, in this case, have the prerogative to only pay for the storage space they currently need. In the long run, this offers significant savings. Why pay for space you might need later but don't need today?
Because cloud service providers are vendor neutral, organizations that use HIPAA compliant cloud storage are not locked into agreements with application vendors--this can be a tremendous benefit, as even within one large regional system, different practices may use different EHR vendors. Epic, athenahealth, Allscripts, Medidata--the cloud is neutral in this respect.
When Hurricane Harvey hit the Gulf Coast, no patient cared about how their health care provider was reaching HIPAA Stage 3 of EHR Meaningful Use. What they experienced, though, was that the facilities with cloud based healthcare data storage and retrieval were able to communicate with them and take care of them in the uncertain aftermath. Their trusted provider had clinical decision support (CDS) intervention in place and was providing coordination of care. What they cared about was that their needs were being met. If there is any argument for moving to cloud storage in healthcare, being able to meet patient needs when it matters most is probably the most meaningful one.
When evaluating different healthcare cloud service providers, an organization's decision matrix will include factors such as scalability, cost, reliability, security, integration, and compliance. But at the center always sits the patient. While it could be tempting to select the WalMart version (as of the time of writing, WalMart doesn't have a healthcare cloud, yet!), the best solution may be one that understands that just like patients are more than a number, technology clients are more than service level agreements, operational specs, and a rotating cast of customer success agents. At Zulucare, we understand that no matter what your size, patient lives are affected by reliable access to records. Our mission is to provide excellent service around dynamic cloud storage solutions.