Cautiously Lofty Hopes for Seamless, Secure Information Sharing

The Veterans Affairs electronic health record – the Computerized Patient Record System – enables providers to review patient health information documented anywhere in the country. A national data "warehouse" archives all content across the enterprise, and supports data sharing between facilities. VA hospitalists use this service daily to reconstruct a seamless narrative for patients receiving health care at multiple locations. This on-demand portal to real-time patient data limits information gaps at the point of care.

But unfortunately, ubiquitous access to patient health information is expensive, requiring a robust infrastructure of network equipment, storage capacity, and support personnel.

Therefore, it is no surprise that smaller enterprises without comparable resources regard cloud computing as an alternative strategy to deliver on-demand patient record data. Nevertheless, the relative risk associated with cloud computing is significant, and the return-on-investment is uncertain.

Smaller organizations and enterprises with less technology infrastructure must carefully consider the risks and benefits of the cloud. They need to understand that the initial investment can be substantial without commensurate perceived value to the end-user clinician. A physician using a new cloud-based system may not notice much improvement in functionality, usability, or record availability compared with their previous workplace system. This is because, among other things, there currently exist neither health information exchange standards nor sufficiently robust data vocabularies to preserve data integrity or clinical context (J. Am. Med. Inform. Assoc. 2009;16:874-81). Without these tools, the seamless experience clinicians desire cannot be reliably expected.

At this moment, it is challenging to cost-justify health information exchange networks because cloud computing technical overhead is not yet completely understood.

For example, Steven Levy commented in Wired Magazine that although hardware and software implementation costs may be small, expenses may be redistributed to data storage overhead, bandwidth, network infrastructure, security, and national support contracts. Game-changers for physicians, such as streaming video content (e.g. cardiac catheterizations) and diagnostic-quality imaging come with hefty price tags for necessary storage and backup strategies.

Finally, the technology is not without limits or vulnerability. Last February, Amazon had a significant crash and Google experienced a problem with e-mail storage. These stand as important reminders that information storage can be volatile.

Any data loss for any length of time can have very dire health care safety implications. Over the near term, organizations would experience serious interruptions in business activities or adverse health events. Over the long term, organizations could see an erosion in consumer confidence, which, in this context, represents support from health care executives, shareholders, clinicians, and patients.

Technical barriers notwithstanding, the evolution of cloud computing and associated software services heralds important breakthroughs in health care delivery and will invariably change the practice landscape for hospitalists.

[Read more: Web-Based Data Management Holds Allure, Risks]

Dr. Lesselroth is a teaching hospitalist at Portland (Ore.) VA Medical Center and assistant professor of medicine and informatics at Oregon Health and Science University, Portland. He reports having no conflicts of interest.

The Veterans Affairs electronic health record – the Computerized Patient Record System – enables providers to review patient health information documented anywhere in the country. A national data "warehouse" archives all content across the enterprise, and supports data sharing between facilities. VA hospitalists use this service daily to reconstruct a seamless narrative for patients receiving health care at multiple locations. This on-demand portal to real-time patient data limits information gaps at the point of care.

But unfortunately, ubiquitous access to patient health information is expensive, requiring a robust infrastructure of network equipment, storage capacity, and support personnel.

Therefore, it is no surprise that smaller enterprises without comparable resources regard cloud computing as an alternative strategy to deliver on-demand patient record data. Nevertheless, the relative risk associated with cloud computing is significant, and the return-on-investment is uncertain.

Smaller organizations and enterprises with less technology infrastructure must carefully consider the risks and benefits of the cloud. They need to understand that the initial investment can be substantial without commensurate perceived value to the end-user clinician. A physician using a new cloud-based system may not notice much improvement in functionality, usability, or record availability compared with their previous workplace system. This is because, among other things, there currently exist neither health information exchange standards nor sufficiently robust data vocabularies to preserve data integrity or clinical context (J. Am. Med. Inform. Assoc. 2009;16:874-81). Without these tools, the seamless experience clinicians desire cannot be reliably expected.

At this moment, it is challenging to cost-justify health information exchange networks because cloud computing technical overhead is not yet completely understood.

For example, Steven Levy commented in Wired Magazine that although hardware and software implementation costs may be small, expenses may be redistributed to data storage overhead, bandwidth, network infrastructure, security, and national support contracts. Game-changers for physicians, such as streaming video content (e.g. cardiac catheterizations) and diagnostic-quality imaging come with hefty price tags for necessary storage and backup strategies.

Finally, the technology is not without limits or vulnerability. Last February, Amazon had a significant crash and Google experienced a problem with e-mail storage. These stand as important reminders that information storage can be volatile.

Any data loss for any length of time can have very dire health care safety implications. Over the near term, organizations would experience serious interruptions in business activities or adverse health events. Over the long term, organizations could see an erosion in consumer confidence, which, in this context, represents support from health care executives, shareholders, clinicians, and patients.

Technical barriers notwithstanding, the evolution of cloud computing and associated software services heralds important breakthroughs in health care delivery and will invariably change the practice landscape for hospitalists.

[Read more: Web-Based Data Management Holds Allure, Risks]

Dr. Lesselroth is a teaching hospitalist at Portland (Ore.) VA Medical Center and assistant professor of medicine and informatics at Oregon Health and Science University, Portland. He reports having no conflicts of interest.

The Veterans Affairs electronic health record – the Computerized Patient Record System – enables providers to review patient health information documented anywhere in the country. A national data "warehouse" archives all content across the enterprise, and supports data sharing between facilities. VA hospitalists use this service daily to reconstruct a seamless narrative for patients receiving health care at multiple locations. This on-demand portal to real-time patient data limits information gaps at the point of care.

But unfortunately, ubiquitous access to patient health information is expensive, requiring a robust infrastructure of network equipment, storage capacity, and support personnel.

Therefore, it is no surprise that smaller enterprises without comparable resources regard cloud computing as an alternative strategy to deliver on-demand patient record data. Nevertheless, the relative risk associated with cloud computing is significant, and the return-on-investment is uncertain.

Smaller organizations and enterprises with less technology infrastructure must carefully consider the risks and benefits of the cloud. They need to understand that the initial investment can be substantial without commensurate perceived value to the end-user clinician. A physician using a new cloud-based system may not notice much improvement in functionality, usability, or record availability compared with their previous workplace system. This is because, among other things, there currently exist neither health information exchange standards nor sufficiently robust data vocabularies to preserve data integrity or clinical context (J. Am. Med. Inform. Assoc. 2009;16:874-81). Without these tools, the seamless experience clinicians desire cannot be reliably expected.

At this moment, it is challenging to cost-justify health information exchange networks because cloud computing technical overhead is not yet completely understood.

For example, Steven Levy commented in Wired Magazine that although hardware and software implementation costs may be small, expenses may be redistributed to data storage overhead, bandwidth, network infrastructure, security, and national support contracts. Game-changers for physicians, such as streaming video content (e.g. cardiac catheterizations) and diagnostic-quality imaging come with hefty price tags for necessary storage and backup strategies.

Finally, the technology is not without limits or vulnerability. Last February, Amazon had a significant crash and Google experienced a problem with e-mail storage. These stand as important reminders that information storage can be volatile.

Any data loss for any length of time can have very dire health care safety implications. Over the near term, organizations would experience serious interruptions in business activities or adverse health events. Over the long term, organizations could see an erosion in consumer confidence, which, in this context, represents support from health care executives, shareholders, clinicians, and patients.

Technical barriers notwithstanding, the evolution of cloud computing and associated software services heralds important breakthroughs in health care delivery and will invariably change the practice landscape for hospitalists.

[Read more: Web-Based Data Management Holds Allure, Risks]

Dr. Lesselroth is a teaching hospitalist at Portland (Ore.) VA Medical Center and assistant professor of medicine and informatics at Oregon Health and Science University, Portland. He reports having no conflicts of interest.