Now, however, outsourcing dominates at Denver Health, but it's not exclusive. “I still have 158 people in my shop even though 70% of our applications are outsourced,” Veltri says. For example, Denver runs its cardiology and radiology systems on-site, but “all of our primary Siemens applications are outsourced.” That includes nurse documentation and speed-sensitive computerized physician order entry, which are run out of the Siemens data center in Malvern. But Veltri says it may be a long time before hospitals move to a pure cloud environment.
“Will I see it in my lifetime?” Veltri says, pausing. “Healthcare is very slow to change.”
For some healthcare uses, cloud time is already here.
Vincent Fusaro holds a doctorate in bioinformatics from Boston University. He is working on a post-doctoral National Library of Medicine fellowship from the Laboratory for Personalized Medicine within the Center for Biomedical Informatics at Harvard Medical School.
For just over a year, aside from some programming initially conducted on personal computers, Fusaro says the laboratory is running “entirely on the cloud.” It uses computational services and storage provided by Amazon Web Services. Since 2006, the Amazon business division has leveraged the IT investments of the online bookseller and retailer by leasing portions of its infrastructure to outsiders.
“We don't have any complaints,” Fusaro says. “We are mapping whole genomes. We take the DNA sequencing and map them to reference genomes to sequence an entire person. We're using clusters of these services to do that.”
Physician informaticist David Kibbe, a senior adviser on IT issues to the American Academy of Family Physicians and principal of the healthcare IT consultancy the Kibbe Group, says cloud computing will catalyze a cadre of new healthcare IT entrepreneurs.
“I think that probably Google, Microsoft, salesforce.com, all of these companies that have this architecture, will be ready if there is in fact a demand for what I'm calling ‘clinical groupware' that make EHR technology possible from a mix-and-match, plug-and-play sort of way,” Kibbe says. A company could compile and offer physicians only those few Web-based services—electronic prescribing, diseases registries, patient summary sharing and the like—necessary to meet the yet-to-be-defined “meaningful use” requirements to access an estimated $34 billion in EHR subsidies under the American Recovery and Reinvestment Act of 2009.
Alfred Spector, vice president of research and special initiatives at Google, also says the cloud-based Google Health personal health-record platform will likely play a role in providers meeting the “meaningful use” criteria under the stimulus law.
“From the Google Health situation, we've gone off to produce a personal healthcare record and associated search and other services that are valuable to the consumer,” Spector says. “We do think that as an important use case that does represent a meaningful use. We really believe that if information is created, stored and aggregated at our physician groups and then is made available to consumers, this is meaningful use.”
Google Health recently added an application to its PHR platform to store digitized clinical images, but for now, Google has no plans to build an EHR or even a collection of services to meet all provider requirements under meaningful use, once an interim definition is produced by the CMS later this year.
“Never say never about anything, but that's not our focus,” Spector says. “We're consumer-facing.”
Spector, like others contacted for this story, sees cloud computing making incremental inroads into the realm of healthcare IT, but not giant leaps.
The Google paradigm of “launch early and launch often” is viable in healthcare, Spector says. Adding digital images more than a year after the Google Health platform was launched is an example. “We didn't have time to do that initially. If we had waited to do everything, we would have done nothing.”