Just what is cloud computing?
For one thing, it's big business with a worldwide reach. Global revenue for cloud-based service providers is expected to exceed $56 billion this year, up 21% from $46.5 billion in 2008, according to Gartner, a Stamford, Conn.-based IT research firm. As much as 60% of that 2008 revenue was from advertising-based services, reflecting the successes of Google, Microsoft Corp., Yahoo and others, he said. Systems infrastructure delivered as a service (a more likely candidate as a healthcare IT substitute) remains a newer and still growing segment of cloud computing, accounting for $2.5 billion in 2008 revenue and is forecast to reach $3.2 billion in 2009, Gartner reported.
Yet, defining cloud computing remains a work in progress. Scientists Peter Mell and Tim Grance of the National Institute of Standards and Technology took a stab at it in June through an online posting on the NIST's Computer Security Resource Center.
Cloud computing, they wrote, deploys “massive clusters of computers” linked by software that not only manages traffic between them, but also is capable of dividing computers into multiple “virtual” machines. It provides clients of the cloud a service that can quickly expand and contract to a client's needs. A cloud utility can “elastically provide many servers for a single software-as-a-service style application” or “host many such applications on a few servers,” they wrote.
Mell and Grance also offered a caveat. Cloud computing is “still an evolving paradigm.” As cloud computing develops, it likely will create “a large ecosystem of many models, vendors and market niches,” they wrote.
Outsourcing of computerized tasks has been a staple of the hospital IT industry for decades. Application service provider, or ASP, practice management and electronic health systems have been touted to physicians in office practices since at least the 1990s, but cloud computing, which includes aspects of both outsourcing and ASP-based systems, is “fundamentally different,” Mell said in an interview.
“Cloud computing is really the convergence of many technologies that IT professionals know,” Mell said. “People say, ‘Oh, cloud computing, there is nothing new,' and they are right, but in the convergence, there is something new.”
The way to understand that difference, Mell said, is to look at what he and Grance call the five “essential cloud characteristics” (See chart). “If a service is running on an infrastructure that provides all of those characteristics, then it is cloud computing.”
In writing about what he sees as the inevitable conversion to cloud computing, Carr said that smaller companies will be pushed quickly into the cloud while “most larger companies will need to carefully balance their past investments in in-house computing with the benefits from utilities.”
These bigger concerns—and large healthcare organizations are likely to be among them—“can be expected to pursue a hybrid approach for many years, supplying some hardware and software requirements themselves and purchasing others over the grid,” Carr wrote. One of the key challenges for IT departments, in fact, is in making the right decisions about what to hold onto and what to let go, he wrote.
In healthcare, most purchasers of IT aren't looking for a competitive advantage, Carr said in an interview. “You're going to be thinking about privacy and security and utility. What we see as a big challenge with medical information is being able to share it quickly and effectively among providers.” Cloud-based systems “are built from the ground up for quickly sharing information,” Carr said. “It's really tapping into that ability to collaborate and share while making sure you have the privacy and security safeguards that healthcare providers really need."