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CIO Unplugged 5/2/12

May 2, 2012 Ed Marx 14 Comments

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Get Off of My Cloud!

1960s entertainment nailed the future. Star Trek tricorders are here. Lapel communicators are ubiquitous. And who can forget the Rolling Stones singing about the Cloud?

Most agree that mobility and agility are the future. The cloud is the infrastructure which enables them. The cloud is the delivery of computing as a service, not a product — akin to a utility. The cloud enables technology to propel the speed of business.

Friends recently returned from a trip abroad. The advanced wireless infrastructures found in third-world countries both astounded and pleased them. By unintentionally leapfrogging the technological revolution, these regions had bypassed the incremental advancements of the last 30 years and gone straight from laggard to leader. Societies that have not had a telephony infrastructure, for example, are suddenly delivering the highest per capita cellular subscribers.

Leapfrog advancement. Can we do it in healthcare IT? Maybe a better question to ask is: do we need to?

YES! Mobility, enabled by the cloud, is the path to the future.

Healthcare organizations viewed as laggards now have the potential to leapfrog peers. The cloud will empower them to bypass heavy capital investment and kludgy hardware and render single-organization data centers obsolete. You can shrink implementation timelines from months to weeks. Focus your institution on implementation and optimization rather than worry over floor space or cooling requirements.

If we don’t transform our organizations by routing capital away from brick and mortar to cloud-based mobile applications and services, the third world will pass us up.

As legacy hardware and software contracts expire, look for cloud alternatives. Basic requirements for any new application should include cloud capabilities. If the vendor has no cloud offering, be concerned. Ask deep questions. You don’t want the clock turn to 2015 and you still have data centers bursting at the seams with legacy applications residing on heavy iron.

The cloud has been around for several years in one form or another. Non-healthcare industries have embraced the cloud successfully. Some worry about security, yet the number of incidents are no different in the cloud versus in-house. Breaches occur in both. Security is not the barrier.

As a leader, show courage. Move your organization forward. Become relevant by leveraging mobility. Embrace the cloud!

Hey you, get onto my cloud!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

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Currently there are "14 comments" on this Article:

  1. Thanks for the motivational message Ed.

    Just this week our cloud only software was excluded from a selection process because of the lack of an on premise option. In reality, because we house customer PHI and other data, our security budget is higher than all but a few of our largest customers.

    In the not too distant future on premise solutions will be like trying to generate your own electricity with your own power plant.

  2. All those hospitals that spent 200M+ on Epic with millions in fees every year to Cache for their database license alone will realize they should have gone to a cloud solution like THR… Oh wait, THR went the “heavy capital investment and kludgy hardware” route too.

  3. The Cloud is definitely the future for computing, but moving enterprise level applications to The Cloud isn’t as easy as everyone makes it out to be. It’s a misconception that cloud computing has a fully range of tools for redundancy, high availability or can completely drive the performance an organization needs. The Cloud must be approached today as a “use it if it makes sense” option. Not everything is right for cloud computing – today.

    Ed, I think you bring up good points and the encouragement is warranted, but to make 2015, many standards and a great deal of maturity in the cloud will need to place before then.

  4. Really! Are we using the word CLOUD too losely here? When Ed mentions get away from Bricks and Mortar, where does he think the CLOUD is running, in a spacial environment? I don’t disagree that the cloud has some benefits. Who wouldn’t want their pictures available on their laptops, desktops, televisions to view with all their friends and relatives, but would you want the same with respect to your Mammograms, EKG, PACS Images and more. I strongly disagree with the CLOUD comments made above. I think that Cloud Computing is just another buzz word for Internet and ASP models, which has been around for decades now. After all, doesn’t Salesforce.com just offers an ASP model. Them too need a Bricks and Mortar facility to hosts all their clients.

    It’s time to stay away from Buzz Words and really get creative in Health IT.

  5. Leveraging mobility is one thing, whether it’s your own “cloud” or one belonging to someone else who is allowing you to rent it; but remember, a lot of factors come into play when you choose to divest yourself from having your own data center.

    First, let’s define “cloud” in your context. Are you talking true remote computing via hypervisor, ESX, or Amazon EC2 virtual machines or are we MAINLY discussing remote-accessibility to some in-house medical applications?

    Things like bandwidth, uptime, maintenance, etc., are things you’re just shifting the costs for when you move the whole thing off-site into someone else’s data center. Though you mentioned security and the lack of any more breaches than non-cloud apps, I’m not too convinced there are just as many places using 100% cloud vs. their own hardware and pipes for core apps. I think it’s still Apples vs. Oranges for at least a little while longer.

    Another thing to bear in mind is that your data is now co-located with all manner of other peoples data with whom you do not relate. Granted, this doesn’t mean you’re automatically going to inadvertently “share” with strangers any more than simply placing a match in a room with a can of gasoline means instant fire; however it does statistically increase the chances of things coming together in a way that could be “burdensome”.

    Will your “cloud”-mate be ready to receive investigators with completely open arms when it comes to a full spectrum of auditing and compliance, or will they shift all that into egregious fees and fine-print absolving them of that responsibility?

    Something that also makes me wonder about everybody getting all comfy in the cloud – when your data is in someone else’s machine, it’s easier for them to sell aggregated, de-identified statistics to sweeten their own bottom line. Can you really be sure they’re not mining your data for you? A fellow by the name of Zuckerberg comes to mind here.

    And let’s be clear – “Cloud” is not some panacea “ZOMG! Pwnies!” technology. We’re just wrapping Application Service Providers, remote hosting, VMWare and even NFS drive shares under this new umbrella buzzword called “Cloud”. I remember in high school it was called “timeshare”. Cloud – indicative of most marketing glossies that are low on content and big on flash – just some nebulous “cloud” in the middle to make people think magic is happening.

    Granted – in some mobility settings, “Cloud” makes sense – but that could be whether it’s being served up by your own data center or under the care and feeding of another entity.

    You mentioned “The advanced wireless infrastructures found in third-world countries both astounded and pleased them…“ Of course it did. Our national infrastructure and technology level with respect to the core underpinnings of sustaining a wireless culture is laughable in comparison. Be sure that whatever “cloud” stuff we talk about here is just as liberal with bandwidth and speed as what they experienced.

    You know it’s funny how people keep mentioning “keeping data center costs low” as a major impetus to moving to a cloud. A lot of this also happens to correlate with how well you run your own data center. I can remember in prior life being a consultant for a company that rhymes with Bell, where the costs of just setting a small 1U Linux server on the floor for testing applications was the cost of a full-time FTE plus bandwidth charges that would have made you think we were doing everything by $.10 SMS messages in bulk. A couple of times I told some sales reps to price deals 3 ways – one with client side hosting, one with “Bell’s” hosting, and one with Rackspace. Needless to say my consulting managers didn’t think very highly of my “compete or die” challenge with our own team.

    I’m not saying don’t do it. I’m not saying that at all. What I am saying is be judicious on how and where you jump on that Cloud bandwagon and do what makes sense from a technical, financial and patient safety standpoint. Are the costs of running your data center too high? Don’t be afraid to look at things like alternative power, alternative cooling, virtual machines, open source software, remote diagnostics, and a plethora of other cost-saving things, too.

    Perhaps we need some generic buzzwords to bring that stuff in vogue, too?

  6. It’s great when it works.
    What happens when you come in Monday morning and find that your “cloud” service has just declared bankruptcy and shut down operations?

  7. So…flavor of the month is now Cloud?

    Just another knee jerk reaction to IT fads by kool seeking CIO’s desperately trying to stay hip.

    Vendors, just wait till the telecoms come and start playing in your sand box.

    Ah…the Facebook generation.

  8. CIO: “…and your solution needs to be cloud based.”
    Vendor: “No, problem. We’ve offered our solution in the cloud for years. It’s our preferred option!”
    CIO: “…and it needs to run on our 512MB XP machines with IE6.”

  9. Isn’t “Cloud” just another rephrasing of “Time Share”..”remote hosted” with a few newer age tools?

  10. As many commenters pointed out, “cloud” is a very broad term, and many versions of the term are rebranded versions of older terms.

    There are however, some new things under the sun, even despite the cloud (har har), because cloud is a combination of different approaches, some old and some completely new:
    – Your cloud can be on-site, off-site, or a hybrid of the two (e.g., primarily off-site with some on-site presence, or vice versa),
    – Your cloud can be public, private, or public/private (most healthcare would obviously be private)
    – Your cloud can be IaaS (infrastructure-as-a-service), PaaS (platform-as-a-service), SaaS (software-as-a-service), or mixtures of those for different components and functions.

    For instance, mixing and matching from the above, you could conceive of an architecture where your clinical data is stored in a private cloud on-site, mapped to a unique ID that is the only PHI contained in a private offsite storage IaaS, with a small internal presence for pulling the clinical data, that is being accessed by a combination of SaaS and homegrown applications running on PaaS and internally in your data center, alongside an ancient EMR running completely internally.

    Architectures like this didn’t exist even 2 years ago, and they’re what is “new” about clouds. Like most other things, it’s an evolution from what previously existed, and the simplicity of the term belies the complexity of what it means.

  11. Are we being a little disingenuous here?

    You buy a classic turnkey solution for millions called EPIC (which can run only on a kluge Citrix cloud), then turn around and sell ‘cloud’ services to nearby providers.

    I think we need some full disclosure…

  12. Just outsource your entire IT staff and be done with it already. Why keep them around?

    Seriously, a few field techs is all you need, put it in the cloud.

  13. My only issue with vendors selling solutions labeled, “cloud” is that they often bundle their proprietary software with their datacenter’s hardware and just leave the healthcare IT shop to provide first-level support (with the vendor still charging support fees of course).

    So what is my purpose as a healthcare IT worker exactly?

    The hardware is being outsourced to the Cloud, programming and technical skills are outsourced to contractors, leadership won’t let us turn over support to the vendor so we can achieve new skillsets, education and training is cut back and scrutinized, there is never any money to develop innovative ideas… EVEN suggestions are outsourced to companies like Navigant. Apparently IT employees cannot be trusted to recommend improvements without being blacklisted by leadership.

    I realize this sounds a bit whiney, but I frankly don’t care. I am a healthcare IT worker and I am simply fed up with more and more skilled work going away and not replaced by responsibilities of value. Perhaps I’m naive to think that leadership should think about their people as true assets worthy of some investment from time to time.

    I agree the cloud should be the future for the INFRASTRUCTURE only. I just loathe how corporate leaders always “leapfrog” into the trap of McSolutions by vendors that always promise tall and deliver short. You keep the lucrative skills with the contractors & vendors then leave the employees with the meaningless support – then have the audacity to complain that your people have no current skills. There has to be a better way. Perhaps it’s time to outsource leaders.

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