Cloud Computing in Australian E-Healthcare System - Case Study Example

Social Informatics Number: Course: Lecturer: Date: Introduction Cloud computing is a familiar phenomenon in the recent past as far as modern computing is concerned. The pace at which the utility is adopted especially among private enterprises is high, and this can be attributed to the intense competition in providing the best services to the consumers. Organizations have adopted cloud computing as a key service provision platform. The state of cloud computing in healthcare industry is unknown. While some organizations have adopted it fully, others are yet to adopt it due to varied reasons. Compared to other sectors, the health industry has significantly underutilized cloud technology to promote operational efficiency. Most healthcare systems still use paper-based system for medical records. Information that is not digitized is not portable, inhibiting sharing amongst physicians, patients and specialists. Use of technology to leverage health care delivery among various healthcare actors is limited. Around the globe healthcare reform has initiated the modernization of healthcare systems via emerging technologies such as cloud computing and social media. Cloud computing is at the centre of transformation in delivering individualized and collaborative care to the needy in real time. The shift in healthcare toward an information-centric delivery model is is facilitated by open standards that cooperation, collaborative workflow, and information sharing. Cloud computing provides a platform for hospitals, medical facilities, insurance companies and research companies to tap superior computing resources at lower initial capital outlays. An additional advantage of cloud technology is that it lowers the barrier for modernization and innovation of healthcare information technology systems and applications. While it may seem apparent that the uptake of cloud computing in healthcare facilities will peak in the next few years, it is challenging to predict the trend in government facilities. This project is founded on this approach i.e. how cloud computing serves to transform the delivery of healthcare in government facilities. In this sense, cloud is mysterious yet increasingly ubiquitous aspect present in all corners of life. Realistically, it is defined as a simple phenomenon that takes into effect economies of scale and resource pooling to provide massive capabilities of computing power and storage to any user subscribing to the service. From email (Gmail) to advanced services such as Amazon’s S3 service, cloud computing has immense benefits to healthcare settings[Pet14]. The case of Australian e-Healthcare system The Government of Australia launched an e-health system in 20102. Citizens and health facilities in Australia register for an eHealth record. The record is a secure electronic summary of the health information of an individual. Healthcare facilities in Australia can register to participate in the eHealth record system, and as more people get on board, Australian health system is expected to improve significantly. In order for healthcare facilities to be registered with the eHealth system, registration with HI service is mandatory. Likewise, all healthcare professionals with the need to access eHealth Records on behalf of a health facility must register with the HI Service under HPI-I. Health Identifier is a unique number given to healthcare consumers by HI Service operated by Medicare Australia. Healthcare identifier is the brainchild of the Council of Australian Governments (COAG) through the National E-Health Transition Authority. The motive of healthcare identifiers is to give assurances to consumers that the right information is provided to right persons at the correct places of care. Overview of Medical delivery service In conventional settings, healthcare computing applications are stored in resources contained in-house or hosted by trusted parties. All the applications including clinical and non-clinical applications are hosted in-house. Clinical applications such as EHR, physician order entry, imaging software and pharmaceutical applications are located within the Government facilities settings. The same goes for non-clinical applications such as payroll management, claims management, automatic patient filing, and revenue cycle management[Lor12]. In most instances, clients seeking medical services will connect with government facilities by visiting them. The patient’s health status is assessed by conducting an assessment and a number of laboratory tests that will lead to a diagnosis. Patients are classified either as inpatients and outpatients. Inpatients are further general, emergency or critical. Where applicable, the patient is treated with varied pharmacological and non-pharmacological remedies. Funding for the medication is by self or medical insurance funds. Doctors, physicians, specialists and nurses work with patients closely to define the best remedy for their condition. The group identifies a mixture of pharmacological and behavioral changes that will facilitate patient’s recovery to their original well-being. Depending on the needs of the clients, the services will integrate education on their condition, training, social support, family support and other possible remedies. Government health care facilities have the mandate to deliver the following to the patients: • Help citizens get the best possible medical care irrespective of their social status, political affiliation or otherwise • Keep patients health information in safe custody, protecting it from unauthorized access and disclosure • Sample appropriate data and analyze it to derive usable insights on the health status of the population and emerging issues • Build linkages and cooperation with other healthcare actors such as physicians, doctors, specialists, nurses, research institutions, pharmacies, local government agencies, Department of Health among others. With effective March 2012, The Pharmacy Guild of Australia took over the responsibility of receiving and processing claims for various Fifth Agreement programs. This role was previously bestowed on the Department of Health Services. An electronic claim system which is geared towards improving timeliness and efficiency was put in place. Shortly after roll out, Guild announced a backlog of cases for subsequent months. This coincided with the rollout of the electronic prescription Scanning Initiative intended to support the uptake of electronic prescriptions. ePSI facilitate uptake of prescriptions and at the same time reducing red tape and streamlining dispensation of medicines. Risks associated with transcription errors will be significantly reduced, and promotion of future integration with electronic records is expected. All these systems though electronic functions from an organizational setting and perspective as they have not been integrated in a single service offering such as cloud computing. A cloud service will assist all the medical actors communicate and share information in an effective manner. Provision of medical care in public hospitals and medical facilities via the clouds is so advanced and efficient than the contemporary setting. The clouds act as an integration point where the physician, nurses, patients and doctors meet and share information. The patient’s medical data is stored in the clouds and not in the facilities computing resources. Access to such records in the instance that the patient visits another medical facility or hospital is improved. All a patient need is an identification of which all the medical history, past and current medication as well as another critical information is retrieved. The same is extended to management of personal health care data and information. Usually, patients monitoring physiological conditions require a device that transmits data such as blood pressure, blood sugar and others. With the integration of cloud service to health management, patients with terminal conditions that require constant surveillance of their physiological conditions will benefit with the cloud provision. Once a patient is diagnosed with a disease, monitoring is improved by using the cloud platform to store transmitted data upon which it is analyzed by physicians and specialists to derive insights on the course of medication and disease management. Providers of cloud services will be required to engage actively with medical facilities to better understand their specific needs and ensure that the patient is accorded the best care using the technology tandem with the demand. Purpose of the Project: Client Statement HI Service is the cornerstone of digital migration to e-health service delivery in Australia. Healthcare identifier service aspires to put Australians on the path to enjoying electronic services. While registration with HI service and affiliated agencies is commendable, there is a need to improve the service delivery further to a level where disadvantaged and rural patients can enjoy the same services as urban clients. In deploying a government controlled cloud service, we aspire to extend service availability to all healthcare clients. The proposed solution is an agile concept that facilitates rapid adoption and costs-efficient adaptation to environmental changes. In healthcare setting, this agility is achieved via active identification of products and services that enhance care, reduce costs and improve revenue control. Risks are also effectively managed. Aspects of Portable Medical delivery How cloud computing can impact delivery of medical services Though cloud computing is a relatively new force with respect to the provision of healthcare in government facilities, it is beginning to make significant changes in health. Cloud computing is good for general practitioners without static locations such as allied health professionals. It is also suitable where the IT support provided by an organization is limited. In many government facilities, demand is outstretched more than supply. Efficient IT support for core services such as radiology, pharmacy and record keeping is rarely achieved. When patient data need to be managed on an individual basis, meeting this requirements become a challenge. Private entities have been on the forefront of providing cloud services for years now, but government adoption of the same is still slow. Medical-Objects has a cloud-based offering that has been in use for several years. They use a standard set of HL7 messaging that allow rich thin clients to be share and access data. Security is enhanced by using message level encryption service. The service is highly scalable and facilitates the addition of clients to the system. With such solutions provided on government level, healthcare could be positively overhauled. Cloud computing will facilitate the delivery of healthcare in government facilities in the following ways: Data resilience and access Cloud infrastructures are known to offer durability and up-time in excess of those provided by any hospitals IT department. Due to utilization of economies of scale, cloud service providers are better equipped to develop large redundant data centers that focus on backup, data resiliency and uptime for low costs. Cloud storage is an example of how economies of scale can benefit organizations. Cloud storage can be as low as $0.1 a monthly for fast storage and a $0.01 for cold storage. In addition, cloud providers are graded according to their excellence and a higher bar is accorded a provider with a reputable service surrounding integrity and ease of access of data. Governments can contract such providers to provide service provision in its health facilities. Data security in the clouds There are continuing discussions as to whether the clouds is safe than organization settings. The Level of security in the clouds is much advanced than what is used in local IT departments of health facilities. Security in a hospital server room is restricted to just making sure that the entry door is locked all the time. Conversely, when data is in the clouds, there is a requirement to aggregate all the data in the application server. Data in the clouds is encrypted with the highest standards to create a blob of bits that even the provider of the service does not have access to. Cloud providers also leverage their economies of scale to develop and maintain systems that attest to privacy controls and standards. There are over 400 controls that cloud providers are audited for. Applicable in this case are policies such as HIPAA control and other Australian privacy policies. One of the impediments to cloud adoption for healthcare service provision has to do with resistance among the eHealth stakeholders, especially the patients who fear that private corporations could access their EHR and expose it for commercial purposes. It is argued that a state-owned cloud service deployed on healthcare industry could be the solution to this issue. Even with the kind of caution displayed by the general public on who accesses the information, solutions such as encryption, separation of access key technologies and authentication provide some form of assurance to Australians that appropriate technology is in place. The new Privacy legislation in Australia is intended to address the key issues for data management by third parties. Deboraah Peel, founder and chair of Patient Privacy Rights, through an article in Government Health IT stressed the need for the development of cloud computing guidelines in security infrastructure, security standards and business associate agreements[Aus]. Advising the Department of Health and Human Services, Peel emphasized the presence of policies which guide and strengthen cloud-based data protections and privacy. This will guarantee the patients that their sensitive health information shared with physicians and other health professionals is not compromised for commercial purposes. Speed of innovation Cloud-based services are undoubtedly the most promising of improving service delivery in all sectors of the economy including healthcare. It has the potential to improve services rapidly, cheaply and efficiently without much interruption. An example id Amazons S3 cloud service. Amazon S3 had ten price drops and 50 new features in its first five years. In the sixth year, there were ten new price drops and 75 new features. Traditionally, a healthcare provider would find it inconveniencing to install and implement a new software package after every three years, rather than continuously updating major releases after every two years. Cloud service delivery concerns rapid innovation where new solutions are developed and deployed really quick than in conventional in-house settings in organizations. The cloud provider is tasked with continually improving data and computing power, relieving local IT personnel of value addition activities such as routine maintenance and administration. In fact, this has been a major impediment to better service delivery in public health care facilities. Mobile applications The proliferation of Smartphone and mobile applications is attributed to some sort of cloud infrastructure. Cloud computing and mobile healthcare are two inextricably connected trends in the 21st century. Mobile users utilize many backend cloud services. By storing and accessing all the data in the cloud, Australian Government would be facilitating access of healthcare data from any location at any instance. Large healthcare facilities or partner institutions such as pharmacy and consultation departments in a hospital could share patient data in real time. Greater speed for healthcare data access is a reality when cloud application is used. An app in a patient Smartphone can fill out data for a general practitioner in an health facility. The Smartphone has an app serve to approve and authenticate the interaction with healthcare providers. Patient would have much control in this case of what healthcare providers can see from their health profiles[Fre12]. Developing trends Cloud computing integrates well with many uses and has the capability to replace some of the traditional uses while empowering people and the systems. Cloud computing is desirable because it facilitate execution of different activities on a larger scale with less money. Most of the inefficiencies associated with IT in healthcare industry are eliminated. Cloud computing in the service industry is more superior to localized systems. There is the ease of access because of the open formats pushed on by the vendors to replace the closed formats. File systems employed in the cloud are open and easily adaptable hence more freedom of access. Requirements Analysis using IAF process model The Institute of Alternative Futures came up with aspirational futures process model to define future and uncertainty involved with a view and a vision of creating preferred futures. Aspirational futures involves a prediction model that predicts what might happen using a clear, shared commitment to come up with a community or organizational aspired future. Both a vivid understanding of the future and the commitment to create an essential situation for the community is the foundation of aspirational futures model. There is need to differentiate between what is plausible and what is preferable when referring to future spaces. The plausible considers what might take place while the preferable considers what is wanted when some degree of commitment and visionary plan of action is undertaken. This understanding is what differentiates this model with other futures models[Ala]. There are three inter-related phases in the recommended IAF model. They include (1) Environmental Assessment and Scenario development, (2) Vision statement to clarify aspirations and identity, and finally, Strategic Analysis. With respect to environmental assessment and scenario development phase, an organization scans the environment to become aware of the economic, global, technological and environmental issues. A health facility operated by the government get to know the environmental conditions it is operating under through literature reviews, surveys and focused group studies. In the delivery of health services, the most outstanding trend in recent times is the use of mobile applications. Personalized healthcare delivery is the trending element in the 21st century. The trend is affected by key forces that serve to shape the future. Technological innovation and delivery are considered the leading force in healthcare. With technological innovations such as cloud computing, forecasts are made to predict the future status of healthcare in between 10 to 50 years[Kei13]. Assessing the trends and key drivers can eliminate some uncertainties concerning the future. It also defines how great those uncertainties are and in order to responsibly deal with them, a style of thinking based on scenarios is developed that explores uncertainties instead of repressing it. Developing scenarios is an important concept that seeks to bound the range of uncertainties and define a wide spectrum of possibilities. In addition, explore the most severe dangers to be avoided and explore the positives that can be adopted. Finally, it tests potential strategies and action plans that might be beneficial in future and their robustness[Ala]. In healthcare setting, any initiative that deliver good transmission of pictures, video and audio files and facilitate face-to-face consultation in real time is useful. The trend in healthcare is shifting to personalized care instead of community-based service-model. A scenario to predict the future of healthcare industry is founded on proper communication between patients, physicians and facilities management. In this case, a future cloud-based scenario is developed. The scenario requires that government-operated healthcare facilities adopt cloud computing as the bona fide form of data storage, retrieval, and management. All the information about patients in Australia will be aggregated and managed from a single central point. The government of Australia will develop a state-cloud for healthcare where all information and data concerning citizens are stored, accessed from and retrieved. Communication and interaction between patients and physicians will be facilitated by robust communication systems and mobile platforms assessed via the cloud. The requirements for the stakeholders/users include: Assurance that their medical information is safe and uncompromised at whatever state they are stored retrieved or communicated Ability to receive efficient healthcare services via various platforms accessible to them irrespective of their location, economic, social, and ethnic status Notification from healthcare providers on when their information is disclosed to third parties The requirements for healthcare facilities and the cloud vendor Ability to offer redundant IT systems that deliver electronic IT services as required without infrastructural or operational failure In the event of a disaster in one member facility, the archival tools should allow continued access and operation in other member organizations. In case of an outage of communication in one member organization, the cloud should continue to accept, process and deliver communication to other health organizations The infrastructural requirements for adopting the cloud solution among health facilities should be significantly low to the level that it is widely accepted An established audit procedure that tracks the service provided by the cloud vendor on a monthly basis is accommodated. The system should track service requests, record the requests and the nature of the action taken to counter the request. Policy, legislative and compliance requirements Healthcare identifier service has been launched as a foundation for e-health initiatives in Australia. Beginning July 2010, healthcare identifier service became functional in Australian health context. The legislation that regulate HI service include Healthcare Identifier Act 201, Healthcare Identifier (Consequential Amendments Act 2010, and Healthcare Identifier Regulations 2010. The Privacy Act 1998 contains Australian Privacy Principles that stipulate the handling and level of exposure of medical information among Australian Government Agencies and private sector entities. Individual Healthcare identifiers are termed as personal and sensitive information that comprise of personal information. When handling IHIs, healthcare providers are required to stick to applicable regulations and obligations under both Privacy Act and HI Act. Access to HI service is restricted to authorized persons only, and this may include healthcare providers assigned a healthcare provider identifier or individual provider identifier. Those employees authorized to access IHIs must be acting on behalf of healthcare provider or a contracted service provider of healthcare provider. The law stipulates that healthcare providers must only collect IHIs for the purposes of communications and information exchange in a bid to provide healthcare to a patient. Other than this, it is an offense to collect IHI for other purposes. Healthcare providers can only collect IHIs for registered patients by downloading it from HI Service. A batch file with patients identity details is provided, and the requested IHIs must correspond to those in HI Service; otherwise, the process is terminated. For compliance purposes, healthcare providers are only allowed to download patient information if it is essential for the provision of healthcare. Healthcare providers are required to evaluate the requirement for collecting IHIs for patients who have not utilized the service for long. Second, the transfer of batch files should be done in a secure way, notably, encrypted format. If providers are not sure of the requirements, they are required to consult with HI Service personnel. Case study Cloud adoption has the potential to improve healthcare delivery significantly without increasing costs. A study conducted in Western Victoria region affirmed this claim. While many Australians remain cautious about cloud-based collaborations, adoption under the right circumstances has the ability to significantly improve service delivery. Using Microsoft Lync Online cloud solution, a dozen general practitioners and specialists were connected for patient consultation. The pilot project tested how videoconferencing can reduce the instance of hospital visits among the patients by linking consultations via the general practitioners office. This is a solution that was developed to solve the problem of access in rural settings. Country doctors face numerous difficulties in getting patients adequate specialist consultation and this project provided a platform to communicate face-to-face with consultants using video, pictures and audio. The project conducted by Microsoft cloud business partner Paradyne run for 120 days. The infrastructural requirements included cameras that were installed in GP offices within a short time. There was no need for other capital investments apart from the cameras and computing devices located in the GP’s working office. All the data storage, processing and transfer is based on the clouds. The costs of the cloud service are affordable with as low as sub-$10, and there are no lock-ins or contracts. According to participating doctors and researchers, the project was a success since doctors were able to move the cameras as they wish to display a convenient view for the specialist to check a couple of examinations and patient condition. In a second study in NSW, tablet-based decision support technology was deployed to social workers in residential aged care homes. The project is part of the Hunter Urban Medicare Local Centre initiative developed by Avia. Deploying cloud based solutions in facilities that traditionally has limited and inconsistent infrastructure is a positive move. The project is still in trial phase and investigation on privacy issues will be the bulk of the study. Design and Impact analysis Technological innovations and development are the lead facilitators of efficient service delivery in healthcare industry. In this case, a futuristic model is anticipated that is based on cloud service delivery. A government cloud dedicated to healthcare industry is meant to trigger immense collaboration between physicians, patients and specialists. In this model, service provision is enabled for all Australian patients via healthcare providers irrespective of their registration with HI Service registration. This model is expected to extend the current model of service delivery in healthcare industry by providing more services and collaboration through cloud computing. Currently, registration for HS Service is not mandatory and interested healthcare providers, and individuals can register. However, in the new design, all government-affiliated health operators will be required to register and subscribe to the government cloud offered in collaboration with industry lead providers. The cloud delivery model advocated for this kind of cloud service is hybrid. A hybrid service provides two or more cloud models with individual unique entities. For instance, technology is shared but applications are kept distinct. Software as a service delivery model provides a platform to share vast resources and data without excessive infrastructural investments. SaaS will provide users with applications remotely via a web browser while storage and application hosting is controlled by the provider. Digital pathology, email and PACS are candidates for cloud service and health facilities are only required to pay for the service. There is no capital investment in this model and maximum uptime and benefit is derived from the cloud. Fig. 1 SaaS service delivery model All participating organizations are required to participate from an exchange server providing seamless messaging and content exchange. Microsoft Exchange server and Microsoft Active Directory are examples. The journaling mailbox feature in the messaging system is leveraged to provide automated archival functions from the messaging server. Messages are delivered to the end-user mailbox as well as the archival server instantly. Communication between archival system and the messaging server is enabled by TLS encrypted IMAP connection that transfer and store all the patient data inside the protected eHealth network. End users and administrators access the system via browser-based web portal encrypted by 256-bit SSL technique. Access to the portal is accessed via a browser or a service such as Microsoft Outlook. The default web page presents and each organization is provided with a unique URL such as http://archive.augov.au/healthinstitution. Access by an health facilities physicians, doctors and specialists are achieved by interfacing the organizations Active Directory domain using LDAP. In this case connection is achieved without unnecessary logons. Other additional features such as account activation and deactivation and password changes follow archival service and do not require administrator interventions. The archival system is configured as a secondary messaging gateway such that in the instances of outages, business continuity is guaranteed. Once restored, archival system will synchronize messaging services to the primary system without any loss. In an extended case of primary service outage, a simple configuration can be done to designate another cloud service vendor system as the primary messaging server, thus giving a solid disaster recovery functionality. The diagrammatic representation of the cloud messaging system is as shown Fig. 2 Messaging exchange service Impact analysis This design is better placed to provide improved quality of care, reduced costs and rapid responsiveness to risks. With challenging concerns in healthcare industry, organizations stretch beyond their budgetary limits to meet increasing demands. In the same sense, technology-savvy consumers are demanding enhanced level of interaction. Instant online access, telemedicine and online interactions with physicians and specialist through their mobile devices and desktops are becoming a norm. Healthcare organizations are also struggling to manage their complex IT systems. A cloud platform deployed on national basis and integrating all government-affiliated entities will do a great deal in healthcare service delivery to Australian citizens. Even with the modernized legacy applications and infrastructure upgrade conducted by healthcare organizations, they continue to be constrained. Cloud deployment in healthcare is the ultimate solution that will transform how entire organizations work. With foundational services such as HI Service, Australian government can make cloud a universal service delivery model not only for record keeping but for seamless interaction and consultations between specialists, general practitioners and patients. References Pet14: , (Pethuru Raj, 2014), Lor12: , (Lorna Uden, 2012), Aus: , (Government), Fre12: , (Frederic Magoules, 2012), Ala: , (Alam, 2013), Kei13: , (Keiko Hashizume1, 2013), Read More