The Cancer Treatment Centers of America (CTCA) provides cancer care to patients from five regional medical centers across the United States, serving both domestic and international patients. Brian Treptow serves as CTO for the privately held firm, which boasts more than two million unique hits on its website – cancercenter.com – every month. With 30 years of experience in IT, 25 of those as a C-level executive in various industries, Treptow knows how to intelligently embrace technology change as it happens. He seemed an excellent candidate, then, to discuss the role of cloud services in healthcare organizations.
The Enterprisers Project (TEP): To what extent is your organization using cloud services?
Triptow: The cloud has matured to be a strategic asset to our infrastructure strategy. In addition to having over 50 applications in the cloud, we are moving all non-mission-critical clinical applications to the cloud, including ERP, back office, and so forth. I’d like to use the cloud for more clinical applications as well, but the industry hasn’t matured there to a degree we are comfortable with – yet.
TEP: What are some of the challenges that cloud services present to healthcare organizations? Privacy leaps to mind.
Triptow: Yes, HIPAA-compliance is one. HIPAA has numerous requirements, which many cloud providers view as cost hurdles to being able to enable their application in the cloud, such as having our data separate from others in a single-tenant environment, encrypting all layers of the stack in-transit and at rest, logging every access to PHI [protected health information] by person, patient, and data.
Security is another. In order for a cloud provider with PHI to be accepted for use by CTCA, they have to meet the same security and privacy requirements that we demand of ourselves. For many providers, the cost is too high to justify.
In order for many applications to be of value to us, they also have to come with a cloud-based integration layer, given the high degree of integration that exists across the healthcare patient care lifecycle. Cloud providers that simply offer to be the host of their on-premises solution, vs. re-building their platform from the ground up to be cloud-oriented, lack effective tools for real-time and near-real-time integration beyond HL/7 [Health Level-7, a healthcare information standard].
Other challenges include support for batch processing for large volume integration, custom development, and distributed printing.
Effective version management and lifecycles is another area. Many cloud providers don’t offer a dev/test environment for us to test their planned changes before they go live so we can understand the impact on our integrations, training, documentation, and customization. Many cloud providers also force all tenants to upgrade at the same time, on the vendor’s timeline. For many of our very large applications with significant user bases and integrations, we need time to prepare for these changes, since sometimes even the smallest changes can turn into a significant impact.
TEP: What are some of the solutions you’ve found to meet those challenges?
Triptow: For most of these challenges, we simply cannot proceed until the needs are met. In general, for the large majority of our largest mission-critical patient diagnostics and treatment applications, the vendor has simply not moved to the cloud yet, recognizing that their applications would have to be significantly modified to operate successfully in a cloud model.
What is lacking right now in the cloud is a set of universally accepted standards, such that, if a cloud provider complied with them, it would guarantee functionality such as interoperability, distributed device integration and so on. As with all new technologies, these standards typically emerge later in the maturity lifecycle.
TEP: What’s the best use of cloud technology you’ve seen to date in a healthcare organization, either your own organization or another?
Triptow: Workday and Salesforce come to mind as premier cloud solutions which were built ground-up as cloud services, addressing 99 percent of the needs that would be met with an on-premises solution. The closest we’ve seen in healthcare-specific functionality is not in diagnostics or treatment, but in patient administration, such as registration.
TEP: Do you have any advice for healthcare IT professionals who are interested in using cloud services?
Triptow: Go for it, but at a measured pace. Start with non-clinical applications. For clinical applications, start with administration functions. Define a set of requirements for all cloud providers collaboratively with security, compliance, and clinical leadership.
IT has a history of wanting to own everything technology-related. With technology now being significantly more consumerized, we have to challenge ourselves on the role that IT plays in a department. The ability for our end users to subscribe to and start using many cloud services without requiring IT involvement increases this degree of consumerization. Instead of trying to block it, we need to get ahead of it, figure how to embrace it, and maximize the value it can bring to the organization.
