Parts of healthcare are moving to the cloud

Healthcare providers are increasingly required to do more with less. Regulations, HIPAA, Meaningful Use, recovery audit contractor (RAC) audits and decreasing revenues are motivating providers to consider cloud computing as a solution to potentially help them cut costs, maintain quality, meet regulations, and increase productivity.

Some electronic health record (EHR) vendors are offering solutions as a cloud-based offering. This offers an approach intended to help providers better manage the IT investments that need to be made to support EHR implementations. And just as we've seen in other industries, there is an ongoing debate within healthcare as to the viability of cloud-based solutions given the care needed for patient privacy and sensitive personal information.

Providers' trust in the public cloud is still relatively weak, but increasing numbers are considering using private clouds. However, EHR applications hosted in the cloud do seem to be gaining traction.

One example of a cloud-based EHR offering is CareCloud. My fellow Radar blogger Andy Oram wrote about them two years ago at HIMSS, and they have made significant progress since then. CareCloud creates apps that help medical professionals run their businesses. Those apps include a community collaboration and communication platform to securely share patient information, a medical practice management system for billing and scheduling, and a revenue cycle management service. CareCloud also provides electronic health records. It's built with Ruby on Rails, a highly abstracted programming language quite well suited for rapid development of web applications. CareCloud was a co-winner of the IBM Global Entrepreneur Silicon Valley SmartCamp competition in 2010 (see video below).

I ran into the folks at CareCloud at the HIMSS 2012 conference and was impressed with both their use of open source and their strategy on leveraging the cloud in healthcare. Mike Cuesta, CareCloud's director of marketing and user experience, defined CareCloud's strategy as one of future survival.

"Being able to deliver the product across platforms is crucial," Cuesta said. "In healthcare there is a glaring lack of modern web apps. What we wanted to do was create an elegant and user-friendly application that is accessible anywhere. Companies have to be able to deliver a desktop-class experience that works across platforms."

CareCloud relies on open source. "I had my eyes opened to open source about eight years ago when I was looking for a project management system," said CareCloud CTO Tom Packert. "I discovered I could use something like dotproject, which is a GPL-licensed PHP-MySQL web-based project management application. It only took us a day to put it up on SUSE Linux and we didn't need SQL seat licenses. Open source allows you to scale horizontally. It's not as scary as a lot of people think it is."

Another EHR in the cloud is athenahealth. Athenahealth's co-founders Todd Park, the new U.S. chief technology officer (CTO), and Jonathan Bush, purchased a birthing practice in 1997. Soon, like most medical practices, they were buried in paper and spent most of their resources trying to get paid. Searching for innovative solutions led them to create their own software. Enlisting the help of Todd's younger brother Ed, a software developer, they created an EHR and financial revenue cycle system with a rules engine of dynamic billing rules data. I met Ed Park at HIMSS when I remarked that he looked a lot like Todd Park, and Jonathan introduced him to me as Todd's "younger, smarter, and much better looking brother." Apparently his programming skills are paying off ...

This year, athenahealth was named to the TR50, Technology Review's third annual list of the world's most innovative technology companies. At this year's HIMSS conference, athenahealth showed the company's plans for an iPhone app that will gives its EHR users access to certain features of its athenaClinicals cloud-based platform. An iPad version of the web-based athenahealth EHR app is also currently under development and set to launch in 2013.

Being based on cloud technology makes athenahealth much more nimble in launching mobile products in services. In the video below, I discuss with Jonathan Bush how athenahealth is using the cloud in their EHR.

(Thanks to Nate DeNiro and Open Affairs Television for their assistance with this video.)

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