Information Technology Reference
In-Depth Information
My SQL database technology and the Veteran's Administration's VistA enterprise
information system). Their technology comes from an era where data sharing among
independently developed systems was not much of a consideration and, as a result,
they tend to have significant interoperability problems.
While there is nothing inherently wrong with client-server, true cloud-based sys-
tems are developed in technologies designed to operate on the web. They can deal
with the much slower connection speed between clients and the servers. They are
designed to operate within a web browser. They may well be designed using stan-
dard components and tools which facilitate the sort of interconnections among web
pages you're used to on the Internet. For example, it is not unusual for the content
on a single web page to actually derive from different servers that may be operated
by different organizations. They are also much more often “open source” meaning
that further development of the technology is done be a community rather than one
vendor. The hope, of course, is that this approach will be less expensive and more
closely align the technology with the needs of the entire community of users.
To give an example, data from a blood pressure device in a patient's home and
that actually resides on a server operated by the company that builds the device
might be viewed within a patient chart developed by a cloud-based EHR company.
To the provider viewing the chart that would be transparent, it would all look like
one system. In fact, data from the device at home might even be graphed along with
blood pressure readings taken by the provider during office visits to give a more
complete view of the patient's status over time.
There can also be major advantages to using the web when all utilization of a
service goes to one system that can then learn and improve from its collective expe-
rience. This sort of arrangement is virtually non-existent in traditional client-server
computing but is commonplace on the web and is much more directly supported by
technologies for web development.
Cloud computing may be a particularly attractive idea for smaller physician prac-
tices where the challenges of operating physical servers and networks can be formi-
dable and economically unattractive. However, cloud computing is increasingly also
being used by large enterprises. Companies in the UK [
2
] and India [
3
] have announced
cloud-based hospital information systems. Of more direct relevance to this topic and
some of its readers, several cloud-based EHRs are commercially available.
Health Information Exchange (HIE)
Earlier we discussed the data logistics problems faced by healthcare, particularly in
the management of chronic disease. We also explained the evidence that sharing of
clinical data among providers may be a key strategy toward improving the quality
and efficiency of care.
Health data is highly confidential and is protected by the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) which mandates severe penal-
ties, including prison time, for violations. The law specifically addresses Protected
Health Information (PHI) which is any health information, demographic or claims
