Cloud Computing for Better Patient Outcomes
Date/Time: 11 March 2016, 09:00am – 12:00 noon
Venue: C-Asean, Cyberworld Tower
Address: 90 Ratchadapisek, Huai Khwang, Bangkok 10310, Thailand
Gatekeepers must see the link to patient outcomes
At present, hospitals in Thailand operate in silos and there is no vision for a single health cloud. Each hospital may have a cloud-based email and CRM software that sit alongside a back-end for patient data that is hosted on-site. Different hospital departments and centres have different needs, different data, and use different solutions with little or no inter-operability between the solutions. This illustrates the fragmentation of healthcare – all hospitals are different, making standardisation difficult to consolidate with the need for customisation to fit the different workflow of each individual hospital, department, and clinic.
The introduction of cloud technologies in healthcare depends on the priorities and decisions of multiple players. Adoption of cloud is slowed down by the concerns of these different actors who thus act as technology gatekeepers. In the case of Thailand, where around 70% of primary care is provided by public hospitals, the primary gatekeepers are the hospitals as healthcare providers and the government as the regulator and funder of healthcare services. Hospital management are concerned about the effects of cloud on regulatory compliance and data protection – and regulators are concerned about the effects of cloud on their ability to safeguard privacy and public health.
The gatekeepers are not always focused on moving in the same direction, and better alignment of gatekeeper incentives is key to facilitate cloud adoption. Hospital managers may view cloud and ICT as tools for invoicing, claims and finances, while government policy may focus on investments in hospital ICT as a tool to improve the speed of care and increasing patient revenues. Hospital managers, regulators and funders must see cloud and ICT as investments to improve access and quality of care – investments in tools that enable better patient outcomes.
Boot-strapping potential in underdeveloped markets
Large hospitals and centralised public health systems already operate large ICT systems – often multiple systems in parallel within a single hospital. These large actors face challenges related to skilled staff, budget, and culture. In terms of hospital management priorities, health always comes before tech, and we therefore need to reframe the message of cloud benefits away from infrastructure towards health.
To fully digitise and bring existing systems into the cloud under a unified system will require great efforts and a significant up-front investment – both in terms of time to define and customise the system and train the users, and in terms of money invested in the system. Smaller hospitals and clinics, including those in remote areas, may be better placed to immediately adopt cloud. Smaller entities do not have large ICT systems in place and may adopt cloud as their first consolidated and digitised health information systems, thereby bootstrapping themselves into a connected health system. This will also facilitate use of new remote medicine technologies and developments in remote diagnostics, improving access to primary care in rural areas.
Consumer health tech is driving demand-side disruption
There are two end-users of cloud and ICT for health: hospital managers, and the patient as the consumer. While hospital management may yet need to be convinced of the link between cloud and patient outcomes, consumers are already driving a demand-side push for ICTs and cloud in healthcare. With the explosion of fitness trackers and other “connected health” technologies, middle class consumers are already convinced of the benefits that cloud-enabled health tech brings.
Companies that sell connected health technologies are harvesting unprecedented amounts of data on end-users – data that to a large extent is not integrated into the formal healthcare system. While this contributes to the developments on non-connected data-islands, it is also taking place at a pace and scale that is forcing providers of formal primary healthcare to take note. This disruption will lead to increased cloud use – and the early adopters of enabling cloud infrastructure will have a first-mover advantage.
Data privacy concerns are not linked to cloud
ICT initiatives by the Ministry of Health (MOH) have focused on safety and security of patient data. Privacy and data security should continue to be the priority. However, evidence from data breaches – most of which take place on-site – indicate that cloud technologies can enhance security. Tier 1 cloud service providers have better data security processes in place than any single hospital can feasibly implement.
The draft Personal Data Protection Act may become a barrier to cloud use by requiring hospitals to get consent from patients before collecting personal data and specify how their data will be used. In addition to requiring front-end agreement from patients before capturing data, the draft Act could cause complications related to data disclosures, such as sharing data between different hospitals and from clinics to hospitals. Deliberations on the draft Act should involve healthcare professionals to make sure the Act will not make it more difficult for hospitals to leverage cloud technology for better patient outcomes.
Single budget causes funding challenges
Hospital budgets are earmarked for medicine and treatment. This makes it difficult to allocate budget for ICT upgrades and cloud roll-out, since increased or one-off spending on ICT implies less resources for medicine and treatment.
Payment for the services offered in public hospitals in Thailand come from three sources: the Universal Coverage scheme, the Civil Service welfare system, and the Social Security scheme. Neither of these funding sources have allocated budgets for bulk investments in ICT and bulk tendering of health cloud services. A coherent government vision with a separate budget for a health cloud would allow hospitals to overcome budget challenges.
Cloud for the public sector needs new approach
The Electronic Government Agency (EGA) has proposed that all public agencies in Thailand must use EGA-provided cloud services. This will result in a cloud service that does not fit the needs of the end user, in this case the hospitals.
The MOH, with support from the PM’s office and other ministries, must work with cloud vendors to develop and roll out a health cloud in Thailand. Vendors should organise themselves into consortia and work with academics on how to leverage cloud for better patient outcomes and to study and understand the needs of hospitals based on case studies.
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