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Tas Hind, director of Healthcare of Essentia Trading Ltd, looks at the role of cloud computing in helping to revolutionise the use of technology in healthcare
In January 2018, NHS Digital announced that it was taking a ‘cloud-first’ approach to technology in the NHS and published official guidance on cloud computing for health and social care. This is an important step in providing clarity to the NHS on storing patient information in the cloud. In effect, it means that the Health Secretary has given the green light for public health organisations to move data from on-site servers to cloud services in data centres run by companies such as Amazon, Microsoft and UKCloud.
Cloud computing is a general term for the delivery of hosted services over the internet, reducing the need to build and maintain computing infrastructures in house. Although some NHS organisations already use cloud services, this is the first time they have been given official guidance to embrace the technology. It is hoped that this move will enable the NHS to save money and benefit from greater security and flexibility. It should also allow staff to be more innovative and productive and enable better engagement with the public. This is because both will be able to access information securely and safely in the cloud, at any time and from any location.
In the guidance, NHS Digital stated that: “NHS and social care organisations can safely locate health and care data, including confidential patient information, in the public cloud including solutions that make use of data off-shoring. Cloud providers have a significant budget to pay for updating, maintaining, patching and securing their infrastructure. This means cloud services can mitigate many common risks NHS and social care organisations often face. Cloud services may provide other advantages for NHS and social care organisations including lower IT costs and the ability to develop, test and deploy services quickly without large capital expense. As more services for patients and staff move to the internet and the need for better data interoperability increases, it is likely that use of cloud services will become more prevalent in NHS and social care organisations.”
The guidance spells out the steps that NHS organisations should take to prepare to use cloud services, as well as clarity when it comes to the storage of data in servers located in other countries. One of the key points is that data should be safely located and safe to locate. Data sovereignty (that it conforms to UK law) must be a major consideration when choosing a cloud provider.
In the public sector, cloud platforms are widely used by the police, HMRC, DVLA and the Ministry of Defence – which cite security and value for money as reasons for the move. Major private companies including oil giant BP and British Gas owner Centrica are users of cloud services. Many people would be surprised to know, however, that it has not been adopted widely in the NHS. The announcement from the government however, is likely to change this.
Why has adoption of cloud technologies been so slow in the NHS and social care?
Some reasons that have been put forward include: the fractured nature of its multiple IT systems and providers; organisations are afraid to take any risks; it is a big step into the unknown; they don’t think it is secure; they don’t know where to start; they don’t know what to put into the cloud; they are too worried about losing control; they recently made a significant investment into a new datacentre; they have existing contracts with solution providers; they are worried about suppliers’ capability to run solutions in the cloud; and no one has asked them why they aren’t using cloud.
The cloud has been touted as the next big shift for the NHS. Although cloud adoption has been comparatively low, it is growing. To date, 67 per cent of trusts do not have any element of IT infrastructure delivered though the cloud. Most trusts are taking an incremental approach for email and data archiving. A few trusts have gone beyond that. The consensus is that there will probably be a tipping point in the next two years as traditional infrastructure contracts end and Trusts increasingly see the potential of using the cloud.
Moving to the cloud would generate multiple benefits for the NHS, not least from cost, flexibility and security perspectives. It will also be better positioned to innovate, modernise its information technology and provide solutions that meet patients’ needs.
We think the cloud will act as the catalyst for providing open source, open standards and APIs to share and stream data securely across healthcare boundaries, breakdown information silos and manage workflows. API stands for ‘Application Programming Interface’, which is a software intermediary that allows two applications to talk to each other internal or external to the organisation and share pertinent information. For example, each time someone uses use an app like Facebook, sends an instant message, or checks the weather on their phone, they are using an API.
Cloud computing will certainly liberate the NHS and social services from the costs, risks and complications of managing hardware, computer rooms and infrastructure, generate opportunities to re-purpose the space, raise some of the much-needed capital and present an opportunity to reduce its carbon footprint.
It will inevitably open a new world in terms of data sharing, both regionally, nationally and internationally, enabling a ‘citizen's health record’ to be developed. This could pull together data not just about health, but also lifestyle (e.g. wearables, insideables, eating and sleeping habits and other home-monitoring systems), genomics, life sciences, research and other areas. Surely, the integration of this information is required to improve our engagement with and the delivery of services if we are to have a fighting chance to transform the health and well-being of our citizens?
Steps towards adopting the cloud
1 - Establish a cloud strategy that meets your overall objectives. There are many steps you can take to establish a strategy that is right for you. You may wish to start small and learn by adopting a few new applications that are necessary and of high value to the trust. Ideally these would be implemented within weeks and months and paid for on a pay-per-use basis. This will provide an invaluable insight into using applications that are available in the cloud and the impact on the organisation and ways of working.
2 - Review your information and technology landscape, the facilities you use, security, manpower you consume and establish how well you are positioned to meet the trust and wider health economy vision and objectives. Focus particularly around data sharing, exploiting information that is available inside and outside your organisation such as genomics, life sciences, research, lifestyle and engagement with patients or the wider public.
3 - Assess the options and opportunities of using cloud and roadmap for transition and transformation. Identify the solutions that are mission critical and those that could initially be managed by an external organisation with little impact on the business.
4 - Determine the consequences and the opportunities of transitioning the hardware and the software to the cloud and the impact this would have on the service provision into the trust and the wider health economy.
5 - Choose a provider that has a multi-cloud approach, so you have the choice and flexibility to place your workloads on the right platforms and avoid the risk of being locked into one provider.
6 - And finally, explore lessons that have been learned by other organisations public and private. Create and execute a roadmap that is understood and bought-in to by all the stakeholders in the business and stick with it.
Mid Cheshire NHS Trust’s ageing IT estate was causing significant problems. Amy Freeman, the Trust’s Associate Director of IT, identified a number of challenges that needed to be addressed when she joined the organisation in 2016.