The 22nd January 2018 was a quietly defining moment for digital healthcare: NHS Digital released long-awaited national guidance on the use of off-shoring and of public cloud services for NHS and social care datai. It was important because embracing cloud technology is much more than an opportunity to reduce cost; cloud technology is itself a catalyst for innovation and a new kind of openness and collaboration in healthcare.
It is perplexing why it has taken so long to reach this milestone. In 2011 when Careflow Connect was still a start-up, the NHS’s then ‘Connecting for Health’ had conflicting views about cloud but there was senior level acceptance that it was the way forward and that guidance was needed. We decided to forge ahead anyway, making us one of the first (if not the first) healthcare company in the world to synchronise patient data into a public cloud platform. Others were less sanguine. I fear that conservatism in this area has had the negative effect of stifling the digital innovation that the NHS so badly needs.
From a customer perspective, the cost benefit of cloud is reasonably well understood. The hardware in a hospital data room requires some hefty up-front capital expenditure, and then regularly updating or replacing by teams of specialist staff. New licences, patches, configurations and updates are constantly required. Although many NHS organisations have spent huge amounts of money upgrading and maintaining their data centres, nearly all have fallen short of the expected security standards now required of themii.
Cloud computing allows these organisations to shed this overhead and leverage economies of scale. It provides dedicated resources to ensure the very latest hardware, software and quality of service is available (which means security patches are applied straight away) and its data centres are built with extreme efficiency in mind. This in turn, lets healthcare organisations focus resource back to their core business of delivering healthcare. A report from Digital Health Intelligence suggests a third of NHS trusts were delivering part of their infrastructure through the cloud and 39% planned to within the next two yearsiii.
Arguably though, a more important benefit of cloud computing is that it provides a new opportunity for software innovation and digital health. Developing and supporting healthcare software has traditionally been slow and expensive. Deploying software separately to each organisation’s servers is complicated: it requires long testing cycles against siloed datasets; local differences of infrastructure; configuration and customisation introduce multiple points of failure; and it requires teams of people on-site. In turn, it means updates to the software are infrequent and different organisations are on different versions, introducing further cost and complexity to the supplier. The net result is innovation slows down and users, customers and suppliers become increasingly frustrated over time. Also, as consumer IT outpaces enterprise IT, users start to turn to shadow IT solutions to provide the capabilities they expect.
Moving healthcare software onto the cloud liberates customers and suppliers to deliver more benefits, more quickly, for patients and their care providers. This liberation comes from the agility of not just maintaining software centrally but changing to single-instance architectures that can leverage cloud specific services (known as Platform-As-A-Service) to further reduce the cost and complexity of software development itself.
But perhaps the biggest transformation in digital healthcare that cloud enables, is an openness and sharing of data via APIs.
The term ‘API’, today, typically refers to the interfaces that two or more applications or parts of the same application use to communicate via secure packets of information transmitted via web services. For example, apps and websites detailing weather, maps, price comparison sites, travel services will all connect to data sources in other systems through APIs. By opening APIs to other developers, software applications become platforms in their own right and they support innovation, interoperability and new uses of their services.
This approach has already enabled our data economy in other industries to rapidly expand to what it is today. It is now time healthcare follows suit. System C, like other leading suppliers, has been investing aggressively in enabling APIs, adopting FHIR standards and moving parts of our solution to cloud-based microservices. At University Hospitals Bristol NHS Foundation Trust, we are deploying software which gives clinicians real-time access to live data from our on-premise PAS/EPR via our cloud-based web and mobile apps.
The NHS should go flat out to encourage other suppliers to follow suit and embrace a cloud and API strategy. This is more than just a cost saving exercise for the NHS, it is a key enabler for innovation and digital health. For clinicians and carers, it means the software they use will dramatically improve, not just catching up with the standards we now expect from consumer and personal applications but responding faster to the changing needs and behaviours of modern healthcare. For patients, it means their care will become more joined up, more accessible, safer and more intelligent.
i NHS and social care data: off-shoring and the use of public cloud services
ii NHS trusts fail post-WannaCry cyber security checks https://www.digitalhealth.net/2018/02/nhs-trusts-fail-post-wannacry-cybersecurity/
iii Is cloud hitting a tipping point? https://www.digitalhealth.net/2018/01/cloud-hitting-tipping-point/