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Fall 2011

How Does Cloud Computing Fit into Anesthesia?

Bryan T. Sullivan
Director, EMR and Clinical Integration, ABC

“Cloud Computing” is a phrase we hear thrown about constantly in the technology industry these days. To the casual observer, it can be synonymous with the internet or perhaps used to identify a specific program available over the web. Large organizations such as hospitals typically understand the nuance that exists when discussing and integrating cloud computing concepts, but since many anesthesia practices must double as their own internal IT departments, confusion may arise as to what cloud computing is and how it affects your business.

Many tout the cloud as the next evolutionary step to the traditional software and support models but fail to evaluate the true benefits and costs. As this software and platform model continues to mature, we must ask, “How will cloud computing affect my practice and how can I benefit?”

What is Cloud Computing?

This seems to be an ever evolving answer. While many industry experts expected to have a standardized definition by this time (Klein, 2011), the scope and breadth of the cloud model continues to develop.

At its core, cloud computing refers to the availability of software applications, data storage, and even identity management services through online resources in a public or private network. These resources are made available to the end users using an “on-demand” or “pay- as-you-go” model.

To better understand this, think of a water utility company providing water to your home. As a consumer, you aren’t interested in whether the water you use comes from a local reservoir or from a nearby water tower. You only care that water is available to you when you turn on the faucet. Additionally, you won’t leave the water continually running either. You decide when and where you want water and achieve this by turning on the faucet.

This is essentially the same idea when it comes to a software product or system available “in the cloud.”

You may have also heard the term “Software-as-a-Service (SaaS)” which refers to a specific application such as Google Docstm or Yahoo Mail. The only requirement to use these applications is a computer, access to the web, and an internet browser.

It should be noted that in many instances, cloud computing and software- as-a-service are used interchangeably. This is not correct. According to the Gartner definition, SaaS is software that is “owned, delivered, and managed remotely by one or more providers.” In simpler terms, SaaS is the specific application you intend to use while cloud computing refers to the larger picture where Saas applications reside.

Why is Cloud Computing Garnering So Much Attention?

Money. That’s the simple answer. The more complex answer is that cloud computing offers organizations the potential to convert capital expenditure budgets over to operational expenditures. Organizations do not have to set up an entire server infrastructure to support a SaaS application as with traditional on-premise software purchases. The hardware to support these applications is typically located in third-party facilities and does not require up front purchase by the hospital or anesthesia practice. Almost as important, the funding to support these systems is no longer needed as the software is maintained by the application vendor.

More than just the financial benefit, cloud computing offers organizations the ease of increasing capacity and quickly deploying new features on the fly. Since end users are not required to install any software other than an internet browser, organizations are freed from the typical “down-time” periods necessary to perform an upgrade in a traditional hospital setting. The required changes and updates are applied directly to the SaaS provider’s end and are immediately available.

According to a survey conducted by SnapLogic, in the past two years, 64 percent of companies have implemented at least one software-as-a-service (SaaS) application. That number should rise during the next two years, as 77 percent of companies expect to implement at least one SaaS applicaton. (Preimesberger, 2011) This rapid adoption has allowed organizations to become more familiar with the technology and comfortable with the security and dependability questions that plagued this architecture since it was first adopted.

How is HIPAA Affected by the Cloud?

Many conversations are taking place concerning how the cloud complies with HIPAA privacy rules. All healthcare organizations that handle protected health information (PHI) must comply with HIPAA. The new model that the cloud offers forces all consumers of cloud services to ensure compliance as well. This includes not only the end users, but also the SaaS providers.

In addition to protecting PHI, you must ensure that SaaS providers do not ship any data out of the U.S. to an off- shore data center. If this were to occur, the data may be subject to international laws which could force the SaaS provider to make changes that put them out of HIPAA compliance.

There are many issues currently exposed when it comes to HIPAA compliance and a cloud computing model. This requires diligence on the anesthesia practice’s or partner’s part to ensure that any systems to be deployed that contain PHI comply with HIPAA and that contracts are in place to ensure this. In today’s healthcare environment, it is simply not sufficient to have a great software application in the cloud. It needs to be a great, secure, and HIPAA compliant application.

What is the Cloud’s Impact on Anesthesia?

Many contracted anesthesia groups currently work under the model of a hospital or facility bearing the financial and operational burden of a software purchase. This has led to slow adoption of Anesthesia Information Management Systems (AIMS) as well as other packages around provider’s quality of care, anesthesia scheduling, and even preoperative portals. The promise of cloud computing makes these systems more attractive to implement due to the lower costs around installation and maintenance. However, it still requires an administrative component that anesthesia groups may not currently be able to support.

New product offerings are continually entering the anesthesia technology market and many have adopted a SaaS architecture. The effort required to evaluate, recommend, and implement these solutions by the anesthesia practices may be reduced by the new cloud platform, but the effort exists nonetheless. This leads to one of the major issues facing anesthesia groups today when it comes to new technologies: How to combine the functionality of a “best of breed” system with the integration value of an enterprise system?

Pursuing an answer to this question will be critical as the requirements on anesthesia practices around efficiency, productivity, and cost-effectiveness continue to increase. It may be beyond the current capabilities of a single anesthesia practice to answer this question and the collaboration of an existing partner may make the difference.

Bryan T. Sullivan, PMP, serves as the Director of EMR and Clinical integration for ABC. Mr. Sullivan came to ABC from Merge Healthcare where he managed and delivered Anesthesia EMRsolutionstothehealthcaremarket. He focuses on providing anesthesia and pain providers with clinical and operational systems as well as integrating existing EHRs. He can be reached at

Johnston, S. (2011, July 24). Wikipedia Commons. Retrieved from commons. File:Cloud_computing.svg

Klein, M. (2011, June 17). Six Cloud Computing Trends – Mid-2011 Update. Retrieved from Online Tech: six-cloud-computing-trends-2011/

Preimesberger, C. (2011, September 14). Retrieved from Cloud Computing: Cloud Application Integration: 10 Key Trends to Follow: Computing/Cloud-Application-Integration-10-Key-Trends-to-Follow-698015/