The data were on the physician’s external hard drive, officials said. Though the hard drive was encrypted, a piece of paper with the password was nearby and is also missing. The physician notified UCLA the next day and officials began identifying patients affected.”

I am continuously amazed at the number of security breaches involving patient healthcare information caused by careless use of portable storage media like external hard drives, flash drives, and even laptop hard drives. Patient information should never be stored or transported this way. I believe that utilizing cloud computing with simple browser access is a much better solution. 

What makes this particular incident so bad is the cause; reckless behavior by a physician. This wasn’t UCLA’s fault, per se. Sure, the medical center must accept a share of the responsibility, the lion’s share of the blame falls in the lap of the physician. Not only did the physician have sensitive patient information on an external hard drive, but was dumb enough to have the password to access the drive on a piece of paper next to it. Kind of defeats the purpose of encryption and passwords, doesn’t it.

For an eye-opening look at the magnitude of data loss and security breaches drop by DataLossDB.org sometime. It’s scary stuff.

Anyway, I found myself in a situation where I needed to move several large files and had no easy way to do it. Fortunately I use SuargarSync, which is capable of quickly and easily sharing files.

Sharing single files

To quickly share a single file all you have to do is create a public link which can be emailed to the intended recipient. From the SugarSync help files:

A “Public Link” is a URL, or a path, straight to the file stored in the cloud. You can send the Public Link in an email or a text message, you can post it on your blog, or you can publish it to Facebook or Twitter. The recipient or website visitor can click the link at any time to download the latest version of the file.

• The link you send is a “live” link to the most current version of the file. If you make changes to the file, your recipients can click the link to download the updated version.
• It’s easy to paste this link into your own email program and send it to your recipients. Since you are not sending the file as an attachment, you save tons of space in your mailbox.
• You can go to Other Places > Public Files in the SugarSync Website to see how many times the file has been downloaded. You can also disable the link in the Public Files dashboard when you no longer want to share the file.
• The recipient does not need to have a SugarSync account, and does not need to sign into SugarSync to access the file.

When you receive the “Public Link” simply put the URL in your browser and you’ll be taken straight to the file. Works great. And when you no longer want people accessing the file simply disable the link.

I’m a proponent of both mobile computing and the cloud, and I think the author of the article finds the right combination of words and logic to articulate why the cloud will provide the platform of the future for healthcare. This is especially true as healthcare continues to attempt to develop integrated solutions and shared databases. “Health IT evangelists often imagine a world where data standards and anonymous sharing enable a whole new level of medical analytics. With pooled health data new hypotheses might be tested that previously would have required expensive observational trials. Drugs with harmful side-effects would be more easily identified and new treatment protocols could be written. The sort of sharing necessary for these robust analytics is made much more difficult when patient data is on local machines, either on a doctor’s computer, or a hospital’s servers. The adoption of Chrome OS has the potential to catalyze the move to the cloud, and thus this holy grail of medical analytics.” I couldn’t have said it better myself.

Below are two videos. The first shows a short run through of the Chrome OS on the CR-48 by Medgadget. The second is an awesome video showing some inventive ways to destroy your CR-48 notebook. Of Course the entire exercise is designed to demonstrate the benefits of using cloud computing to preserve your precious data regardless of how your CR-48 meets its demise.

I’ve read several reviews of the Cr-48 and for the most part users haven’t been all that impressed. The reviews interest me because I don’t believe the people using these machines get it. First and foremost, the Cr-48 is clearly a work in progress as is Chrome OS. Second, the idea of an internet based, fully cloud enabled system is ideal for creating a hardware agnostic future. It appears to me that Google is testing the waters and collecting data for a future run at something bigger. Do you really doubt Google will continue to develop a better cloud concept for an operating system? It would be a mistake to do so.

I remember similar thoughts from the so called experts when the Android OS rolled out, and now it’s slowly becoming the most prominent operating system for mobile devices. I don’t see that changing anytime in the near future.

I’ve embraced the cloud and actively pursued it in my personal computing. It’s clearly not perfect and still feels immature as a “desktop” platform for all to use. My attempts to rid myself of traditional legacy applications have been met with failure at times. You must be connected to the internet to make use of the cloud-only space for example. And until wireless access is truly ubiquitous it will continue to be the bane of the cloud. For now the use of hybrid applications seems to be the most logical. I consider applications like Dropbox to be a model example of what more developers need to do if they want to drive the cloud forward. Dropbox is cloud based, but resides locally on the device. It’s also available for most computing platforms, i.e. iOS, Windows, Android, etc. It’s nearly perfect.

Another barrier to personal cloud computing is the lack of a hybrid office suite. The problem remains the same; you need access to the cloud to use cloud based applications. I attempted to convert exclusively to Google Docs late last year and quickly returned to using Microsoft Office on the desktop. Lack of access killed me. A solid hybrid office suite has yet to be developed. Microsoft has made valiant attempts, but hasn’t quite pulled it off yet. Office Live is conceptually perfect, but in practice falls woefully short. Office 365 may be the right answer, but I haven’t had the opportunity to play with it or see it in action up close and personal.

Consider the potential of Chrome OS in combination with the Android OS; a mobile platform and a desktop platform that share a common architecture similar to the combination of Apple OS and the iOS. Now add to that the functionality, benefits and potential of the cloud; something that Apple has failed to take advantage of. I’ve utilized Google Sync functionality several times to set up new laptops. It’s awesome. Simply install Google Chrome, type in your password and in just a few minutes you’re in business. I’ve had the same experience with Evernote and Dropbox; my web clipping and file synching applications of choice.

Taking the concept one step further, imagine doing this with an entire desktop. It would make the hardware irrelevant. Get a new machine, type in your Google credentials and watch your entire desktop get restored on the computer right in front of you. All applications, documents and files continue to be stored locally while being synced to the cloud. When the machine reaches the end of its life simply nuke it, buy a new machine, type in your Google credentials and you’re off and running. Include the same features on mobile systems and you’ve created a very flexible platform for a mobile workforce.

So don’t dismiss Chrome OS or Google’s first attempt at a notebook just yet. Google may not have invented the cloud, but they’ve certainly done more than anyone else to bring the concept of utilizing the cloud to the forefront of everyone’s mind. The Cr-48 is a rare bird indeed, and I’ll unfortunately never get my hands on one, but it’s an important development nonetheless. Consider it a concept car.

Anyway, it’s always a headache setting up a new laptop as most people like me have to transfer gigabytes worth of data from the old machine to the new one. Not this time.

As one who preaches the benefits of cloud computing I’ve been trying to live in “the cloud” as much as possible. So when I received the new e6510 there really wasn’t any data migration to speak of. I use Google Chrome as my browser of choice, Microsoft Office synced with Live Sync, SkyDrive and Office Live for much of my personal document creation, Dropbox and SugarSync as my primary data storage and back-up solutions, and Evernote as my solution for just about everything else. I suppose I could have gotten along without Microsoft Office, but I wouldn’t want to try. All my documents at work are created in Office and just about everything I receive from colleagues is in Microsoft Office format, so it’s just easier to use it. I really like the Microsoft Office suite, and in addition the newer versions of Office offer a significantly improved experience on the tablet PC when compared to other office suites.

I installed Google Chrome, logged into my account and synced my bookmarks; absolutely seamless. Then I installed Dropbox and SugarSync, logged into my accounts and synced my documents; simple. Finally I opened IE, logged into my Windows Live account, downloaded a couple of small apps and within a few minutes was off and running; awesome. Nothing could have been simpler. The entire process took less than an hour and that was while working on other things in between. It took longer for all my documents to sync over the internet, but that didn’t cause any problems.

Overall the process was simple, smooth and painless. The experience has further cemented by impression of “the cloud” as the only way to go. It has also given me a deeper appreciation for products like Dropbox, Evernote and SugarSync. These applications were already at the top of my must-have list, but they have clearly separated themselves from the rest of the pack. While Windows Live offers great potential for Microsoft Office users, it has a long way to go before it can be thrown in with the likes of the applications previously mentioned. Microsoft should just acquire Dropbox and get it over with already. I’m just sayin’.

In the article a pediatrician that is also director of clinical informatics for Atrius Health is quoted as saying “At the moment I’m not convinced that there’s a secure enough place in the cloud or that the functionality exists for us to do everything that we need to do in the cloud. The cloud allows for a tremendous amount of interconnectivity between computers because it’s using data storage that’s free amongst different networks and I wouldn’t want healthcare information being scattered in a way that I couldn’t protect it appropriately.” I’m not sure I understand the perceived insecurity of the cloud as the existing infrastructure for storing patient information in healthcare is, by design, insecure.

I don’t think most of the fear swirling around the cloud is necessarily associated with the physical security of the servers or the lack of encryption, but rather the regulation attached to healthcare. Everyone wants to know that information is safe and they don’t want to get dinged by one of the regulatory agencies. Everyone is worried about being HIPAA compliant along with the fines associated with the HITECH Act for breaches of patient information. I can’t guarantee that every cloud provider meets HIPAA regulatory compliance, but that’s why you have a sit down with the cloud provider and understand what you’re getting yourself into before you jump in head first.

However, consider the results of a recent survey conducted by New London Consulting and FairWarning in which nearly one-third of survey respondents stated that their organizations were not currently in compliance with or feel that they will be in compliance with the HITECH requirements. How is that a good thing?

On the other hand, it’s in a cloud service provider’s best interest to be in full compliance with state and federal laws if they plan on staying in business. This could be a win-win, especially for healthcare systems that need someone to help control their data.

Based on available cloud models one could argue that data is more secure in the cloud than it is with many “in-house” systems. Cloud service applications are developed with cloud platforms in mind and use a common security model. Cloud providers tend to be aware of technology and security trends before the typical end-user. In other words, they pay more attention to issues such as physical security, access controls and perceived threats. It’s what they do, people.

Many consider data control and security in the current healthcare model a myth. It consists of data located in various places split among computerized storage and paper files. Do you really think this is a safe, secure and efficient way of storing healthcare information? A more important consideration might be whether or not the people arguing against cloud storage models understand the current state of healthcare data integrity.

Many people in various locations need access to healthcare information. In the current healthcare model this results in duplicate information found in paper charts stored by the thousands. It’s not uncommon to find these files lying around in various places like nursing units, physicians desks, etc. Don’t even get me started on what can happen when a hard copy of a record gets lost in transit to another location. And let’s not forget that some facilities may not have a readily available backup of these paper records.

Unfortunately, the problem with data integrity and security isn’t limited to paper records. Electronic records inside facilities are at risk as well. Medical records are accessed by many people for lots of legitimate reasons, but what happens when a physician or other healthcare provider walks through your door with a flash drive, an external hard drive, or even a laptop with patient data on it? That’s a walking HIPAA nightmare.

Laptops are everywhere and some physicians use them to transport patient data back and forth. In addition, laptops remain a mainstay for home health nurses and hospice care outside the hospital. They are both an indispensable tool and a tremendous security risk for healthcare institutions. If you don’t believe me just do a cursory online search for “lost laptop with healthcare data” and see what pops up. You’ll be shocked and horrified by what you read.

Information from a 2009 report by the Ponemon Institute indicated that Approximately 10,000 laptops go missing in airports every week. Some get recovered, but many don’t. The loss of these laptops is not only a security breach when they contain sensitive healthcare data, but they create a financial burden as well. It’s not just the cost of replacing the hardware itself, which we know is cheap, but the cost of detection, forensics, the loss of productivity and the possible fines associated with the data breach.

According to the Ponemon report, the average value of a lost laptop for all industries is $49,246. That’s a bargain when compared to healthcare where it’s actually around $67,873. Sure you can encrypt the data and take steps to minimize data breaches on these stolen or lost devices, but doesn’t it make more sense to simply avoid it all together? I think so.

A cloud model means that your information doesn’t need to be moved around and it doesn’t need to be copied or transferred from one system to another because the end user has the information available to them at any time from any device with internet connectivity. Pick your device: smartphone, laptop, iPad, it doesn’t make any difference as long as the device is web enabled and can see the information in the cloud.

Regardless of the situation – pharmacy needs information about a patient’s allergies or a patient gets admitted to the hospital and you need the old chart or you’re a physician on call that needs to know what a patient is taking or what their most recent labs are – as long as you have web access you can see that information. With the increasing availability of wireless connectivity it’s only a matter of time before having access at anytime from anywhere won’t be a slogan, but a reality. In addition the information remains safe because it’s not stored locally on the device. You’re simply using the device as a window to view the data.

A 2009 report on “Cloud Computing: Benefits, risks and recommendations for information security” by the European Network and Information Security Agency actually took an independent look at the technical and legal aspects associated with the issues of ‘cyber security’ and determined that “The scale and flexibility of cloud computing gives the providers a security edge.” Their reason for making such a bold statement was that they felt that service providers had the flexibility to instantly correct security issues, apply patches or implement additional security features if necessary.

Regardless of current feelings toward cloud computing, it is apparent to me that the consumer market is driving adoption. The InformationWeek article goes on to say “Nevertheless, last month two major announcements may have been the clearest indication yet that vendors believe there is promise in offering cloud computing to healthcare delivery organizations, especially among small and medium-size physician practices. In June, GE Healthcare introduced Centricity Advance, a new Web-based, SaaS platform that offers a combination of EMR, practice management, and patient portal solutions for small, independent physician practices. Last month also saw Dell announce a partnership with SaaS provider Practice Fusion to offer an electronic medical record package for small and medium-size medical practices.” We’re headed toward the cloud whether we like it or not. The market will eventually force healthcare to adopt the model, and being forced into something is never a good thing. While I believe in improving and optimizing existing systems, I also believe it’s important to explore future technology and decide where you want to be. Just a thought.

I use both Live Mesh from Microsoft and Dropbox to manage and synchronize documents on multiple computers. The combination has worked very well for me. I use both applications because I like to try new things; Live Mesh came first followed by Dropbox at the recommendation of my brother.

Live Mesh has become my primary location for blogging material – ideas, images, etc. – while Dropbox has developed into my storage spot for larger documents and presentation materials. Don’t ask why I use them this way because I have no idea.

Anyway, last week I noticed a few files missing in Live Mesh. I may not have ever noticed except that the files I was looking for were rough drafts of blog posts. I couldn’t find them anywhere. I checked on my laptop. I checked on my tablet. I even checked online at www.mesh.com. Nothing, nada, zip.

Where the heck did my documents go? A Google search gave me a little insight into the problem as Live Mesh appears to have problems with documents with conflicts secondary to a synchronization algorithm. According to the Live Mesh blog “Live Mesh is not deleting or losing files. Even if they don’t all appear in Live Mesh folders on your computer, they are all present in a hidden state, as well as on your Live Desktop if the folder is synchronized there.” Ok, that’s fine and dandy, but how do I get them back. This particular article is from September 2008 and promises a quick fix. Guess they haven’t gotten around to it.

I’m not completely stupid and do perform weekly back ups to an external drive, but the items I was looking for had not been backed-up yet; bummer. Further investigation revealed that my last backup contained 931 more files than my Live Mesh folders on my laptop. Whoa cowboy, that’s a lot of missing files! I can’t be sure what all was lost, but I know I did lose some great iPad screen shots and several other images that I was planning on using in future blog posts.They are technically replaceable, but knowing exactly what they were is the real problem.

In Microsoft’s defense it is clear that Live Mesh is still a “beta” product, but that doesn’t ease my irritation in the slightest. Once bitten, twice shy. So like all good red blooded Americans I’ve decided to abandon Live Mesh and move on to something else. The combination of Dropbox and Evernote looks like a good solution. In addition I signed up for a trial of SugarSync yesterday and plan to use it to back up my Dropbox files.

SugarSync has received a lot of press lately as a great way to back up, access and share files. It’s especially nice because of their iPhone and iPad applications.  I spent a fair amount of time last night playing with SugarSync on my iPhone and laptop and have to say it was impressive. They offer a free 2GB account for those of you that what to give it a whirl.

I have to say that I am disappointed in Microsoft because I really like what they have to offer. Live Mesh, Office Live and Skydrive, combined with Microsoft Office 2010 has been working very well for me on my tablet. Maybe I’ll just wait for them to remove the “beta” tag and try again, then again maybe not based on how well Dropbox and SugarSync perform.

I’m going to leave Live Mesh installed on my machines for a while in the hopes that these hidden files will magically reappear, but I’m not going to hold my breath. I’m also going to ramp up by back up schedule to minimize the damage should something like this ever happen again. Lesson learned.

Then I noticed a trend at a lot of the web sites that I frequent: Microsoft has slowly, and quietly, been positioning itself to jump into the healthcare market.

Consider the following:

• Microsoft has been plowing forward with their cloud and Software-as-a-Service model: Azure Platform, Office Live, etc.
• Microsoft is offering American scientific researchers free access to their new Window’s Azure platform. This should allow centralized data collection for scientists to collaborate on research projects.
• HealthVault is one of the key players in the personal healthcare record (PHR) race. Google Health is the other big boy on the block. Sure, there are other players in the game, but even they recognize the need to acknowledge the dominance of Microsoft and Google.
• Microsoft announced HealthVault Community Connect, which is designed to help hospitals and patients control the flow of data stored in multiple systems.
• The Cleveland Clinic and Microsoft partnered to use HealthVault with the hospitals EMR to track patients with chronic conditions.
• EHR vendors are starting to get on board with the Microsoft platform.
• Microsoft already offers a health information system, i.e. Amalga Hospital Information System. Why isn’t anyone talking about it?
• Take a look at some of Microsoft’s activity at HIMSS 10.
• Microsoft Surface – what a great tool for physician interaction with patients.

• Mobility – at the moment, the only real player in the tablet computer game is Microsoft. I’m encouraged by the iPad and the Adam, but for now there is only Microsoft and Windows XP tablet, Vista and Windows 7. Microsoft will have to do a better job with their smartphone platform, but take notice that they continue to push forward with the concept even though they’re getting trounced by the iPhone and Android devices.
• Microsoft and Philips are collaborating to build clinical decision support tools (CDST).
• Microsoft is already entrenched in numerous healthcare systems across the country, perhaps the world, as an enterprise partner. Windows is still the dominant operating system found on desktop computers in hospitals, and how many millions of healthcare providers already use a Microsoft productivity application, i.e. MS Office, Exchange Server, MS Outlook, MS SQL Server, so on and so forth. This gives Microsoft an extensive user base from which to build an incredibly integrated system.

Further consider that software like our pharmacy information system (PhIS) and BCMA system from Siemens is built on the .NET framework using Visual Basic.NET. Yep, another Microsoft product. How long do you think it will be before other vendors begin partnering with Microsoft to develop and integrate products that will work in the healthcare arena? I’m betting not long.

I’d love to spend a few days in Redmond running around playing with all their toys. I can’t imagine the research and development that goes on behind those walls, but it must be pretty cool. I’m sure we only see a fraction of what they’re working on.

Microsoft may be aging and their bite may not be as vicious as it used to be, but they are still an 800 pound gorilla in the the software industry. And what can an 800 pound gorilla do? You got it, anything it wants.