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Cloud computing and GP practices

Dr Neil Paul says using the cloud has many advantages, but not where patient data is concerned.

Cloud systems are not a good idea for patient data storage (Image: iStock)
Cloud systems are not a good idea for patient data storage (Image: iStock)

What is cloud computing? At its simplest, think of it as computers and or hard disks you connect to through the internet that can either store your files for you or even run software for you.

The key to cloud computing is that you buy the service and you don’t need to know anything about the location, the equipment or the software and, more importantly, you don’t have to do anything to it.

You don’t need to run nightly backups or reboot the server this is all done for you - at least in theory - by experts.

Extra storage

You can use cloud computing in several ways: probably the simplest is as extra storage. Many GPs are familiar with Dropbox or Microsoft SkyDrive, where you can connect your computer to a big hard disk in the ‘sky’ often free of charge to begin with.

If you have a website you may be using a cloud service to host it. Up until two to three years ago, people bought their own servers and stored them in data centres.

Now it is more likely you are on a cloud-based host and you are not on one machine but on a virtual machine made up of hundreds of real machines.

Money saving

However the cloud is not just for storage and website; its real power is in something called software as a service (SaS), which can save you money.

SaS means that instead of having to buy a full copy of Microsoft Office for every computer you own, while knowing full well that most people only use Word and are not using Excel and Powerpoint, you pay only for what you use.

The cloud software version usually works through your internet browser. To all intents and purposes, it looks like any other piece of software but you only use what you need and you are always using the latest version.

Non-healthcare businesses

If the practice was a normal business and I was your computer consultant, this is what I would be advocating:

  • Use cheap computers with great screens
  • Deliver all your software from the cloud
  • Only pay for what you need
  • Minimise your support and infrastructure costs.

Cloud computing reliability is better than anything you could hope to do yourself. The size and scale of these systems is that they are often spread over numerous countries with, in theory, multiple ‘redundancies’ (peripheral systems that take over when a primary unit fails) and other fail-safes.

The most dangerous link in the chain is your internet link. But that is as good as you are willing to pay for as you can put in multiple backups including Wi-Fi and even ISDN lines.

Security

For most businesses operating legally, security is not an issue. They are much more likely to lose data from a disgruntled employee’s actions than a hacking attempt on a server farm with top of the line security.

The only issues are for large companies like Sony with millions of credit card details or for the NHS where we are paranoid about patient identifiable data. Here we have a problem as the effort to hack might be worth it.

The NHS works on something called N3, which you can think of as a private network connected to the internet. If you want something to store your practice meeting minutes - even your practice accounts - I wouldn’t worry about doing this on the internet-based cloud.

Personally, at home I use the cloud all the time, but it is not going to work for your patient data and, in practice, you are going to run into trouble trying to keep the two separate.

For example, typing a letter about a patient in online Word will mean the data leaks out onto the cloud. Here the remoteness and fact that it can be anywhere in the world is a disadvantage.

There are ways of making the link to the cloud more secure. But especially if data is held outside the EU, there will always be a worry that governments or other agencies can access the data on the cloud.

Private cloud

The answer to this is a private cloud held within N3 although unfortunately, you lose some of the cost benefits of competition and size. Perhaps it might be possible to have multiple suppliers and a competitive market that different NHS bodies can choose between?

In summary the cloud is a fascinating topic that the NHS needs to address.

Meanwhile, from the practice's point of view, you need to be really careful about which cloud services you use - especially if there is any patient data involved.

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