1. Cloud Enabled Healthcare Presented by: Ron Parker and Stanley Ratajczak Emerging Technology Group Canada Health Infoway Inc. May 28, 2013Copyright © 2013 Canada Health Infoway Opportunities and Considerations

2. 2 © 2013 Canada Health Infoway Inc. Faculty/Presenter Disclosure Faculty: Ron Parker, Stan Ratajczak Relationships with commercial interests: Nothing to disclose

3. 3 © 2013 Canada Health Infoway Inc. Disclaimer This webinar represents solely the views of Infoway. It is intended to be informative only, and cannot be interpreted as providing any indication of Infoway’s present or future strategies or investment criteria. Infoway does not implicitly or explicitly endorse any particular technology or solution of any vendor or any other person, it does not guarantee the reliability or any proposed results related to the use of such technology or solution, and this notwithstanding that reference may be made directly or indirectly to any such technology or solution in this webinar.

4. 4 © 2013 Canada Health Infoway Inc. Agenda Cloud Computing in Canadian Health Care Introduce Cloud Computing Describe its features Illustrate relevance to health care A possible scenario for use Infoway key messages regarding cloud in health care Cloud as an enabler of innovation and sustainable transformation in health care

5. 5 © 2013 Canada Health Infoway Inc. Examples of cloud enabled solutions

6. 6 © 2013 Canada Health Infoway Inc. Introduction of “Cloud Computing in Health” The first in the Emerging Technology white paper series Designed to address cloud computing from a Canadian health care perspective Intended to: Scope and provide insight on the potential applicability and utility for this technology Provide some context for business opportunities and challenges Suggest some possible approaches Be a call-to-action for further focused conversations on this topic

7. 7 © 2013 Canada Health Infoway Inc. Next: The three major components of cloud 1. Computing infrastructure 2. Three service models 3. Four deployment models

8. 8 © 2013 Canada Health Infoway Inc. First major component of cloud computing 1.Computing infrastructure (network, CPU, storage) that is “virtualized”, meaning: On demand and self-service Broad network access Resource pooling Rapid elasticity Measured service

9. 9 © 2013 Canada Health Infoway Inc. Second major component of cloud computing 2.Three service models Cloud Software as a Service Cloud Platform as a Service Cloud Infrastructure as a Service

10. 10 © 2013 Canada Health Infoway Inc. Third major component of cloud computing 3.Four deployment models Private cloud Community cloud Public cloud Hybrid cloud

11. 11 © 2013 Canada Health Infoway Inc. How do I know what model to use? Each deployment model has different implications for use in health care: Degree of organizational control, transparency and accountability Governance of cloud use and infostructure Privacy and security of personal health information (PHI) manipulated or held in the cloud Capital expenditures versus operational expenditures Complexity of managing multiple cloud service providers to delivery highly available solutions

12. 12 © 2013 Canada Health Infoway Inc. Possible use scenario Community Chronic Disease Mgmt Care Collaboration Care Transition e-Referral Scheduling Health Region Hospital Home Care LTC Private Operational systems Clinical systems Specialized apps Public Reference Information Clinical Decision Support Social Apps (no PHI) Clinics / FP

13. 13 © 2013 Canada Health Infoway Inc. By the way: the EHRS Blueprint?

14. 14 © 2013 Canada Health Infoway Inc. Can be seen as Software as a Service Jurisdictional EHR Infostructure

15. 15 © 2013 Canada Health Infoway Inc. Cloud as an enabler The scalability and extensibility made possible by virtualization and service oriented architecture will be a critical success factors for coping with the proliferation of mobile devices and “apps” The pace of cloud adoption in health care is likely to quicken due to: Financial constraints Demand for increased agility in response to social and mobile drivers

16. 16 © 2013 Canada Health Infoway Inc. Privacy and security considerations All computing models have similar set of privacy/IT security risks and requirements, such as authorized access to information and information resources (e.g., consent, RBAC), cloud computing is no different Privacy and security issues are manageable, but must be “by design” and take into account cloud context Key privacy and security differentiators of cloud deployment models Level of transparency, oversight, governance, and management of privacy and security controls

17. 17 © 2013 Canada Health Infoway Inc. Generic privacy/IT security considerations Governance Data custodial responsibilities and delegation Potential externalization of oversight, accountability and compliance PHI aggregation/consolidation Shared data storage and IT resources Support for multi-tenancy business solutions Alignment of privacy/IT security requirements Defining privacy/IT security requirements and safeguards for PHI prior to choosing a cloud deployment model Assessing levels of assurance of IT security mechanisms

18. 18 © 2013 Canada Health Infoway Inc. Generic privacy/IT security considerations (cont’d) Confidentiality and integrity End-to-end confidentiality and integrity, especially in multi-tenant contexts Auditing, monitoring, compliance Data custodial responsibilities for auditing and monitoring Independent third party audits and compliance Risk management frameworks Appropriate risk management framework −Privacy impact assessments −Threat risk assessments −Vulnerability assessments −Result and remediation plan transparency

19. 19 © 2013 Canada Health Infoway Inc. Cloud as an enabler IT security in the cloud (SaaS) Typically greenfield deployments SaaS encryption Federated Identity Management Cloud-based authentication mechanisms Consent directives management solutions Enterprise mobile device and app management Secure e-mail (i.e., Government of Canada community cloud) Public clouds Use of anonymous or de-identified data can allow for −Big data analytics −Diagnosis options −Predictive analytics

20. 20 © 2013 Canada Health Infoway Inc. Key assertions Privacy/IT security risks and requirements are similar across all computing models; cloud computing is no different Privacy and security issues are manageable, but must be “by design” and take into account data classification and cloud context Key privacy and security differentiators of cloud deployment models Level of transparency, oversight, governance and management of privacy and security controls

21. 21 © 2013 Canada Health Infoway Inc. Key assertions Use of public clouds for storing and accessing PHI requires Serious consideration of risks End-to-end encryption and control over encryption keys Public clouds can provide value when de-identified data is used Many opportunities for cloud-based privacy/IT security solutions Greenfield deployments Must be interoperable with existing infrastructures

22. 22 © 2013 Canada Health Infoway Inc. Key assertions There are many opportunities for use of cloud in health Greenfield deployments in community settings or at program levels A necessary computing model for e-referral, clinical decision support, PHRs, chronic disease management and remote monitoring We need roadmaps and business cases to support the gradual migration of existing infostructures to private or community clouds and to determine how to deliver health care programs in a hybrid environment

23. 23 © 2013 Canada Health Infoway Inc. Key messages Cloud and SaaS are enablers for: Data anywhere User anywhere Use from any device Access anytime This is well aligned with the five Rs of: The Right information About the Right client Available to the Right person In the Right place At the Right time

24. 24 © 2013 Canada Health Infoway Inc. Discussion & Questions? Emerging Technology resource documents: https://www.infoway-inforoute.cahttps://www.infoway-inforoute.ca => resources => presentations => emerging-technology

25. 25 © 2013 Canada Health Infoway Inc. Thank you