Safe among the clouds

Benefits that private cloud technology can bring are being recognised and applied by the NHS, reports Fleur Doidge

With all the publicised losses of confidential personal data in recent years, one could be forgiven for thinking that the last place for the NHS to put patient data would be in the cloud, albeit the private cloud.

However, an e-health pilot that puts such data into a private cloud - which holds fewer fears around privacy and security for users - is nearing completion.

Scottish cloud software and services provider Flexiant has provided its cloud platform Extility for a research project that, according to the vendor, promises NHS patients complete control over their medical records and gives them the power to decide who has access to their data.

Tony Lucas, founder of Livingston-based Flexiant, says that services are shared in this private cloud system, but the patient actually has more control.

"Hosting the data in the cloud as soon as results are published means that the patient can go online and access them, sharing them in real time with everyone who needs to see them," says Lucas. "They will be able to invite their GP, consultants, health carers and family members: people they trust and who need to know the results. This has massive implications for the future of patient treatment in the UK.

"For the first time, patients can have control over their treatment and their records, and that is enormously empowering."

The E-health Cloud pilot, in development for the past 18 months and now under way at London's Chelsea and Westminster Hospital, is due to go live in September. The project is promoted as the first large-scale UK deployment of the cloud in e-health.

Clouding the issue

The data goes straight into the pilot's private cloud, which makes it easier for patients, GPs and hospital consultants to communicate with each other. When communications are faster and more efficient, cost is not only reduced, but response times - and therefore treatment and final prognosis - should also improve.

Researchers at Chelsea and Westminster are working with Edinburgh Napier University and Flexiant on the next-generation e-health project. Bill Buchanan, professor of computing at Edinburgh Napier University, is one of the project leads.

"This is an e-health platform that exists within the cloud infrastructure. It is private cloud, so cloud computing is easy for us because we can just keep putting the servers in and grow the data," says Buchanan. "There is a bit of negativity in the market just now, where they think of cloud [simply] as the internet. It is really a cloud of computing power and storage, like a utility."

Private cloud infrastructure could offer users secure and private access to information in a dynamic, scaleable fashion, in the same way that electricity providers source power from the national grid. Just as the launch of the grid boosted access to electricity all over the nation, private cloud infrastructure promises vastly expanded access to information on an as-needed basis.

"We can move the platform from one physical location to another quite easily," adds Buchanan. "In a lot of computing systems, it is difficult to take it all away from the hardware and actual machine. It is a heavily secure environment, and we have made sure it is locked down. No machine can get access unless it has proven that it has the rights to be able to do so."

Concerns about patient data being easily accessed and thus relatively insecure are misguided, he suggests. Private cloud with tight authentication and access procedures is just as secure as on-premise, traditional IT data storage. A demonstrably high level of patient record security will, unsurprisingly, be critical to the success of the pilot, so Flexiant is deploying a multi-factor authentication process on the demonstrator that builds on and integrates with existing NHS IT security systems.

Private cloud also offers a major advantage that on-premise simply cannot match: the ability to untether from the physical technology and location. Another benefit is that it removes the need for a great deal of paper documentation.

Eventually, says Buchanan, a new e-health cloud system has the potential to solve many existing problems with electronic patient records in the NHS, including a lack of common patient record standards and the inability to share records between different parts of the health and social care domains.

Even further down the track, the system could be used to integrate all phases of healthcare treatment, from assisted living to primary and secondary healthcare, so the same data can be used throughout.

This dovetails neatly with the current public sector drive towards shared services, a goal that offers the promise of massively slashing public sector administration and IT costs while maintaining - or even improving - services.

"The current infrastructure in the UK often has a non-integrated approach to patient care, where data is not used effectively between GP, hospital and assisted living," says Buchanan.

"Our system allows for data to be stored with its context, such as information about where it was captured, and then used in whatever way is necessary through well-managed clinical services. Security is integrated into every single transaction, and we host it on Flexiant's cloud to give us a scaleable and robust e-health infrastructure."

The two-year pilot project is being funded by the Technology Strategy Board and the Engineering and Physical Sciences Research Council. Buchanan is working with other key players, including professor Derek Bell, clinical lead at Chelsea and Westminster; professor Christoph Thuemmler; Dr Lu Fan; Dr Elias Ekonomou and Owen Lo. The e-health platform has been created as both a private e-health cloud within Chelsea and Westminster Hospital, and also as a public demonstrator on the Flexiant public cloud.

Working together

The demo system simulates patient records taken in triage, with clinical information that includes body temperature, blood pressure, oxygen saturation and the like. Real patient data will not be used in any trials, but only if and when the system is rolled out in full after testing and development are complete, Buchanan says.

"The system produces an early warning score. If you go into A&E, they test you and come up with a numerical score, which is part of your risk assessment," he says. "They check up on this score and see if the risks are increasing or reducing. So you are provided with that as part of clinical services, which allows them to look at your risk over time. When it goes to amber, and red, you may be referred to a consultant."

Clinical staff have been directly involved in the design, adds Buchanan, which is meant to reflect current best practice in the emergency department. When the system goes live, patients will be able to access their own records in real time. Clinical information and data will be accessible on the go from a range of devices, including smartphones and notebooks.

It is hoped that the efficiencies and accessibility inherent in the system now being tested will boost public trust in next-generation healthcare, as well as genuinely improving the current system.

"It will get everybody working together," claims Buchanan.