"Cloud Computing" and Why It Matters to Public Health

Early time-sharing systems allowed users in a community to do their computing all in one place. “Cloud Computing” creates the same kind of functionality by supporting homogeneous access to applications and data in the internet “cloud,” creating a national, even international, community. This style of computing combines current notions of service orientation, virtualization, and standardization, and it can build on existing infrastructure such as the Public Health Grid. Because it is accompanied by a business model that minimizes up-front capital expenditures, it will prove attractive in some healthcare contexts. For example, small practice physicians can elect to pay for Electronic Health Record (EHR) use as a service on the internet, paying only for the resources they consume and reducing vendor “lock-in”. Outside healthcare, inexpensive applications that run on hand-held devices can be downloaded from the internet and manage small-scale, multi-user concurrency and micro-semantics; these applications serve as an example of what could be done in public health information gathering and use. Cloud computing will generate obvious challenges and opportunities for public health informatics. Among the challenges will be an escalation of the need for secure communications and storage especially when public health data is collected and transmitted using non-healthcare infrastructure. Among the opportunities is support for the use of EHR data standards to be mandated by the Secretary of Health and Human Services later this year, as required by the 2009 American Recovery and Reinvestment Act. These standards should be made available for download from, and runtime use in, “the cloud,” so that complying patient records created today can be interpreted in a standard way in the present and in the future. In related ways, cloud computing should make the experience gained with current, scalable, public health informatics efforts involving grids and service oriented architectures even more broadly applicable.