To Cloud or Not to Cloud?

In 2024, healthcare IT spending is expected to reach nearly $390.7 billion with cloud services predicted to reach up to 89.4 billion by 2027.

Laboratories can no longer ignore the cloud phenomenon that is taking place and must understand they do have considerable options regarding WHERE to house their servers, data, and applications but also HOW their LIS (lab information system) can be managed. Let’s dive into some options and where they fit within the pathology lab space.

It is important to mention that the term “cloud” may be referring to a number of things and may become confusing as organizations use it in many contexts. For the sake of this blog, we’ll dive into the options of cloud computing and cloud services as a term that encompasses multiple hosting configurations, varying software solutions, and multiple pay models.

Cloud Computing

Wikipedia defines cloud computing as the on-demand availability of computer system resources, especially data storage and computing power, without direct active management by the user. Large clouds often have functions distributed over multiple locations, each of which is a data center.

To understand cloud computing further, laboratory leaders will have to grasp the difference between public, private, and hybrid cloud environments as they are all not the same. Each type comes with its own advantages and disadvantages.

Public Cloud

In a public cloud, a lab would share the same hardware, storage, and network devices with other organizations or cloud “tenants,” and the lab would access services and manage your LIS using a web browser.

Advantages of public clouds:

• Lower costs—no need to purchase hardware or software, and you pay only for the service you use.
• No maintenance—your service provider provides the maintenance.
• Near-unlimited scalability—on-demand resources are available to meet your business needs.
• High reliability—a vast network of servers ensures against failure.

Private Cloud

A private cloud environment is used exclusively by one laboratory only.  The private cloud can be physically located at your organization’s on-site data center, or it can be hosted by a third-party service provider. But in a private cloud, the services and infrastructure are always maintained on a private network and the hardware and software are dedicated solely to your lab.

Advantages of a private cloud:

• More flexibility—your organization can customize its cloud environment to meet specific business needs.
• More control—resources are not shared with others, so higher levels of control and privacy are possible.
• More scalability—private clouds often offer more scalability compared to on-premises infrastructure.

Hybrid Cloud

Hybrid is what it sounds like. It is a combination of a private cloud with a public cloud. Hybrid clouds allow data and apps to move between the two environments.

Cloud Services

Cloud services can be described as any type of “services” that are delivered via the cloud.  Typically these types of services are segmented into three different categories; IaaS, PaaS, and SaaS. Microsoft describes each service as:

• Infrastructure as a Service (IaaS): The most basic category of cloud computing services. With IaaS, you rent IT infrastructure – virtual machines, storage, networks, and operating systems from a cloud provider on a pay-as-you-go basis. A lab leveraging only IaaS would be able to host their proprietary LIS in the cloud but would still need to manage and maintain their:
  • Application
  • Data / Runtime
  • Middleware
  • Operating System
  • Security
• Platform as a Service (PaaS): Supplies an on-demand environment for developing, testing, delivering, and managing software applications. PaaS is designed to make it easier for developers to quickly create web or mobile apps without worrying about setting up or managing the underlying infrastructure of services, storage, network, and databases. A lab leveraging PaaS would be able to host their proprietary LIS  but would still need to manage and maintain their:
  • Application
  • Data/Runtime
  • Security
• Software as a Service (SaaS): A method for delivering software applications over the Internet, on-demand, and typically on a subscription basis. With SaaS, cloud LIS providers host and manage the LIS, the underlying infrastructure, and the maintenance, like software upgrades and security patching.

Users connect to the application over the Internet, usually with a web browser on their phone, tablet, or PC.

NovoPath 360 – The First SaaS LIS

NovoPath 360 is the only platform on the market with 100% SaaS capabilities, giving users access wherever they reside without unnecessary IT complexities.

With an intuitive user interface, revised workflows to reduce the number of clicks, and a wide range of features to enable lab faster turnaround times, NovoPath 360 is enabling labs to offer more services to their clients.

• Automated case assignment for pathologists
• TC/PC support
• Accession to storage specimen tracking
• Library of pre-defined dashboards and reports
• Voice dictation
• Case auditing
• Whole slide imaging
• Easily attach images directly to a case
• Collaborate with pathologists across the hall or in another state
• Easily report to ontological registries and database querying tools
• Customize reports how you like them
• Quickly move from one screen to the next without having to wait
• Configurable security policies
• Automatically compile AP and molecular tests into a single case file and report
• Role-based profiles and settings
• Complete audit trail
• Automated stainer interfaces to reduce redundancy
• Release cases in seconds
• Pre-configured diagnostic codes and descriptions
• Two-factor authentication

Benefits of a Cloud LIS

IT Responsibility Shifts to Vendor

One of the primary benefits of moving to the cloud is that the primary responsibility for physical IT infrastructure goes to your LIS vendor. This typically results in less personnel expenses because of the reduced IT administration, and the shifting of the responsibility to the LIS vendor:

• Internet uptime and backup
• firewalls and network security
• data storage
• server and data backup
• remote access
• electric consumption
• electric power backup
• cooling and environmental controls
• security

It is important to mention that this benefit only materializes if ALL systems are moved to the cloud LIS vendor. In other words, if one or more systems must remain at the lab’s facilities this benefit goes away as the functions still need to be performed by a qualified IT professional and that leads to duplication of costs and efforts.

Universal Access

Increasingly, laboratories are utilizing a wide variety of mobile devices to access information—smartphones, tablets, laptops—from many geographic locations. Even if a laboratory, pathology group, or healthcare facility has multiple locations, data and intelligence stored at one location can be easily made available.

Decreased Start Up Costs

Obviously, not having upfront hardware costs and IT personnel on a full-time basis is one area of savings even when factoring in the services of an IT professional during the initial selection. A cloud LIS offers several pay models that are attractive in the short term. These include fixed-term contracts, subscription-based, and volume or usage-based pricing models.

HIPAA and Security

This is often cited as a major concern regarding the use of cloud-based LIS, because protected health information (“PHI”) is being stored outside the lab and, in fact, is being transmitted via the Internet, which increases security concerns.

Putting the primary responsibility of HIPAA compliance and security on the shoulders of the LIS vendor does not absolve the laboratory or pathology group from responsibility but it places a significant part of the costs and protocols onto the vendor.

Our recommendation is to ensure your cloud LIS is SOC2 compliant. SOC2 Complaint described by Google is:

“The SOC 2 is a report based on the Auditing Standards Board of the American Institute of Certified Public Accountants’ ( AICPA) existing Trust Services Criteria (TSC). The purpose of this report is to evaluate an organization’s information systems relevant to security, availability, processing integrity, confidentiality, and privacy.”