HIT Service in the Cloud and Reasons for Redundancy

Posted Posted by Martin Peacock in Business Continuity, Cloud, High Availability     Comments No comments

After the Instagram Ts&Cs palaver, an interesting piece on cloud service terms, conditions and acceptable use.

Of course almost all Health IT – related cloud services are based on infrastructure provided by one of the underlying vendors – Amazon, Rackspace, Azure, et al.

It is possible “…simply because a customer, a politician, or even a competitor claims there are issues with your — or your customers’ — activities” for the underlying vendor to shut down the service being provided – in the article, based on on allegations of DMCA transgression.

But Health IT – particularly clinical services – may have a comparable achilles heel – the certifications such as FDA 510(k) and EU CE Mark.  It isn’t impossible for a given software product to be classified differently by different companies.  For example, I know of two vendors selling effectively the same product – one of which has it classified as CE Class I, the other, Class IIa.  The difference in effort between the two is not insignificant and depends entirely on legal opinion.  It is possible (I don’t think it has happened) that the latter vendor has used the difference in legal opinion to pressure potential customers to avoid the possible risk should litigation come knocking, but then, it is up to individual hospitals to consider that as a possible hazard.

But for competing services in the cloud – a small word in the right ear that the cloud provider (at the level of Amzon, Microsoft or Rackspace) is hosting services that are incorrectly classified and may be open to legal action – would certainly generate a phone call to General Counsel. And action may well follow.

Simon Phipps in the article linked above suggests 3 mitigations of varying degrees of ‘implementability’.  The third is part of what I would call Full Stack Redundancy – avoid single points of failure all through the hardware/software stack (at least where possible) – including cloud vendor.  Its a tough ask, but hey:

Shoot for the moon. Even if you miss, you’ll land among the stars

Les Brown


Devil’s Advocate

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