More Discussion on the Cloud

EHR System Technical Functionality vs. UsabilityProposing New Terminology and Acronyms

William A. Hyman
Professor Emeritus, Biomedical Engineering
Texas A&M University, w-hyman@tamu.edu
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Recent discussion here about what being in the cloud really means inspired me to delve further into this issue, and to propose some new terminology (and acronyms) to better reflect the reality of cloud services.

In essence, everything you look at or use via a browser or related interface is a cloud service. A simple personal test of this is can you do what you want to do if you are no longer connected. A simple example of this is that if WORD is loaded on your computer, then you can type a document without an internet connection. However if you use Office 365 and have no connection then you can’t type a document. In this regard being cloud based means that one or more necessary components of the process do not reside on your computer, or on your organization’s hardware. The two key components in this regard are the software that you are using, and the data that using that software generates. In the software arena the software is owned and managed by a remote provider while you have access to that software, typically under a subscription or licensing agreement (with its associated disclaimers). In some circles this is called SaaS, or Software as a Service. It is good to remember that if you discontinue your relationship with the provider, or the provider goes out of business, or the host is temporarily down, then you cannot perform any of the functions that the software provided. Without the software you might also find that any work product generated using that software (i.e. data) is no longer available to you. Remote data storage means that your work product is stored off site somewhere, even if the software that generated that work product is running on a machine you (or your IT people) control. Such data can become inaccessible either temporarily or permanently depending on remote mishaps and the business relationship with and viability of the host. Related services are whether remote entities are actively managing some aspect of your business operations. This might include supply chain functions ranging from medical to vending machines, as well as things like building operations. All of these activities involve other entities having direct access to your system and/or your data, this creating HIPPA and other security risks. In this regard it should be remembered that in general responsibility cannot be contracted away, i.e. you do not get a pass on HIPPA violations because you contracted with an external source who assured compliance.

I propose that rather than the benign term “the cloud” we adopt terminology that better reflects the reality of what we have done when part of our computer based activities depend on contracted/licensed offsite hardware and software. One possibility is USES, or Using Someone Else’s Server. The challenges that this can present might be reflected in TDOT – Totally Dependent on Them, or OOMH – Out of My Hands; with the associated BTP – But They Promised. And for those that don’t quite understand what they have done there is BMU-Beyond My Understanding.