Informatics became an important component of healthcare, especially after the introduction of the Quality and Safety Education for Nurses (QSEN) project, with the information technologies being used to ensure the provision of quality care and manage the work of clinics and hospitals. However, the degree to which the personnel of the health facilities are familiar with them differs, which makes it difficult to assess the effect of information technologies on the nursing practice efficiently. In particular, cloud solutions are among the most recent additions to the tools used by nurses and physicians in the course of their everyday work. As a result, their role in the improvement of the provided care quality still needs to be identified. Therefore, it is necessary to review the contribution of cloud solutions to the QSEN project, as well as identify the most considerable vulnerability area of this technology and propose the ways of mitigating the negative effect it may have on the nursing practice.
Cloud Services and QSEN
The cloud computing is a relatively new concept in healthcare that was introduced not long ago. However, despite this fact, the tool is used in numerous spheres of application, with it making a considerable contribution to the implementation of the QSEN initiative. Such effect of the cloud services stems from the fact that the possibilities they provide complement the key principles of the mentioned initiative (Hayn & Schreier, 2017). Naturally, the most obvious of those is informatics due to the direct connection between cloud solutions and information technologies, which impose certain requirements on the expertise of the medical staff (Kelly, Vottero, & Christie-McAuliffe, 2014). However, the impact of this technology is not limited to the described competency as it also positively influences various fields of activity of health professionals.
First of all, cloud solutions can become indispensable for patient-centered care, specifically when it comes to providing support to the patients in terms of maintenance of their health status. In particular, the healthcare facility can utilize cloud solutions to provide its clients with instant access to the relevant information in the form of the personalized health records. In turn, they make it possible to create a foundation for the efficient patients’ self-management, thus encouraging the improvement of the health level of the nation in the long-term perspective (Griebel et al., 2015). Such activity can be particularly effective when dealing with the population that is not covered by any kind of health plan and thus has no opportunity to visit a clinic or a hospital frequently enough (Hayn & Schreier, 2017).
The technology of cloud solutions also contributes to the use of a multidisciplinary approach, which is also a competency of the QSEN initiative (Kelly, et al., 2014). For example, this technology is used to store and share the information obtained in the course of a clinical research conducted by various healthcare professionals (Griebel et al., 2015). Such exchange can become particularly efficient in case the latter utilizes a customized network dedicated solely to the scientific purposes. Moreover, this technology also contributes to the efficiency of evidence-based practice as the data required for the efficient treatment of particular health conditions can be obtained much faster due to a considerable amount of computing resources it presents, as well as the ability to share the findings quicker.
Finally, the efficient quality improvement can also be achieved with the use of cloud solutions. In particular, the latter can be utilized for the creation of a service delivery framework on the basis of a given healthcare facility. In this case, the resources (data, software, etc.) can be shared between the departments in a clinic or even between several hospitals. Such approach would be especially beneficial for the smaller facilities that operate in collaboration with the larger ones as their expenditures associated with the investment in the new tools and their subsequent maintenance will be much lower than usual (Griebel et al., 2015). In turn, the existing situation may provide an opportunity for the more efficient allocation of financial resources, allowing the clinics to direct their efforts to the improvement of the provided care quality, which is particularly important under the conditions of the pay-for-performance model (Hayn & Schreier, 2017).
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Negative Effect of Cloud Services
As mentioned before, cloud services provide a wide array of benefits to the healthcare industry, especially in terms of the implementation of the QSEN project. At the same time, their efficiency is aggravated by the negative effect associated with the information security. In particular, the environment of the cloud computing programs is primarily controlled by the provider instead of the users, which may compromise the safety of the data stored there, thus affecting the security and confidentiality of nursing practice (Bahga & Madisetti, 2014). As a result, it is possible to review several scenarios associated with this negative side of the cloud solutions. The first is the theft of the confidential information (patient data, research findings, etc.). This issue is common for any organizations with an IT infrastructure, but the cloud model opens up the new lines for the attack on its users (Bahga & Madisetti, 2014). Specifically, in a database with multiple leases, namely the one that is used by the several healthcare facilities, the flaw in the application of a single client can make the private information accessible to the attackers (Bahga & Madisetti, 2014).
The next challenge posed by the cloud solutions consists in the potential data loss that is not associated with theft. For example, in case the cloud service provider fails to take the proper backup measures, the valuable files can be accidentally deleted. On the other hand, the users that encrypt the information before uploading it to the cloud may suddenly lose the encryption key, making the former unusable (Bahga & Madisetti, 2014). The problem is exacerbated by the relative novelty of cloud solutions in general, which results in the use of inappropriate interfaces of software or API to manage and interact with those, and this is what subjects the facility to a number of security-related threats. Moreover, the organizations and third-party contractors often use cloud interfaces to provide additional services, which makes the latter more complex and increases the risks associated with the integrity and security of the confidential data stored in the cloud (Bahga & Madisetti, 2014).
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The probability of an insider attack is also quite high, especially for the systems that rely solely on the cloud service provider in terms of information security. Under such conditions, even the use of encryption does not guarantee complete safety as the keys would be available to the healthcare professionals only for the period of the data use (Bahga & Madisetti, 2014). Additionally, in any cloud delivery model, a threat of vulnerability through shared resources is quite significant. In case the key component of the shared technology, for example, a hypervisor or an element of a common platform is hacked, it puts at a risk not only the affected user, but other stakeholders as well. In fact, the entire cloud environment becomes vulnerable to the attacks that may compromise the information security of a healthcare facility as a whole, resulting in data leaks and loss of the important information (Bahga & Madisetti, 2014).
All of the described issues have a negative impact on the nursing practice. On the one hand, the loss of the confidential data of the clinic’s clients may result in the lowering of the credibility to the latter, with the patients filing lawsuits against the medical personnel as the stolen information may present a threat to their well-being. For example, by obtaining credit card numbers, the attackers may gain access to the financial resources of their victims while the disease history can be used for the purpose of blackmailing. On the other hand, the loss of research-related information may hinder the evidence-based practice in the facility, along with creating obstacles to the efficient and productive collaboration between the healthcare specialists (Hayn & Schreier, 2017). In both cases, the situation with patient outcomes is expected to worsen due to the lack of data on the effective treatment. Thus, the negative effect caused by the use of cloud services in healthcare is primarily associated with the existing contradiction in regard to one of the core competencies of the QSEN project – the patient safety (Kelly, et al., 2014). As a result, the implementation of this initiative may become hindered, meaning that the process of the continuous improvement of the provided care will be stopped. Under the conditions of the pay-for-performance model, this implies that the clinic will stop receiving incentives associated with the high quality of the medical services, resulting in a strain on its budget, the insufficient allocation of financial resources, and consequently, the worsening work conditions of healthcare professionals (Hayn & Schreier, 2017).
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Mitigation of the Negative Impact
For the cloud services to remain a valuable asset in the healthcare industry, it is necessary to mitigate their negative effects on the nursing practice, ensuring the proper protection of the patient and research data. Apart from taking some general measures, such as choosing a reliable provider, it is necessary to take actions at the level of the clinic management to prevent the scenarios involving theft or loss of the private information (Bahga & Madisetti, 2014). The first measure consists in the creation of a protected cloud server for data processing, with the subsequent transfer of the necessary files to the new storage. Provided that as a result of this process, the data is stored outside the physical access area of the clinic staff, it is necessary to ensure its protection from unauthorized users (Hayn & Schreier, 2017). The latter can be provided with the help of full encryption of the virtual disks. In case the data needs to be accessed, it is decrypted during reading, and then again encrypted when writing to the disk. Such approach will help to avoid the situations involving the long-term storage of the unencrypted information by service providers, especially in the form of backup copies (Bahga & Madisetti, 2014).
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At the same time, the encrypted data storage alone cannot provide the necessary level of information security. In particular, the reliance on the multidisciplinary approach to the provision of patient care results in the need for sharing the research information on the regular basis. In this case, that latter is transferred in an unprotected form, so that without integrity checking, the risk of its loss increases significantly. As a result, the encrypted transmission becomes an obligatory condition for the secure processing of information stored in the cloud (Bahga & Madisetti, 2014). In the healthcare industry, a combination of encryption and secure transmission technologies can be regarded as the most viable choice due to the highly confidential nature of the patient data (Hayn & Schreier, 2017). Currently, most of VPN and SSL protocols use digital certificates in the process of authentication. It allows health professionals to check the identity of other users even before the data transfer begins. Virtual hard discs are normally used to store the certificates. It means that they can be used only after verification of the system integrity by the main server. Therefore, such a chain of interdependencies will allow data to be transferred only to those cloud servers, which have been pre-tested (Bahga & Madisetti, 2014).
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It is also necessary to indicate that the problem of information security in the cloud is very extensive. Much attention should be paid to the context, in which the servers tend to operate. For example, in case of the outer clouds, the nearest neighbor may be the main competitor, meaning that the medical personnel of the clinic should initially be aware of being in the enemy territory in order to implement the appropriate security measures timely (Bahga & Madisetti, 2014). Additionally, the promises made by the providers of cloud services should be treated with caution since the legal responsibility for the data safety and its loss usually lies with the users (Hayn & Schreier, 2017). Thus, the protective activities must be comprehensive in their nature.
Despite being a relatively new technology, cloud computing has numerous spheres of application, including the field of healthcare, especially for the entities that are familiar with the principles of its work. The introduction of the QSEN initiative has increased the value of cloud computing even further due to the latter’s ability to complement the core competencies of this initiative. However, the benefits provided by this technology are somewhat aggravated by the risks associated with its use on a regular basis, especially the ones related to the security of data used in the course of patient education and treatment. Data theft or loss is likely to present numerous threats both to the facility and its clientele. Because the patient’s safety is considered to be one of the core competencies of the QSEN initiative, the described issue cannot be ignored. Therefore, the personnel of the healthcare facilities (both managers and nurses) are to take a range of specially designed measures to prevent the undesirable scenarios described above in their performance. These include the creation of a separate, protected server for data processing, encryption of all the information utilized by the healthcare facility, and the mandatory integrity checks during the transfer of the files. Provided that the patient and research data are protected properly, one may expect the cloud services to become an integral part of the modern healthcare industry, with this technology being used for a wide array of purposes, from scientific research to quality improvement.