The comments below add significant thoughts to what I said – be sure to read them.

A lot of people are intrigued with using “cloud” applications and storage for personal health data. This week we’re seeing what I think is the final nail in the coffin of “cloud only” for anything important. You gotta have offline backups: two huge cloud vendors – Amazon and now Google – have demonstrated that even they can go down, leaving their users absolutely powerless.
Cloud applications diagram from Wikipedia

Cloud computing (Wikipedia) is hugely attractive to software developers and businesses. As shown in this diagram from Wikipedia, the idea is that you do your computing using storage or tools that are on some computer somewhere out there “in the cloud.” You don’t know or care where, because somebody out there takes care of things. As your business or database grows, “they” take care of it.

And it’s real – it works.

But when “they” screw up, you could be screwed.

Last month Amazon Web Services went down for a couple of days. PC Magazine posted a good summary, and many of us learned that well known companies like Hootsuite and Foursquare don’t actually own the computers that deliver their product: they rent services from Amazon Web Services (AWS). So when AWS went down, there was nothing they could do to help their customers.

Now the same problem has happened with Google’s Blogger.com (“blogspot”) blogs. For at least 48 hours the back end of their blogging system has been dead. For instance you can read my old blog (patientdave.blogspot.com), but when I try to log in to create a new post, here’s what I get:

Blogger Is Down screen shotZDNet reports that all posts and comments added since the problem started have “been removed,” a euphemism for “lost forever.” ZDNet asks, what keeps this from happening to other cloud products, like Google Docs? (What if you’d stored your business documents in Google Docs? What if your last two days of Gmail were lost?)

What’s the relevance of this to patient engagement? Well, a lot of people talk about cloud-based personal health records (PHR), and cloud-based medical tools. Here’s the lesson: For anything you can’t afford to be without, you gotta have non-cloud backups.

  • You gotta have offline data backups.
    • My personal website is built using WordPress; every day they email me a backup file of my complete database. I can’t lose more than a day’s work. It’s vital, it’s obviously not complicated software, and it’s free.
    • At my old day job, I used to manage a pretty big cloud-based database for our sales and marketing needs: Salesforce.com. Every week they emailed us a link to download a zip file of our entire database, plus a daily update.
  • For any “can’t afford to be down” situation, you gotta have ironclad availability.
    • Here at e-patients.net, we don’t rely on the cloud. Our WordPress blog is hosted on the highly reliable servers of one of our board members.
    • Salesforce.com has a  huge number of redundant server farms, and they’re totally transparent about outages and even degradation. To earn the trust of the corporate world, they published trust.salesforce.com. It displays the uptime, performance degradation and outages of every system around the world. Click on any symbol and see the root cause, how it happened, and what they did about it. (And you can subscribe to any RSS feed for all updates! Hey Google and Amazon, you gonna offer that?)

People I talk to tend not to “get” this unless it’s expressed as their kids’ medical record. A couple of years ago I spotted this message on the Google Health user forums:

Help – leaving for hospital – data won’t print.

I do believe in the cloud – it makes sense for many situations. It makes innovation far faster and less risky. But for anything important – which health is – you gotta have offline backups and you gotta be sure you won’t go down.

Of course, there’s an ultimate trap for anything online: if the internet goes down, the whole cloud goes down. That happens sometimes, and it could very well happen if an enemy hacked the Web. For anything mission-critical you have to consider whether you could afford to be offline for hours or days, and think out what you’d do meanwhile. (Same for power outages, which is why hospitals etc. have backup generators.)

All  this has been debated for years in the IT community, but once again the health IT world seems to be naive. As we consumer/patients (and health workers) start to acquire IT tools, we must insist that tools we rely on have sufficient reliability – even in a disaster.

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