Making The Case For Cloud-Based Storage

Wake Forest School of Medicine is comprised of a Level 1 trauma center which receives more than 100,000 emergency visits a year and an academic program with 40 residents and 25 faculty members. Wake Forest was using antiquated processes to make medical protocols and administrative information available to physicians which resulted in the loss of critical information. Additionally, these systems were not integrated with the physician’s mobile devices, resulting in vital exam time being lost as doctors were forced to leave the exam room to find a room with computer access to search for relevant information.

Resident physician Illtifat Husain, who had used Box cloud-based storage as a medical student, suggested the cloud-based storage provider to James O’Neill, M.D., assistant professor, Wake Forest Baptist department of emergency medicine, as a possible solution. After testing by a select group of residents and faculty, Wake Forest chose Box for all its cloud-based storage needs. This Q&A with O’Neill and Box health advisor Missy Krasner looks into the reasons why Box was selected and the results Wake Forest experienced.

Q: What was your understanding of what Box was going to provide prior to implementation, and are they in line with what you received?
O’Neill: We knew Box would provide us with unlimited storage, ease of use, asynchronous communication, and security for shared documents. We could do a lot of that on a website, but Box requires no programming or lockdown security while allowing us to seamlessly use our mobile devices. We had to ensure our IT department we would not put patient information on the cloud – even though Box does that very well and protects the information. We expected all of this, but have been pleasantly surprised by upgrades that have come at no extra charge. In fact, we are going to expand our number of seats to increase the educational value and, while we originally intended to use Box for residents only, we’re going to use it with our physician assistants and nurse practitioners.

Q: How are you currently leveraging Box technology?
O’Neill: We are using Box primarily for sharing educational documents, PDFs, and lecture video, and we have also been able to use the discussion feature to have asynchronous meetings on topics that affect our faculty. It is difficult, even in a faculty meeting, to get everyone together. It is even more difficult to hear everyone's opinion on a specific topic. Box has made it easier to read each other's thoughts and have time to digest what the other members are saying. Obviously, face-to-face meetings are essential, but this technology allows more voices to be heard, especially if someone is more comfortable writing their ideas rather than speaking in front of a group. We are also using Box for asynchronous learning by utilizing the discussion function to have an educational interaction between residents and attending physicians. The discussion capability is particularly important because our Emergency group has multiple campuses that do not share the same IT infrastructure and Box enables mobile learning at home and at other centers. We also plan to have Box store training videos and PowerPoint presentations for our PA and NP staff and we are going to use our ability to share links to training materials without having them have full access to Box.

Q: Box reports more than half their healthcare customers who use mobile devices access documents on the iPad – are these numbers in line with what you see happening at Wake Forest?
O’Neill: Yes, although a lot of our people use Droid and iPhone more than iPads. But we do have a number of iPad users and Box works very well on them with documents and videos, and sharing PDF files and information when away from a desktop has become much easier. We really had no mobile capabilities with the SharePoint version that we had access to. Many of our faculty were using their devices for secure email – sharing the documents just became easier. The nice thing is that we don't have to use only Apple products – Droid works just as well and the app is seamless and free for all devices. It has been incredibly easy.

What were the unique problems that SharePoint and email caused and how did Wake Forest overcome them?
O’Neill: With email, we were able to have a discussion chain, especially with our asynchronous meetings, but it was hard to keep a record of it many months into the future. That’s no longer the case. We also often discuss proposals contained in documents. The documents kept on Box are easily accessible and can be previewed and not necessarily downloaded. SharePoint was a non-starter and we didn't find the discussions remotely user friendly.

Q: How has the staff reacted to the implementation of Box?
O’Neill: Our goal was to spend less time in front of our computers and tablets and more time with our patients. Box has had a direct impact is in the Emergency Department where there is now more rapid access to educational documents, an impact that will be felt even more as residents and attending physicians get comfortable with the technology. We have made access to training materials, schedules, online discussions, and meetings more accessible through box. It is hard to measure and prove if this has led to more time with patients, but we do know that we save time on many small tasks. When these tasks are multiplied by 100 people, there is definitely time savings.

Q: The jury is still out on cloud-based storage with the demise of Revolution and Google Health countered by the early success of Blue Button. With a shaky past and uncertain future, why utilize cloud-based storage now?
Krasner: Healthcare is still struggling with the interoperability juggernaut. The government is doing a lot to drive simple file transfer and data exchange in healthcare industry, but overall we are not there yet. What Box is good at is providing secure access to files in a “one to many” fashion. This allows healthcare customers to use Box for whatever their daily workflow requires: from sharing files within or beyond the healthcare enterprise, to mobile access to health information on any device, to care coordination.

Q: Box generally allows for the secure storing and sharing of static content in the cloud. How do you envision edits, communications, and additions to this information make its way back into the patient’s electronic health record?
Krasner: Box is still very early on in its thinking about medical record exchange with regard to simple file transfer. As of now, users can upload any type of file format into Box. Within the Box UI, users can add comments or assign tasks in a social stream that surrounds the piece of uploaded content. Box also allows users to directly edit certain file formats with its editor feature and includes feature that lets users edit files directly from within Box – in one click the document saves back to the cloud seamlessly and users don’t need to download a file to edit. But with regard to medical record edits, Box may look to industry partners and apps to help think about this use case, especially around flagging provider edits to protect the authenticity of the original medical content.