Barriers to optimal use of Online Healthcare Apps

I’m a big proponent of software as a service (SaaS), application service providers (ASPs), and related “online application” technologies. Online applications make great sense in healthcare because of the network effect: they are inherently collaborative, they are designed for integration, and easy to install and begin using. However, we’ll have to solve the following problems before we can really call online apps a success in healthcare settings:

• Application availability offline — online apps are great but what happens if there’s downtime? In healthcare we need “always on” and high availability; if you use online apps what’s the offline usage strategy?
• Data Ownership __— what kinds of contracts, pricing, privacy, and other mechanisms are available to ensure that my data stays mine? If the online company ever goes out of business, is sold to someone else, or I ever want my data back without anyone else having a copy how would that happen? Who owns all this data in an online app is a big question and big problem that we need to resolve. How can you get your data in backup format that you could actually use?
• Single sign on (SSO) — in our hospitals we’ve strived to give our caregivers and front line users a single security credential with roles that could give them controlled access without remembering dozens of passwords. Most of us don’t have single sign on in our enterprises but are working towards it; with online applications we’ll be back to square one so what’s the identity management strategy that will allow online apps to be tied into our SSO implementations? Another problem is account provisioning — how do you establish that process on someone else’s system through your current help desk?
• Billing and usage — the more online apps we have, the more usage and billing will need to be tracked. What type of consolidated reporting and billing will be available to make sure that our finance folks can handle the apps?
• Workflow and business process integration — online apps are usually task oriented but they don’t integrate well with existing business rules, workflow, and policies. What standards can we start using to make sure that multiple online apps from a variety of vendors can start to talk to each other without us having to do all the integration work?

What do you think? What other major problems need to be solved before online healthcare apps become mainstream?