"Our cloud strategy is to create private clouds that are more reliable, more secure, and cheaper than public clouds for those applications which require higher levels of availability and privacy," says John D. Halamka, chief information officer of the world-renown Beth Israel Deaconess Medical Center in Boston, as reported on his blog, Life as a Healthcare CIO. "For those use cases where the public cloud is good enough, we're considering external solutions."

Halamka, who also is CIO at Harvard Medical School and supports 3,000 doctors, 1,800 faculty, and 3 million patients, added, "Someday, it may make sense to move more into the public cloud, but for now, we have the best balance of service, security, and price with a largely private cloud approach."

And thus one of the biggest debates in healthcare continues to be fueled: private versus public cloud?

Halamka chose a private cloud or virtual infrastructure that is securely controlled and operated by his organization, versus a public cloud, provided by an external entity. For many practices, the private cloud has numerous advantages over a public cloud.

Putting data on a private cloud has geographical certainty – there's no doubt where your information is – and you have a say on who has access to it and for what reason and what credentials are needed to access that data, says Bahman Saless, founder and CEO of Earthnet, a Boulder, Colorado-based data center. "A private cloud can have all the bells and whistles of the big public cloud related to file sharing and communication and business efficiency but with much higher security."

This is compared to the big public cloud solution providers which may have limited control of what happens to your data when, for example, the hard drive holding your data fails. "Who replaces it? Which country is the server located in? Who has authority over the correct deposition of the hardware and the data on it?" says Saless, who gives these as possible problem scenarios with a public cloud.

Physicians' HouseCall is one practice that is using a private cloud with a server-hosted EMR that is using the technology quite successfully, says Saless, who adds that the data center hosting any private cloud should have all the redundancies needed to ensure high availability and uptime.

"Redundancy in backbone, cooling and electricity are the most important items. How does your cloud react to an outage or a brownout? You want your data to be available to your colleagues at all times. A patient's life can depend on how quickly one can gather medical records about him," Saless says.

When establishing a private cloud, Saless gives these tips:

• Find the right IT partner and leave the network strategy to your IT partner.
• Communicate your individual needs for establishing a central information bank that only selected personnel can have access to.
• Establish a high bandwidth connection, perhaps through a VPN, with your cloud server which will allow a direct link to your system for access and local backups.