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Considering a cloud-based EHR system? Here's what to know

Implementing an EHR platform in the cloud can offer healthcare organizations lower costs and more accessibility, but they must be aware of connectivity and infrastructure drawbacks.

When a healthcare organization implements EHR software, a big point of consideration is whether or not the platform should be cloud-based. 

There are generally two models of EHR implementation. The first one is the client-server model, which has been the more popular option over the last two decades. This traditional model requires the EHR application to deploy to on-premises servers that IT or other technology vendors manage. End users such as physicians and nurses use software on their computers to access data that is centralized and hosted internally. The second EHR implementation model, referred to as cloud-based EHR, utilizes off-site servers hosted by the vendor and only requires a secure connection through the web browser or apps.

Due to the popularity of other cloud-based applications such as Salesforce, physicians and other healthcare professionals are actively seeking to evaluate the different EHR platforms available in the cloud. With this infrastructure model, most of the processing power and all the data resides somewhere outside of the medical group in a data center either owned by the vendor of the platform, or hosted on their behalf by Google, Microsoft, Amazon or other cloud providers. Buyers should be aware that some vendors mislabel their products, advertising them as cloud-based EHR, when in fact these products are hosted off site in a data center with thin clients or remote desktop utilities (not the same as a true cloud born platform that is being delivered as a true web-based system).

Benefits of cloud-based EHR

Faster deployment

Ease of deployment is a major benefit that a cloud-based EHR system can offer. A cloud-based EHR typically requires very minimal IT support -- with just the web browser on a machine or an app downloaded from the Apple Store or Google Play as a requirement, a healthcare organization can quickly get up and running in no time. 

EHR platforms are constantly undergoing updates and upgrades. Some updates are related to bug fixes while others are simply feature enhancements. In the on-premises EHR model, IT admins were traditionally responsible for updating the system and usually required downtime and IT resources to roll out the changes to the machines. With the cloud-based EHR model, the full responsibility for this is back on the vendor who often delivers the updates and upgrades behind the scenes without disrupting end users or requiring in-house IT involvement from the client side.

Cost flexibility

Due to the popularity of other cloud-based applications such as Salesforce, physicians and other healthcare professionals are actively seeking to evaluate the different EHR platforms available in the cloud.

The majority of the cloud-based EHR platforms offer their product in a subscription model, where buyers can purchase a license and pay on a monthly basis per user. This flexibility allows a healthcare group to either increase or reduce the number of licenses purely based on their user needs.

Some upfront infrastructure costs are still necessary to support and deploy the EHR platform. These costs include servers, network equipment, storage, backup systems and other IT fees. Fortunately, a cloud-based platform generally requires very little, if any, upfront infrastructure purchases since it is available as a service and no servers are necessary to deploy the application. The only common upfront costs are related to updating workstations and endpoint devices to support the modern and latest browsers required for a cloud-based EHR.   

Accessibility

For healthcare professionals who are constantly on the go, access to healthcare apps and patient data is critical. A cloud-based platform provides more accessibility than what the alternative products have to offer. In the case of true cloud-based EHR software, web accessibility is a native feature that requires no VPN or infrastructure investment outside of basic internet access. This makes the platform accessible to physicians and nurses both on premises and remote.

Simpler IT infrastructure

By eliminating the complex healthcare infrastructure necessary to host the EHR on premises, organizations can find that cloud-based EHR have very minimal requirements. All that these systems require from infrastructure are redundant and reliable internet connectivity and basic machines with compatible web browsers.

Better compliance and tighter security

Vendors typically invest more in security than what a medical practice or hospital would in an on-premises platform. Most of the popular cloud-based EHR software in the marketplace like Athenahealth, Practice Fusion, DrChrono and CareCloud all tout that their data centers meet most of the top regulatory compliance requirements of Sarbanes-Oxley Act, PCI and HIPAA.

Editor's note

With extensive research into the EHR market, TechTarget editors have focused this series of articles on EHR software with considerable market presence that offers a cloud-based platform option. Our research included Gartner, Forrester and TechTarget surveys.

Drawbacks of a cloud-based EHR

Lack of hardware integration capabilities

There are several healthcare specialties -- cardiology, dermatology, ENT, neurology, radiology, etc. -- that use medical devices to measure and treat patients. Most of the necessary medical devices  such as ECG, scale, PACS or fetal monitors require a computer connection via USB or serial ports in order to download the data to the EHR. Unfortunately, that can be a challenge for most cloud-based EHR software as many of these platforms rely on browser connections and may not support some of the peripherals and hardware that admins need to access the computer. This can be limiting for some groups as some of the necessary devices may not be compatible with a cloud-based EHR.

Data accessibility for third-party applications

Cloud-based EHR software generally stores the health information within a shared infrastructure that the vendor will host and manage. This forces the EHR vendor to eliminate all direct client access to the data and back-end systems to ensure client data protection and to avoid performance issues or data breaches. So far most of the vendors only offer access to some of the data via APIs. This method limits the opportunity for outside vendors to interact directly with the data in its native format and forces any third-party integration to be done at the vendor level and not at the practice or hospital level.

Interoperability

When the EHR system is hosted on premises, there are a number of integration and interface applications available to help with data exchange. However, cloud-based EHR systems have made it far more challenging to gain access to the health information due to increased security and concerns around systems that host multiple data sets for the different health clients. This forces practices looking to connect with their state or regional HIE to rely on the vendor to build those connections on their timeline rather than the timeline of the organization.

Data connectivity

The use of any cloud-based application is heavily dependent on a strong internet connection. This poses a challenge for healthcare organizations in some rural areas where internet connection can be spotty and unreliable. It goes without saying that a weak internet connection can have disastrous results for organizations that rely on a cloud-based EHR to access health records.

Cloud-based EHR platforms are becoming more commonplace as vendors turn to these systems to implement subscription-based models for their software. Healthcare groups may also consider it a less complex implementation option for their EHR system. Not only does the cloud-based model offer more benefits to healthcare professionals, but it helps give organizations a much more cost-effective and admin-free system to utilize.

This was last published in October 2018

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