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Top Considerations for Choosing a Cloud EHR Infrastructure

Cloud EHR infrastructure options may be trendy, but is a remotely hosted electronic health record solution the best choice for your organization?

By Jennifer Bresnick

- More and more healthcare organizations have their heads in the clouds these days as they take advantage of what externally-hosted EHR technology has to offer. 

Cloud EHR infrastructure

From lower subscription-based prices instead of up-front implementation fees to less hassle surrounding upkeep and maintenance, cloud EHR infrastructure is becoming a viable choice for many organizations unsure about their ability to succeed with an in-house system.

But cloud EHRs aren’t always a trouble-free solution, and they may not be the best option for some providers looking to achieve specific health IT goals.

What are some of the top issues to consider when choosing whether or not a cloud EHR is right for you?

Picking a pricing strategy

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Many cloud vendors offer their software as a service (SaaS), which means that providers pay a recurring licensing fee to maintain access to the system and their externally hosted patient data.  While this may help to avoid a crushing up-front implementation fee that can range from thousands to millions of dollars, those monthly bills may actually start to add up in the long term.

In a recent Black Book Research poll, seventy-nine percent of providers said that they would consider a cloud-based EHR primarily because of their low initial costs.  However, forty-eight percent of small physician practices in the same survey said that the financial strain of implementing or switching to a cloud-based EHR has negatively impacted the stability of their revenue cycle.

Healthcare providers should take a cue from potential first-time home owners and ask themselves about the financial balance between renting and buying.  At what point does paying for SaaS access become more expensive than paying a one-time implementation fee? 

Understanding data access and ownership

Organizations may find that they are receiving added value from their cloud vendors that makes up for the long-term commitment to the scheduled fee structure, but they should also make sure they understand what happens when they wish to part ways with their service provider. 

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Some EHR companies – cloud-based and server-based build in convoluted data ownership clauses that leave healthcare organizations unable to access their patient data when a financial dispute arises.

2013 was a bad year for providers looking to replace their EHR systems with something better, as a series of data ownership questions made headlines and prompted the ONC to release an EHR replacement contract negotiation guide.

No matter what type of EHR is on the agenda for your organization, be sure that you understand the ins and outs of who owns your data, where it is stored, how to ensure continuous access in case of a disagreement, and if there are any fees involved in any of these situations.

Cloud security in the era of constant data breaches

Serious patient data breaches seem to happen nearly every day in the healthcare industry as hackers target rich hunting grounds and human error exposes organizational flaws. 

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Cloud EHRs generally enjoy a good reputation for security among providers, Black Book found, with ninety percent of providers participating in their poll believing that cloud technology may provide increased protection from data breaches.

But healthcare is subject to a number of industry-specific constraints that affect compliance and security in the cloud realm, chief amongst them being HIPAA

EHRs may be inherently tailored to the privacy and security needs of the provider segment, but complementary technologies, like general data storage offerings, communication tools, or business intelligence products, might operate across several verticals, and may not have healthcare’s concerns at the forefront of their designs.

When choosing a cloud-based service or product, healthcare organizations should be absolutely sure that their new business partners understand the details of HIPAA compliance and cybersecurity in the healthcare world.  Providers should also institute strong internal protocols and administrative safeguards to prevent human error from exposing sensitive data.

Are there interoperability and integration limitations?

One of the major benefits of cloud-based EHR products is the ability to use the same instance of the software across all sites.  Updates are often instant and painless for the individual provider, who can be sure that all her colleagues are using exactly the same system as she is.

That may make interoperability a breeze amongst providers using the same vendor, but it does not necessarily mean that your cloud vendor can play nice with any other vendor products on the market.

As providers start to make care coordination, health information exchange, and population health management strategic priorities in an era of value-based reimbursement, the ability to communicate and exchange health data with external partners is becoming a critical competency.

Some well-known cloud EHR vendors, such as athenahealth and eClinicalWorks, are taking part in industry-wide initiatives to increase interoperability across vendor lines.  But health information exchange struggles still plague the majority of providers looking to swap data with their peers.

Providers may wish to make sure that their potential vendors are staying current with industry developments in the interoperability space, and that they are not going to be locked into systems that use proprietary data standards to keep information stagnant.

Leveraging the cloud for big data analytics and population health management

Population health management is one of the most promising emerging initiatives for reducing costs and improving outcomes, but it is often stymied by poor interoperability and spotty access to key patient data. 

Since some cloud vendors hold their clients’ data in centralized repositories, they have access the large-scale datasets required to engage in big data analytics

A few cloud EHR companies, like Practice Fusion and athenahealth, have even released reports and tools that allow providers, government agencies, or the public to explore insights gleaned from millions of deidentified patient records.

The cloud has opened up promising opportunities for cancer research, precision medicine, clinical decision support, business intelligence, revenue cycle management, remote monitoring, and predictive analytics by offering providers a nimble and scalable solution for their storage and communication needs.

Before embarking on their population health management and big data adventures, however, providers should conduct an assessment of their current abilities, goals, data integrity shortfalls, and workflow restrictions to see if a cloud-based service or storage solution is appropriate for their needs.


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