Do You Trust the Cloud for EHRs?

A blog post today by Microsoft’s Dr. Bill Crounse got me thinking again about the cloud.

Crounse cited a new CDW poll showing that 30 percent of healthcare organizations could be considered “cloud adopters,” and for good reason. “The flexibility, scalability and lower costs associated with moving certain line of business applications to the cloud are compelling, especially for an industry like healthcare. After all, the primary focus of hospitals and clinics is caring for patients, not running an IT empire. There’s not a CIO, CFO, CEO, COO, CNO, CMIO, or CMO who wouldn’t love to shift some of their IT spending to delivering better care to the communities they serve,” Crounse wrote.

They were more likely to turn to the cloud for “commodity” services such as e-mail, file storage, videoconferencing and online learning. “Moving your ‘commodity’ applications to the cloud is an excellent place to start,” Crounse said. “I’d suggest first reaching out to your health industry peers and professional organizations to get a better sense of who’s doing what. I think when you’ve learned about some of the best health industry practices in cloud computing, you’ll be ready to explore what might be possible in your own organization.

But the fact that 30 percent of healthcare organizations use the cloud means that 70 percent do not. I suspect a lot of hospitals and physician practices still run aging, legacy client-server management systems in-house, just because that’s how people did things when those systems were first installed. As they replace their legacy technology, expect more healthcare organizations to opt for cloud services for these commodity-type services.

And what about clinical services?

At HIMSS11 back in February, Athenahealth honcho Jonathan Bush, a longtime fan of the cloud, told me he wanted to lead the “Cloud Cavalry” into Las Vegas (there’s no better place for an over-the-top spectacle, of course) next winter for HIMSS12. (See the second video for that.) Athenahealth, which has a certified, cloud-based EHR, straddles the line between clinical and administrative, and it’s not alone. I can’t think of a single ambulatory EHR vendor that doesn’t offer at least a cloud option if not a full-fledged SaaS product.

But is the cloud truly reliable for critical applications such as inpatient EHRs? In the wake of April’s Amazon EC2 cloud outage, I can imagine more than a few CIOs, practice managers and, especially, physicians are a bit skittish now.

What do you think?

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Neil Versel

Neil Versel


  • Here’s what I know: a) most people (including the preponderance of executives) still don’t know what the “cloud” is or does, other than, “we use someone else’s stuff and save money”; b) most people are unaware of the functional limitations and security issues with cloud based infrastructure; c) a surprising number of people (including the author of this blog) confuse SaaS application hosting with cloud services, even though they are entirely different birds.

    Athena isn’t a cloud service at all (that’s a pure marketing ploy), they are a pure SaaS offering (we’ll let you run OUR software on OUR servers).

    While cloud services are maturing, there are still tremendous landmines in that landscape for line of business and mission critical applications. As CTO/VP-Engineering of a primary care start up I would LOVE to use a cloud platform, but that would be considered reckless endangerment.

    Instead, using really smart networking vendors, devices, and leading edge application architectures, we’re building a platform that is able to weather unusually high levels of failure and still keep running. Normal clouds and normal SaaS don’t provide that…they can’t unless it’s engineered into the entire software/hardware platform.


  • We are so obsessed to use dedicated hardware systems for any applications. When such a critical application infrastructure is planned some basic questions to ask to yourself. What if my server crash, what if my datacenter goes down. If you have answers for these, the same applies to cloud. Do proper planning of infrastructure the same way you do to your dedicated machines.

    You are on a better half on cloud that you dont need tons of hardwares and understand their MTBF. Cloud owners do for you these planning and charge it back to you of course as a shared cost.

    Which ever way you take your strategy, do your planning right for rainy days. Cloud is the future of Infrastructure and dedicated server management is going to be on the rise in coming years. So it a matter of early adopter or a follower.

  • Mike,
    I think most people would include SaaS based offerings within the definition of having your EHR in the cloud. This isn’t to be confused with Cloud Computing which is what I think you’re referencing.

    You hope that the EHR vendor did proper cloud planning for you. I’d be careful to investigate what your cloud EHR vendor actually has or hasn’t done. Done right and it’s more reliable and effective than an in house server. Done wrong and a practice has cause for concern.

  • Chiming in a bit late here…but as much as I wanted to purchase a system that was ‘cloud’ or SAAS based. I found the limitations for customization to be a huge deterrant. When asking ‘said’ vendors about the adoption of a new third party application or addition of new decision support tool it was always met with “we can’t do it” Or at best “we would have to poll our other users and if a majority agreed to wanting the feature then the vendor would commence the start of the new addition. Depending on the situation sales reps relayed that it may take up to a year.
    Were these sales reps misinformed or could this be the standard expectation from a SAAS product?

  • Tammie,
    The better question you might want to consider is, could an in house EHR be customized any more? Be very careful if there answer is “they could.” Also, if they say they can, then be sure to ask them how much it will cost. If it’s important, it should even be detailed out in very specific details what they’ll deliver and at what price.

    For example, not all interfaces are created equal. Is it a one way interface? Is it a 2 way interface? Which details can be interfaced? Will the other company you want to interface with work with the EHR you chose?

    My point being that the issues you describe could be as much of a challenge for any EHR company.

    To answer your question more specifically, a cloud or SaaS based EHR could allow for the customizations and interfaces you describe. However, they need to have a robust API that would allow you to extend their product. From what I’ve seen so far, not many of them offer this…yet? A few more in house EHR companies offer it, but still not many. Part of the reason many don’t really offer it is that it sounds cool, but is a lot of work and expense that most doctors don’t want to incur. Most just want out of the box functionality.

  • John,
    Did you ever hit the nail on the head…Be very careful if there answer is “they could.”

    I studied, read everything out there, knew the ‘sales ploys’ but worn down with indecision, and yrs of time invested, I fell for it! They ‘can do’ it all according to representative and his jargon speak explaining possible scenarios sounded impressively knowledgeable and bam! I (and others) was sold.
    Now I need a support group for those who have EMR remorse (likened to Buyers Remorse).

    Am strongly considering trying to find a freebie or close-to EMR and loading in all the forms and never looking back. We truly are in a nightmare implementation.
    Sorry to unload on everyone…

  • Hi Tammie,
    You’re not alone for sure. Actually a site called EMR Remorse would actually do very well I think. Maybe I should start one. Only problem is that it would be prone to spam.

    I know some therapists at a place called Hendricks Therapy that could help;-)

    What you describe about switching to a free EHR and not looking back is what the doctor who writes at did. A lot of EHR vendors have told me that they’re best customers are those that are picking an EHR for the second time. Not a very good consolation, but shows how common it is.

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