Power of the Cloud EHR – Hidden Technology

Today’s post will be short. I’m hitting up the Black Hat conference in Las Vegas today and tomorrow. For those not familiar with Black Hat, it’s a hackers conference. It’s not quite as hardcore as Defcon when it comes to hacking, but they warn you about getting your devices hacked. I personally plan to play it safe and not bring my laptop and to turn my cell phone off. Anyway, hopefully I’ll do some future posts on security based on what I learn at the event. I always find deep value in going to a conference that doesn’t apply specifically to what I’m doing. Although, in the past they’ve had some medical device hacking sessions, but I digress.

The title of this post describes a concept I was recently considering. In fact, it was inspired by a comment on a previous post by Suzanne McEachron, that talked about a clinic needing to upgrade their in house EHR server from Windows Server 2003 to Windows Server 2008. Here’s the full comment:

Your statement, “While it’s sometimes disappointing to look at the old technology that powers healthcare,” must refer to an ambulatory vendor I am aware of, which installed its software onto a Windows Server 2003 just 3 years ago, and is now demanding the provider upgrade to Windows Server 2008. The provider wants to upgrade to Windows Server 2012, but the software company’s software won’t reliably work (yet) on that version. What is a poor country doctor to do?
He will be dumping his current vendor and finding a software company which uses the cloud instead of servers in his office.
Companies which continue to not keep up, will be left with few customers.

The last two lines are probably worthy of their own post. So, we’ll mostly set them aside for now. However, I was struck by Suzanne’s comment that they would be going with a cloud solution after this experience with an in house EHR vendor.

I’d never thought of this before I read this comment, but is one of the benefits of a cloud EHR that the user has no idea what type of back end technology you’re using to deliver the software? Sure, some of them will ask some questions during the EHR selection process, but I’ve never seen anyone ask a cloud EHR vendor how they’re doing at keeping their technology stack up to date. The reality for end users is that they don’t really care what technology is being used. They only care about the end result. Does it work? Yes. Is it fast enough? Yes. Then, since it’s in the cloud, who cares what technology is being used?

Of course, this may be exaggerating the situation a little, but not much. Certainly very few if any people are asking cloud providers how they’re doing at keeping their technology up to date. No doubt some do care about this and run into this problem even with cloud providers. My favorite example of this is when a cloud EHR provider requires a clinic to use an extremely outdated version of IE (internet explorer) to run the EHR. Yes, then they start to care a lot more.

Maybe it’s a mistake that practices don’t keep after their cloud provider more. However, the reality today is that the don’t. That makes it a huge advantage for cloud EHR providers. At least it does until they’re so outdated that they can’t hide it anymore. For example, when they can’t launch an iPad app because there’s no way for their old technology to work with it. Sounds like I need to create a new jokes series called, “Your EHR might be outdated if….” The problem is the jokes won’t be too funny if you’re suffering through it.

Side Note: So much for it being a short post.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • A short suggestion for a short post…

    Make sure your cloud EMR server is not based on Windows!!!

  • From time to time I’ve been involved in purchasing IT or related services for whatever bank I was working for at the time. If you do this enough, you learn a lot about the possible problems that come up.

    Clearly, how a vendor keeps its technology up to date is even more critical now then in the past given the constant attacks on web sites and communication portals. It’s also about what level of support they provide not just to end users but also to their own systems.

    In one case, we were choosing a financial derivatives trading and processing system. The one we liked the most was far ahead of others in usability – but it was also a very small startup with no track record and an extremely small staff, which for us would have created a very risky situation. We ended up staying with our existing vendor with a system we really didn’t like because they did have adequate support, and we knew the system worked.

    I’ve also encountered vendors – in the Financial Market Data world, that had very nice trading systems, but which were completely non-compliant in terms of data licensing and redistribution, and had no plans to fix the problem. Kind of like an EHR vendor that could care less about HIPAA – completely unacceptable even if the systems were otherwise fantastic.

    Another vendor problem in the ‘cloud’ – are their DR and primary facilities secure against break-in (both electronic and physical), fully backed up both in terms of data and power, and far more.

    We’re only scratching the surface here – but Financial IT has been dealing with these problems a lot longer then HealthIT, and we can tell you – you had better know what you are doing in vendor selection and contracting!

  • @R Troy
    What you are describing is the classic “choose IBM or else” issue.

    When making a choice of vendors (in about anything), generally the person in charge of making the choice will go with that big known vendor, because, “your not going to be fired for choosing IBM”.

    In the medical world you can list half a dozen EHR vendors that could be in place of IBM.
    The same goes for various other medical services.

    And yes, the medical IT world could learn a lot from the financial IT world.

  • Let me throw one more cloud thing out there.
    Putting aside all the asinine sales pitches that push the cloud, in the end a private practice gets the impression that, since they are on the cloud, and since they “just need a computer” to get on the internet, they no longer need IT support. That is, they no longer need short call IT support.
    No doc wants to pay ongoing fees for IT support, especially when they get on that all comforting cloud.
    Yet, when a computer won’t get on the wireless, they wonder what is happening…then when they call that computer guy and he doesn’t respond in under an hour, they again wonder…what is happening.
    It is an ongoing cycle.

  • John B,

    When I started learning to program over 40 years ago, IBM was the big monster in the room. And while my college computer systems were UNIVAC (common in Pennsylvania), we were taught COBOL and BAL (IBM Basic Assembler Language), presumably to prepare us for the IBM world (but also giving us a very strong basis in programming skills). A couple years after college, I went into Manufacturer’s Hanover Trust’s programmer trainee class (only way to break in) – when I finished the course material weeks before everyone else, they asked me what type of work I wanted to do – I said ‘realtime’. That got me assigned to DEC PDP-11’s instead of IBM! While some years later Chase had me trained in CICS, I never used it – I stuck to VAX/VMS from DEC. But IBM was always looming in the background! And along the way I used systems that were far more advanced and cost effective – and easier to program, as a result of going DEC.

    Medical practices going cloud can easily lead the docs in charge to think that they no longer need any IT or PC support at all – let alone decent Internet access, a secure network, a safe place to put equipment, backup arrangements and far more. And cloud vendors may not mention such needs – at least until contracts are signed and money paid!

    A while back I was talking to a doctor with a part time allergy practice about using one of the free EHR’s – and I walked her through what the free product would actually cost her! It wasn’t horrible, but by the time you paid for a couple of good laptops, secure wifi and internet, billing system access and other niceties, there was both a noticeable initial outlay and monthly cost. A lot higher then what she would save or make from going EHR!


  • We all need to keep an eye on the raging net neutrality war. If net neutrality goes away healthcare IT could be seriously impacted especially with a massive shift to cloud dependence.

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