Cloud-based EHR: Worth it?

One of the many choices you have to make as a doctor running your own practice is whether or not to use a server-based or cloud-based software solution for your office. There can be some benefits to cloud-based solutions, but do they outweigh the drawbacks?

Drs. Nikki Saxena and Eileen Chan decided to open their own practice instead of becoming employee physicians because they “didn't want to hand over the keys to a car that someone else is driving.”

And when it came time to choose an EHR and practice management system, Drs. Saxena and Chan were just as wary of handing over the key to the wrong vendor. They were first-time EHR buyers used to working with paper charts. What's more, finding the right system became even more critical when they learned the scope of their new office would be bigger than they thought; Dr. Saxena's former partners decided to join her after all. The planned three-pediatrician practice now ballooned to five providers and three times the number of projected patients.

To Dr. Saxena, it wasn't just about picking a pediatric-specific EHR, it was about picking a pediatric-specific EHR that she could trust to keep her data safe. This meant researching the pros and cons of server versus cloud-based systems.

“When we opened the doors of our new location, 4,000 charts and eight clinicians and staff came would come with us, so we had to upscale very quickly,” Dr. Saxena said. “We don't have a Medicaid population, so we didn't need Meaningful Use money. We needed a pediatric-specific EHR and a practice management system that allowed us to control and use our data in a way that's meaningful.”

After a vetting process, which included hiring national consultants and exchanging peer advice on the AAP's Section On Administration and Practice Management (SOAPM) online thread, Dr. Saxena and her partners chose an EHR and PM system that was client server-, not cloud-based.

“Our data and financials were really important to us, so when it came down to choosing between two vendors, we picked the system that had a much more robust practice management side and was server-based,” Dr. Saxena said.

With server-based systems, computer hardware and software are physically housed at the practice. This means patient information is stored on-site. Practices own their own servers.

Cloud Questions

Cloud-based server models can be an attractive proposition, especially for those practices that want to save money; obviously they will save on the purchase and, often, maintenance, depending on the vendor, of hardware and software.

The Cloud can also be an appealing choice for small practices who don't have the space to house an on-premise data center.

But there are lots of cons to using the Cloud. Here are a few (from the Healthcare Information and Management Systems Society):

  • Trust - Under the cloud computing paradigm, an organization relinquishes direct control over many aspects of security and, in doing so, confers an unprecedented level of trust onto the cloud provider.
  • Data Protection - Data stored in the cloud typically resides in a shared environment collocated with data from other customers. Organizations moving sensitive and regulated data into the cloud, and must account for the means by which access to the data is controlled and the data is kept secure.
  • Incident Response - The cloud provider’s role is vital in performing incident response activities, including incident verification, attack analysis, containment, data collection and preservation, problem remediation, and service restoration. Revising an organization’s incident response plan to address differences between the organizational computing environment and a cloud computing environment is an important, but easy-to-overlook prerequisite to transitioning applications and data.
  • Loss of Control - While security and privacy concerns in cloud computing services are similar to those of traditional non-cloud services, they are amplified by external control over organizational assets and the potential for mismanagement of those assets.
  • Shared Multi-tenant Environment - Public cloud services offered by providers have a serious underlying complication: subscribing organizations typically share components and resources with other subscribers that are unknown to them.
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