Meaningful Use Goes to 'the Cloud'

Faced with the expensive and complex process of implementing an EHR system, more first-time purchasers are opting for Web-based, remotely hosted EHR systems, often referred to as "cloud" based EHRs.

Web-based EHRs are not new. Most major vendors have offered Web-based systems along with their client-server EHRs, for years. But as HIMSS, the country's largest annual healthcare IT event, gets underway Feb. 21, an emerging theme among EHR vendors is catering to the burgeoning market of smaller and mid-sized practices, who are looking to cash in on government incentives, and more likely to opt for Web-based systems.

Unlike client-server systems where the software is installed and hosted at the user site, cloud-based EHRs maintain all data and software remotely. Whereas client-server systems are accessed through desktop software, cloud systems are subscription-based, and accessible through Web browsers.

Other benefits of cloud systems include lower start-up costs; maintenance is the vendor's responsibility. Software updates can be handled more easily, too.

"What we’ve seen nationally, five years ago, there were more client/server models but it became clear very quickly that the ASP model was going to become an important part of practices," says Cathy Costello, the regional extension center coordinator for Ohio’s health information exchange, the Ohio Health Information Partnership (OHIP).

Rosemarie Nelson, a healthcare consultant who works with physician practices, also says she has seen a big uptake.

"Easily twice as many of my clients have opted for this model of subscription-based service this year over the previous year," she says.

Web-based EHRs are often less expensive, less cumbersome, and easier to maneuver than client-server-based software EHRs.

Why Cloud EHRs are Growing

In the last two years, physician comfort level with Internet-based technology has come a long way. Today, physicians do everything online, from looking up medication side effects to sharing information on Web portals to sending e-mails to patients. So it’s no surprise the idea of storing information online has become more acceptable, says Bruce Kleaveland, a healthcare IT consultant.

"Because technology has advanced and become more widespread and prominent, doctors are more comfortable with accessing the EHR over the Internet than they were before," says Kleaveland. "When the Internet first came out, there was almost a sense of voodoo, ‘do I really want my stuff out there’?"

Just as important a driver is cost, Kleaveland says.

"In general, with a cloud-based computing type of model, you’re paying a monthly fee, which may be more affordable than making a large investment," says Kleaveland.

Though there are some who will argue that the cost of using something cloud-based ends up being about the same as using a software-based system, the idea of getting 24-hour support also makes remotely hosted solutions so appealing.

"[Practices] save time by not having the complexity of running the operation themselves," says Nelson. "They don’t have to do those upgrades, and the interfaces aren’t something they have to maintain."

Kleaveland agrees that with a cloud-based system, "you’re outsourcing support to a professional who does it as a fullwtime job, who isn’t just doing it in addition to running the practice. You don’t have to come up with a lot of money to purchase it as a service."

Privacy and other Considerations

Using a Web-based EHR is becoming more popular among the new crowd of mobile-loving physicians, such as those who want to access their EHR via their smartphone, iPad, or laptop at home without having to go through a remote-desktop application. However, if you’re accessing data remotely - for example, through a mobile phone - it’s important to put measures in place, such as password protection for idle Web browsers, to ensure data doesn’t get into the wrong hands.

"The biggest risks are at the endpoints," says Andy Podgursky, a computer science professor at Case Western Reserve University and co-author of the recent report "E-Health Hazards: Provider Liability and Electronic Health Record Systems."

One advantage of using a hosted system is that in the event of damage to your server, your data is safe if your practice goes down for some reason (such as fire or flood).

But even clouds, which are supported by data centers in various locations, aren’t completely safe, which is why some physicians may opt to pay for supplemental cloud-based backups, often referred to as "redundancy" systems. This might also be a good option for those physicians who already have client-server software systems in place, Nelson says.

"Let’s say you have water damage or something, and your server is dead," says Nelson. "Where are you going to load your backup? What are you going to do in the meantime? With remote hosting, you don’t have that problem."

A cloud-based system is more likely to have “an elaborate, intensive architecture for protecting its data” than a practice’s server, Podgurski says.

That doesn’t mean it’s foil-proof against hackers, however.

“If the cloud provider’s security database is compromised, then all of those records could become available to hackers,” Podgurski said, outlining a rare, worst-case scenario. “So you could literally have millions of records fall into the wrong hands.”