There has been an obvious trend towards medical practices moving or purchasing cloud-based EMRs. For many practices – especially those on the smaller side – there is almost always no cost reason to undertake the effort of provisioning a server, paying for its installation, paying the cost of patching and maintenance, and replacing it every three-five years. Additionally, EMR vendors themselves have been pushing cloud-based solutions as it is more efficient for them to maintain their clients on their own infrastructure and, often, hosting is an additional revenue line for vendors. This trend is not exclusive to ambulatory practices; increasingly, vendors are offering cloud-based solutions to healthcare systems as well. For example, Cerner partnered with Amazon to assist in more effectively deploying and maintaining its HealtheIntent analytics platform.  Hospitals – especially smaller ones – are also increasingly examining cloud-based EMRs to compensate for smaller IT staffs and leaner IT capital budgets.

            Practices looking to move to the cloud may concentrate on the benefits – fewer costs, access to a more robust infrastructure, and better security – without thinking through the items that may be potential pitfalls in the migration. The first item that a practice must consider is what type of cloud to move to. For example, what sort of cloud does one want to move to? A practice can often move to a completely hosted solution by their EMR vendor. In such an environment, the practice or their MSP (managed service provider) would no longer need manage any EMR infrastructure with the exception of possibly managing the client PCs that run the EMR. While that may seem easier there are, however, downsides. Selecting this option provides the EMR vendor with complete control over one’s EMR infrastructure. In this case, the practice is essentially at the mercy of the EMR vendor to get access to one’s data. This could be expensive and time-consuming especially if one is in the process of migrating to a different vendor.

            The other alternative is to use a third-party to host ones EMR. Options would include companies such as AWS (Amazon Web Services) or Microsoft Azure. There are also smaller third-party hosting companies that can be used. In comparison with the EMR vendor-controlled option, the practice or the MSP on their behalf has access to the underlying infrastructure. It is – in a sense – a rented server or servers (and sometimes a rented database). In this case, the practice can access the EMR data and use the database server to manage a migration to another EMR. There are, however, some downsides. The costs are usually more than hosting with an EMR; however, there are some capabilities that may make it more worthwhile One could access data more readily by pulling it directly from the database. This could make connectivity to an analytics system or migrate more easily to a different EMR. A practice must, however, review security processes and capabilities to ensure that the third-party hosting company is adequately protected.

            Regardless of the type of cloud hosting chosen, a practice must also consider a few items. First and foremost, one must consider bandwidth. If the practice has slower internet access but there are a fair number of providers and staff, one may consider – if it is available – getting fiber optic broadband. Additionally, the practice must decide if it makes sense to get backup internet access. One could use – if there are few users – portable cellular WIFI hotspots or, if there are a fair number of users, it may make sense to obtain DSL or cable to act as a backup to the main internet access method. With a cloud hosted EMR, it must be recalled, that if Internet connectivity is down, so is EMR access. One could also invest in downtime tools. One tool is Carefinity from eMedApps; it makes a copy of the EMR database frequently. There is then a local application that can be accessed to read clinical information in the event of a downtime. A practice must also ensure that BAAs are existing with the correct parties are covered.

            Cloud hosting is likely going to continue to be a trend. Practices deciding to undertake the move to cloud will probably benefit in the long-run from doing so; however, there are some warnings that must be addressed to ensure that the migration is smooth and the work in the practice is not interrupted.