The why and the how of EHR migration to the cloud

28.01.2020
6 min.

It seems that all the discussions about comprehensive health records gave rise to the theory about an upcoming cloud-based EHR era among healthcare software developers. Global Market Insights reports the global healthcare cloud computing market was valued at $20 billion in 2018 and is expected to surpass $55 billion by 2025.

Healthcare cloud computing marlet

Even with such an optimistic forecast, healthcare organizations can find it challenging to initiate the transition to the cloud. This article will help weigh up the reasons for migrating to a cloud-based EHR and draft a plan for doing so seamlessly.

5 reasons to go for a cloud-based EHR

Many healthcare organizations are struggling with maintaining on-premises EHR systems. Even when the software and infrastructure are up-to-date and their capacity is sufficient, there will still be reoccurring issues to deal with. Data volumes will continue to grow, demanding more resources. Computing environments, such as disaster recovery and tests, will need to be resized every three years, not to mention factors such as merges and acquisitions which may bring in extra resizing.

Cloud-based EHR software can offer a solution to those and other related issues. Besides, moving their EHRs and other health data to the cloud will make it easier for healthcare organizations to adopt next-generation solutions such as big data analytics in healthcare and population health. Moving data to the cloud will also facilitate taking on the internet of medical things. Additionally, by providing the required computational capacity, the cloud technology will make it possible to apply predictive modeling in the healthcare industry.

#1. Saving money and time

Starting with significant one-time setup payments, non-cloud EHRs come hand in hand with continuous investments such as licensing fees, maintenance costs, system updates, and replacements caused by the technological evolution or hardware obsolescence. Hiring specialized professionals is also a major part of incremental expenses, since an on-premises EHR requires a dedicated team to support and maintain it.

On the contrary, cloud-based EHRs come as turnkey solutions, which means that healthcare organizations only invest in recurring subscription fees with the ability to cut costs on the following:

  • Hardware installation
  • Licensing fees
  • Software updates and hardware maintenance
  • In-house IT staff

With a lot of these systems [on-premises EHRs], you have to buy the hardware, the software — millions of dollars — and you have to install all these licenses, which are typically paid for upfront.

Steve Kelley

The cloud technology also allows companies to patch and update the systems automatically without going through the lengthy cycle of contacting an IT team, communicating the need, and waiting until they perform certain tasks.

#2. Ensuring HIPAA compliance and data security

Running an on-premises EHR means that this healthcare organization is the one responsible for keeping the system HIPAA-compliant, protecting it against security breaches, and safeguarding data integrity with fail-safe backups. The EHR owner also has to introduce an effective updating policy to avoid required patches and upgrades slipping through the cracks and leaving the system exposed.

In the cloud, healthcare providers can have peace of mind because EHR data is stored in a private and encrypted data center, ensuring both the compliance with the HIPAA regulations and an increased protection against breaches. Some vendors offer additional options such as extra security layers and stricter access controls to ensure HIPAA compliance.

However, healthcare organizations should be cautious when selecting cloud providers, since some of them can be offering services in cooperation with external vendors who may not be HIPAA-compliant, even though the primary cloud provider is.

To ensure that the cloud provider and all the subsequent vendors are HIPAA-compliant, healthcare organizations need to pay attention to the following:

  • Consent to sign a business associate agreement: Signing this agreement makes the cloud provider contractually liable for ensuring compliance with all the HIPAA requirements. Declining to sign such an agreement will obviously raise a red flag.
  • Availability of protocols for data migration: Compliance with HIPAA implies that the cloud vendor will allow the healthcare client to remove their information stored in the cloud when the services end or are terminated.
  • System availability and reliability: Healthcare organizations need to pay attention to the uptime score of their selected cloud vendors, since availability and data accessibility are made imperative by HIPAA.

Is the vendor you choose willing to sign a business associate agreement? If they hesitate or don’t know what that is, they aren’t the right vendor to choose because they don’t understand your healthcare compliance needs when it comes to HIPAA.

Jeffrey Thomas

#3. Introducing accessibility

Cloud computing allows transforming an EHR from a record-keeping system into a major point of care, enabling remote access to real-time patient data across multiple locations and devices such as the internet of medical things. Patient data stored in cloud-based EHRs can be created, updated, modified, and viewed from different gadgets, which offers invaluable benefits of the connected care environment characterized by:

  • Care team collaboration
  • Seamless data sharing
  • Paperless workflows
  • Less duplicated information
  • Patients’ increased control over their own data

Additionally, cloud EHRs provide higher flexibility of managing schedules, shifts, claims, and medical history forms for both patients and providers, cutting on delays in care delivery.

#4. Scaling up with less risk

Merging disparate on-premises EHRs, which is often the case at ACOs, is an error-prone process that requires a substantial effort from the IT team.

To ensure consistency across care processes, healthcare organizations need to be able to expand their EHRs as soon as the need arises, for example, when a new facility is added to the health system. Cloud-based EHRs support codeless modifications and allow adding new users, health specialists, and locations to the system with minimal costs and downtime.

Contrary to traditional on-premises EHRs, a cloud-based system supports dynamic resource management, where more resources can be added if necessary. In the on-premises environment, the server needs to be cut off in order to configure more resources, which results in delays among other inconveniences.

#5 Facilitating disaster recovery

If any issues are to impact the hardware at the healthcare provider’s location, either resulting from human error or a natural disaster, they will not impact the data stored in the cloud.

Cloud-based EHR solutions typically go through automated vendor-initiated backups and updates. In case of an on-premise EHR, backups are performed manually, which is a time-consuming and resource-demanding process that requires an extra data center for storage. With consistent automated backups, cloud-based EHR solutions will be able to provide a speedy disaster recovery with minimal downtime and service disruption, should the need arise.

Key steps of EHR migration to the cloud

At some point, an on-premises EHR will no longer satisfy the needs of the industry, forcing healthcare organizations that use one to switch to the cloud. Prior to making any further steps, though, it’s necessary to analyze the legacy system in depth to ensure as little data and productivity losses as possible.

Conduct preliminary analysis

Healthcare organizations need to study as many details about their current system in use as possible, including:

  • Policies
  • Security architecture
  • Dependencies
  • Compatibility
  • User interactions

Without knowing their system in and out, the EHR owner can miss significant gaps and fail to plan the transition accurately.

For instance, a legacy on-premises EHR can contain a specific patient record with “seafood allergy” entered in plain text. To ensure successful migration of each patient’s history into a cloud-based EHR, this “seafood allergy” record should be translated and codified according to ICD-10, referencing a specific shellfish allergy. At the same time, the plain-text record should be automatically deleted to avoid duplicating the information.

Without a proper translation and mapping of allergies to the new EHR, it won’t be able to trigger respective patient safety alerts, for example in case of drug allergies.

Additionally, the EHR migration team should be assembled according to the following criteria:

  • It should be led by an experienced project manager and a business analyst.
  • It should include health specialists who are the end users of the current EHR. They will be the early adopters of the new cloud-based system and help other clinicians become familiar with it.
  • It should have a dedicated expert who will analyze the vendors according to their bandwidth requirements, SLA, and escalation policies for eliminating connection lags and downtimes during technical support.

Decide on virtualization

Virtualization is the method of delivering complex applications, such as EHRs, by offloading them into a virtual ecosystem that isolates and secures big data sets for performing big data analytics in the future.

  • Application packages and streaming: The system is deployed to a server and streamed to the endpoint as a package. It allows tucking specific network settings, policies, and drivers into an application.
  • Hosted applications: This option is similar to streaming, but a hosted application is deployed to a virtual server instead of a physical one. Hosted apps can feature complex architectures with a shared secure access for a wide range of users.
  • Virtual desktops: Here, specific solutions are deployed to virtual desktops with the policy-based access, allowing system administrators to make user actions visible and controllable.

Ensure maximal data security and accessibility

The system must remain accessible during migration, otherwise healthcare organizations risk their EHR productivity and even patient safety. The catch is that it’s impossible to move all the data at once during the transition for these three reasons:

  • Big data migration is restricted with the network and hardware parameters.
  • Data becomes inaccessible during migration.
  • Data becomes vulnerable when in the state of transition.

Accordingly, providers should consult with their vendors or IT teams about dividing data into manageable chunks for gradual transferring. For example, users can be grouped by the data they need to access, their departments, or required permissions. Patient records can be grouped alphabetically or by their PCPs.

Data migration to the cloud might also require reconfiguring the network security. Additionally, most vendors choose to duplicate the environment for migration and work with a replica to avoid affecting the live system through compatibility issues or mistakes that result in data loss. Replication is also needed at the final migration stage. This way, if there’s a security breach or interruption, all the migrated data will remain safe.

Real-life stories of EHR data migration to the cloud

There are many examples of healthcare organizations successfully migrating their EHR systems to the cloud.

Novant Health moves to a cloud-based EHR

Novant Health is a four-state integrated network of hospitals and healthcare clinics with the total of 28,000 employees, headquartered in North Carolina in the US.

Novant Health has been using the Epic EHR system locally since 2011. Throughout this time, the system has been through many updates and the infrastructure was replaced more often than planned. Moving to Epic’s Virtustream Healthcare Cloud platform was expected to reduce those tedious tasks and free up the engineering staff to work on other projects.

This transformation is happening gradually and includes application retirement, operational optimization, and, finally, migrating the organization’s integration engine together with its daily transactions.

Novant Health believes that healthcare facilities only recently started to recognize and appreciate the benefits of the EHR cloud model.

We have to be able to adapt to patient shifts in care. Those open-minded and willing to look at things differently and invest in people differently will be the ones who see the benefits.

James Kluttz

VA uses EHR migration to relieve veterans

Initially, Veterans Affairs (VA) depended on their decentralized VistA system for storing veterans’ health records from all across the country. However, this system was not interoperable with the Department of Defense’s health records system, which forced veterans who separated from the military to carry boxes of paper-based records to their medical appointments.

For decades, VA and DoD have been struggling to achieve interoperability and seamlessly share patient records between our health systems — placing an unfair burden on our Veterans and their families.

Robert Wilkie

This lack of interoperability, in addition to the high maintenance costs of the VistA system, triggered VA to look for an alternative solution for health records storage. VA opted for a new cloud-based Electronic Health Record Modernization (EHRM) system, and by mid-2019 achieved a major milestone by migrating 78 billion of veterans’ health records, including vital signs and lab tests, to the new EHRM system.

MEDITECH upgrades its services with Google Cloud

MEDITECH is a software and service company based in Massachusetts, specializing in healthcare information systems. MEDITECH recently announced its collaboration with Google to offer its EHR services through the Google Cloud Platform.

MEDITECH is confident this new setup will provide better access, enforce stricter security protocols, and simplify operations of MEDITECH’s healthcare clients. Additionally, the company states that the new cloud-based platform will contain intuitive solutions for doctors and nurses, allowing them to innovate in their daily work.

MEDITECH believes that cloud-based EHR solutions are what healthcare organizations need today.

We’ve been retooling MEDITECH for the new healthcare paradigm, reshaping our company to meet the needs of today’s market and today’s customers.

Howard Messing

Ready or not, the cloud EHR is coming

Migrating from on-premises software to a cloud-based EHR system can be intimidating yet rewarding. The more agile a provider’s clinical environment, the faster this provider will adapt to industry changes.

At the moment, there is a number of compelling reasons to start planning the transition, from extra accessibility and painless scaling-up to improved security assurance, safeguarded HIPAA compliance, and reduced expenditures. The cloud allows healthcare organizations to withdraw from maintaining a complex IT infrastructure with servers and storage area networks as well as from staffing an extensive team for managing these resources.

Even though EHR migration poses a challenge, it is not an uncontrollable process. By making progress one step at a time, investing in analysis, and consulting with experts, healthcare providers can make their EHR transition to the cloud secure and seamless.

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