January 28, 2020
EHR migration to the cloud explained
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.
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.
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.
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:
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.
CEO at Ellenville Regional Hospital
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.
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:
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.
Former Chief Technology and Security Officer at Forward Health Group
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:
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.
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.
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.
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.
Healthcare organizations need to study as many details about their current system in use as possible, including:
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:
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.
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:
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.
There are many examples of healthcare organizations successfully migrating their EHR systems to the cloud.
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.
Chief Technology Officer at Novant Health
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.
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 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.
Chief Executive Officer at MEDITECH
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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