Migrating EHR to the cloud: Why and how

11.09.2018
6 min.
title

It seems that discussions about Comprehensive Health Records sparked among healthcare software developers a theory of upcoming cloud-based EHR era. Recent Netwrix infographic supports the theory and claims that 69% of healthcare organizations plan to transfer sensitive data to the cloud in the near future.

But even with the statistics on the cloud side, healthcare organizations can find it challenging to initiate a transition. This article will help them to weigh the reasons for migrating to a cloud-based EHR and draft a plan of seamless transition.

4 reasons to go for a cloud-based EHR

#1. Saving money and time

Starting from significant one-time setup payments, client-server EHRs come hand-in-hand with continuous expenditures such as licensing fees, maintenance costs, system updates, and replacements due to technological evolution or hardware obsolescence. Specialized staff is also a major part of subsequent expenses since an on-premise EHR requires a dedicated in-house or external team to support and maintain it.

On the other hand, cloud-based EHRs are provided on a turn-key basis, which means that healthcare organizations deal with subscription fees only:

  • No hardware installation costs
  • No licensing fees
  • No updating and maintenance expenses
  • No need to keep an IT team

Clouds also allow patching or updating the system automatically and 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, security, and disaster recovery

Running a client-server EHR means that healthcare organizations are responsible for keeping the system HIPAA-compliant, resisting security breaches, and safeguarding data integrity with established backup processes. They also have to introduce an effective update policy to avoid necessary patches and upgrades slipping through the cracks and leaving the system exposed.

In the cloud, providers can have more peace of mind because EHR data is stored in a private and encrypted data center, ensuring compliance with up-to-date HIPAA regulations and increased protection against breaches. Any natural disasters or malicious acts leading to loss or significant damages of hardware won’t affect the data kept in the cloud, especially with backups and updates held automatically.

#3. Introducing accessibility

Cloud computing allows transforming an EHR from a glorified billing system into a major point of care with an increased remote access to real-time patient data across multiple locations and devices. Patient data stored on cloud-based EHRs can be created, updated, modified, and viewed from smartphones, tablets, PCs, and Macs, which offers invaluable benefits of connected care environment:

  • Care team collaboration
  • Seamless data sharing
  • Paperless environment
  • Reduced information duplication
  • Increased patient control over their own data

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

#4. Scaling up conveniently

Merging separate client-server EHRs, which is frequent in the case of ACOs, is a mistake-prone process that requires a substantial effort of the IT team.

To ensure consistency across care processes, healthcare organizations need an ability to expand their EHRs as soon as the need arises, say, a new facility is added to the health system. Cloud-based EHRs support codeless modifications and allow for adding new users, health specialists, and locations to the system without undergoing major cost or downtime burden.

Key steps of EHR migration to the cloud

At a certain point, an on-premise EHR will simply no longer make any sense. The industry demands or internal needs eventually will make healthcare organizations go to the cloud. Prior to making any further steps though, deep system analytics and further mapping are needed.

Conducting preliminary analysis

As understanding and mapping, the mix of standard and proprietary legacy data in the EHR is challenging, to say the least, healthcare organizations need to grasp as many details as possible about their current system, including:

  • Policies
  • Security architectures
  • Dependencies
  • Compatibility
  • User interaction

Being unaware of the system’s peculiarities, an organization can miss out on significant gaps in their current EHR and won’t be able to plan the transition accurately.

For instance, a legacy client-server EHR can contain a patient record with “seafood allergy,” entered in free text. To ensure successful coalescing of each patient’s history into a cloud-based EHR, this “seafood allergy” should be translated and codified according to ICD-10, referencing a specific shellfish allergy. Free text can also be automatically deleted to avoid information duplication.

Without proper translation and mapping of the allergy, the new EHR won’t be able to use this information to trigger specific patient safety alerts, such as drug-allergy interaction warning. Staying in free text, the indication of patient allergy won’t get to another healthcare IT system, such as a clinical decision support system, a patient portal, or an HIE.

Additionally, we suggest assembling an internal migration team, which should:

  • Be led by a mature project manager and supported by a business analyst.
  • Include a team of end-user health specialists whose workflows are tightly bound to the current EHR. They will be early adopters and will help other clinicians to get used to a new EHR.
  • Contain a team to analyze vendors according to their bandwidth requirements, SLA, and escalation policy to eliminate connection lags and downtimes when technical support is needed.

Making virtualization decisions

Virtualization is a way to deliver complex applications, such as EHRs, by offloading them into a virtual ecosystem that can isolate and secure big data sets and workloads. Particularly, healthcare organizations have three delivery paths to go with:

  • Application packages and streaming. In this case, the system is installed on a server and streamed as a package to the endpoint. It allows tucking specific network settings, policies, and even drivers into an application.
  • Hosted applications are similar to streaming, but the application is presented on a virtual server instead of being installed on a physical one. Hosted apps let creating a complex architecture with shared and secure access to a wide range of users.
  • Virtual desktops. Here, specific solutions are deployed into virtual desktops with access to policy-based user groups, allowing administrators to make user actions transparent and highly controllable.

Making the final decision on a fitting virtualization option can be challenging, therefore we suggest providers engage with migration consultants and keep in mind that transition means enhancement, so the new EHR’s goal is also to optimize workflows, improve user experiences and ensure better control over data.

Ensuring data security and accessibility

The system must remain accessible during migration. Otherwise, healthcare organizations can risk the EHR productivity and even patient safety. But the catch is that within transition, data can’t be moved at once due to three reasons:

  • Systems can’t migrate big data simultaneously due to network and hardware restrictions.
  • During migration, the data will be inaccessible.
  • Being at the state of transition, data is vulnerable.

Accordingly, providers should consult with their vendors or IT team and pick certain data sections to transfer them gradually. For example, users can be grouped by the data they access, by departments or by permissions. Patient records can be grouped by the alphabet or their PCPs. Archived records can be also grouped by alphabet.

The migration process may also require reworking or reconfiguring the network security to move data to a new cloud storage. Additionally, most vendors will duplicate the current environment to work with a replica and avoid affecting the system itself with live compatibility issues or mistakes that can result in data loss. Replication is also needed on the final stage of migration. This way, if there’s a security breach or transition interruption, all migrated data will stay safe.

Ready or not, the cloud is coming

Migrating from a traditional client-server EHR to a cloud-based system can be intimidating but it is rewarding. The more agile clinical environment organization uses, the faster it will adapt to industry changes. Right now, there is a number of compelling reasons to start planning the transition, from extra accessibility and painless scaling 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 staffing an extensive in-house or third-party team to manage and upkeep these resources.

However challenging, migration isn’t an uncontrollable process. Going step by step, allowing a bit more time and analysis, consulting with experts if needed, providers can achieve a secure and seamless EHR transition to the cloud.

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