Cloud-based EHR: making healthcare digitalization accessible

Cloud-based EHR: making healthcare digitalization accessible

August 4, 2022

Sergey Ivanov

Head of Healthcare Solutions Department

Ever since the healthcare industry started its journey toward digital transformation, switching to electronic health records has been one of its target missions. In the US in particular, healthcare organizations are financially encouraged to adopt record-keeping software and penalized for not doing so. Therefore, the demand for EHR development services is rapidly growing, with Brandessence Market Research predicting that the EHR global market size will reach a total of $53 billion by the end of 2027. 

In the 2010s, providers implemented EHR systems on their own hardware and were in charge of its maintenance and upgrades, however, the situation has changed in recent years as cloud-based EHRs have now taken over the market. According to Grand View Research, this segment accounted for the largest revenue share of more than 50.0% in 2021.


US electronic records market

In this article, we will explore why healthcare providers, especially small and mid-sized ones, are more willing to go for a cloud-based EHR compared to locally hosted systems, compare two types of EHRs, review the challenges of switching to another type of EHR software and learn how to overcome them.

Cloud-based vs on-premise EHRs

Choosing between cloud-based and on-premise solution types is how any provider’s EHR implementation journey begins.

At first glance, the only difference between them is the deployment method. Software and data (patients’ health information, scheduled appointments, etc.) are either stored on external servers, with an internet connection required to access it, or hosted within the organization’s premises. However, the type of deployment determines the resources needed for EHR interoperability, adoption, scalability, security, installation time, and other factors that ultimately have a significant impact on the organization’s performance.

That is why providers should carefully weigh all advantages and disadvantages of both solution types before committing to one. 

  On-premise Cloud

Optimal for organizations with an unreliable internet connection

All data in one place

Ensured data security

Can be customized extensively for your organization’s specific needs

Small upfront cost

More flexible and scalable

Fewer runtime errors

Fast and effective vendor IT support

Provider takes care of data security and backups

A variety of business models to choose from


Cannot be accessed from outside of the facility

Cannot be integrated with some apps, particularly cloud ones 

Regular backups and disaster recovery planning is your responsibility

Longer development times

Requires dedicated hardware and In-house personnel to maintain

Higher risk of a data breach

Requires a high-quality internet connection

Less data management and control options

Customizable only to a degree

Some solutions may contain ads to make up for their low cost

If used for a long time, their cost amounts to that of an on-premise solution

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The cost of cloud-based EHR systems

The cost of cloud EHRs vary significantly depending on the features they offer, the amount of storage space needed to incorporate a provider’s data, the vendor’s business model, and other factors.

Some cloud EHR vendors charge providers per month, but there are also “per patient”, or “per event” pricing models. These are entirely different business models, where patients pay to access their health information, schedule an appointment, etc., acting as the end-subscribers to the system. In other cases, EHRs may bring their developers revenue from advertisements embedded into the system. Pharmaceutical companies, medical device manufacturers, and other healthcare-related businesses gladly pay for a chance to influence clinicians’ and patients’ opinions in such a way.

Cloud-based EHRs’ upfront costs are lower, which makes them popular with small and medium-sized care providers that don’t have enough resources for on-premise EHR implementation.

Yet, there may have hidden expenses that healthcare organizations should consider before EHR implementation. Besides paying for the EHR out-of-the-box solution itself, providers can be charged additionally for its customization, expansion of storage capabilities if there’s more data than was initially planned, upgrading hardware to make it compatible with the EHR, and transferring data to the new system.

How to migrate ERH to the cloud successfully

According to EHR Intelligence, 15% of hospitals that already have an EHR are actively looking to replace it with an external server-based system. When a provider makes a decision to move, one of the biggest challenges along the way can be data migration. If not executed properly, it may result in patient information loss or damage, and negatively impact the operation of a newly adopted cloud-based system. Luckily, you can prevent such an outcome by following these migration steps.

EHR migration steps

1. Conduct preliminary analysis 

Studying the specifics of the current system helps plan the transition accurately, bridging any gaps in data formatting or storage that may exist. 

For instance, a legacy on-premises EHR can contain a specific patient record with “seafood allergy” entered in plain text. To ensure a 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.


2. Assemble the EHR migration team

Ideally, it should consist of a project manager, a business analyst, end users of the system (they will be the early adopters of the new cloud-based system and help other clinicians become familiar with it), and an expert who analyzes, chooses a cloud EHR vendor and works closely with them. Said expert may be an internal professional or a hired consultant.

3. Choose the migration strategy

Usually, providers migrate to cloud platforms using some of the time-proven strategies for a particular platform. For example, AWS cloud migration can be done in seven different ways or a combination of them. Hiring a migration consultant can help simplify this step.

4. Decide on virtualization

Complex applications like EHRs can be delivered by offloading them into a virtual ecosystem that isolates and secures big data sets for performing big data analytics in the future. There are three major virtualization options: application packages and streaming (the system is deployed to a server and streamed to the endpoint as a package), hosted applications (similar to the previous one, but the app is deployed to a virtual server), and virtual desktops (specific solutions are deployed to virtual desktops with the policy-based access, allowing system administrators to make user actions visible and controllable).

5. Ensure maximal data security and accessibility

Consult your vendors or IT teams on dividing data into manageable chunks for gradual transferring, possible network security reconfiguration, or other measures to protect your patient information. Some EHR vendors use third-party cloud services to ensure maximum security and compliance: for example, Epic uses AWS, Meditech collaborates with Google Cloud, etc.

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EMR/EHR software development

EMR/EHR software development

Our experts are well-versed in technologies necessary for full-cycle EHR software development and data migration and can deploy EMR/EHR software in private, public, or hybrid cloud environments.

Cloud-based EHR in the real world

There are many examples of healthcare organizations adopting cloud-based systems to enhance their patient service, help personnel with daily tasks, and increase productivity without spending too much time and resources.

Novant Health moves to a cloud-based EHR

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

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 engineering staff for other projects.

This transformation happened gradually and included application retirement, operational optimization, and, finally, the migration of 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

James Kluttz

Chief Technology Officer at Novant Health

VA moves to cloud 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

Robert Wilkie

VA Secretary

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 veterans’ health records, including vital signs and lab tests, to the new EHRM system.

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

Howard Messing

Chief Executive Officer at MEDITECH

Carter Clinic adopts EHR to become more patient-focused

The Carter Clinic is a behavioral health clinic group in Raleigh, North Carolina. Clinicians at Carter see 20 to 25 patients a day, treating behavioral health problems, mental illness, dementia, and substance abuse disorders. They needed an electronic health records solution that would facilitate controlled substances’ prescription, easy document management, and enable medical professionals to provide telehealth services.

Practice Fusion became their cloud-based EHR of choice because it is highly customizable, can be easily integrated with other systems like the controlled substance database, and has great customer support. 

Clinicians at the Carter Clinic are satisfied with their solution as it gives them more time to interact with their patients – even remotely.

When I think about where we are today at the Carter Clinic, it’s hard for me to imagine us functioning as well as we are without Practice Fusion.

Ojinga Harrison, MD

Ojinga Harrison, MD

President and Medical Director

Cloud-based EHR systems are here to stay

The rise of cloud computing has changed the healthcare industry forever, making IT services more accessible for all types of healthcare organizations. Cloud-based EHRs let providers reap the benefits of digital transformation without the tiresome and expensive process of adding new software to their on-premise systems. They also help healthcare organizations to adjust to the rapidly changing world and become more resilient in the face of natural disasters, pandemics, and other emergency events.

Nothing is perfect of course, and cloud-based solutions have their issues. Some are concerned about patient information protection, and others argue that such a model is not fit for rural areas with a poor internet connection. However, EHR vendors work hard on advancing their solutions and telecom providers are upping their connectivity game, so it is likely we will see the above-mentioned problems resolved soon.