Considerations for cloud-based EHR hosting — hospital CIOs and CTOs weigh in


The cloud is driving healthcare organizations to rethink hosting options for their EHR systems, ranging from public and private clouds to vendor-hosted solutions. To better understand the evolving cloud-based EHR landscape, Becker’s Hospital Review, in conjunction with Hewett Packard Enterprise and Intel, convened health system technology leaders for a conversation about factors influencing their EHR hosting strategies. During the October advisory call, leaders discussed the requirements for hosted solutions and debated their advantages and disadvantages.

Cloud-based EHR deployment is more than a technology decision

Before implementing hosted EHR solutions, CIOs and chief technology officers must educate the broader organization about the advantages and disadvantages of cloud technology. Many people don't understand the differences between different types of cloud hosting options. "The most important aspect of strategy development is stepping back and ensuring that the board of directors and the C-suite understand the pluses and minuses of each alternative," said Randy Davis, vice president and chief information officer of Sterling, Ill.-based CGH Medical Center.

The size of the organization and its core competencies are other key considerations. Most importantly, for all hospitals, from the largest to the smallest community hospitals,  patient care is the top priority — not developing the best in-house IT capabilities.

"Other industries identify the core value that they bring to the market and everything they do is in service to that," Jeff Allport, CIO at Van Nuys, Calif.-based Valley Presbyterian Hospital. "For community hospitals, I think it's hard from a sustainability perspective to find a reason to host anything. Large health systems and integrated delivery networks, however, may have different requirements and a greater need to manage locally." 

In some cases, the local telecommunications infrastructure may also limit an organization's ability to deploy a hosted EHR model. The University of Mississippi Medical Center (UMMC) Batson Children's Hospital, for example, is located on a peninsula with a single highway. All the fiberoptic cable for the county runs down that highway.

"I joke that we're one [construction mishap on that highway] away from losing the cloud," said Kevin Yearick, CIO at UMMC Batson Children's Hospital. "Until we don't have to worry about a single point of failure geographically, hosting isn't a realistic option for us."

Hosted EHR solutions address flexibility, security, financial concerns and more

Infrastructure scalability, along with certified technical resources to manage it, are major benefits of hosted EHR systems. "As an Epic customer, if you host your own system, every three years you have to upgrade your hardware infrastructure. The nice thing about outsourced hosting is that with a single phone call, you contact your vendor, tell them that the EHR requires a certain number of processors per user, and the upgrade happens quickly," explained Joseph Venturelli, vice president and CTO at Hartford (Conn.) Healthcare.

In addition to scalability and flexibility, hosted hardware and software vendors have tremendous technical expertise. "One of the main reasons for moving toward a cloud-hosted, vendor-hosted environment was the vendors' expertise in delivering the whole Epic environment across our sites and data centers," said John Crooks, IT division chair at Mayo Clinic Florida in Jacksonville. "We've been working with Epic to implement best practices to minimize outages and EMR downtime. Our experience to date has been quite good."

Concerns about cybersecurity are a compelling reason for healthcare organizations — especially smaller ones — to move to a hosted EHR strategy. "Cloud-based EHR solutions offer cybersecurity tools and other resources that may not be available to smaller shops," said Shane Pilcher, CIO at Chattanooga, Tenn.-based Siskin Hospital for Physical Rehab. "We can take advantage of their economies of scale to achieve near minimal or nonexistent recovery time objectives. If something goes down, we want to spin back up very quickly."

Of course, cost is also a key driver for cloud-based EHR solution adoption.  A true cloud-based solution will offer pay-for-what-you-use consumption and leverage the sharing of all required resources. "A robust total cost of ownership model is vital to make the case to the C-suite," Mr. Venturelli said. "As long as you're willing to make the appropriate reductions, the TCO model should be easy to develop."

Some smaller organizations are exploring shared instances of cloud-based EHR systems. Tahoe Forest Hospital District in Truckee, Calif., for instance, has implemented Epic Community Connect. With this model, Tahoe Forest works in an instance of Epic that is run by Chesterfield, Mo.-based Mercy — the nation's first healthcare provider accredited by Epic to offer EHR solutions to other hospitals. "As a small, rural, critical-access system, this approach has lowered our licensing and hardware costs and we get better expertise from our centralized hosting partner," said Jake Dorst, chief information and innovation officer at Tahoe Forest Hospital District.

Looking ahead, many health systems want to exit the data center business, and cloud-based EHR solutions offer a path forward. "As we approach the time to refresh our infrastructure, we are looking at migration to a hosted environment," Mr. Pilcher said. "Our intent is to get all our compute and storage into the cloud, including ancillary applications."  To facilitate an emerging strategy, the EHR as a Service delivered by a Hybrid Cloud solution, starts with managing the EHR from on-premises or co-location data centers, and also offers the ability to integrate with other true cloud options to enable a safe and effective migration from an on-premises to a fully cloud-based EHR operation.

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