Cloudy With a Chance of EHRs: The Ins and Outs of Cloud Computing

In a panel discussion at AHIMA's 2011 Legal EHR Summit on Aug. 15 in Chicago, Sandra Nunn of KAMC Consulting; Daniel Orenstein, senior vice president and general counsel at athenahealth; and Gerard Nussbaum, JD, director of technology services at Kurt Salmon Associates, discussed the benefits an electronic health record system can gain from cloud computing as well as some legal and business aspects that any healthcare provider should know when implementing a cloud-based system.

Cloud computing, in essence, is the health IT model where providers can obtain almost any computing application, business process or other item relating to the health computing infrastructure ubiquitously and anywhere there is a wireless signal. Benefits can be seen instantaneously with less involvement of the hospital's IT department. "It reduces your necessity to rely on the IT department," Mr. Nussbaum said. "You don't have to talk to IT everyday, but you will have to talk to your vendor." Mr. Orenstein said another key benefit was the ability to conduct benchmarking across all practices across the country. For example, through the cloud, a provider could see how all practices are doing on meaningful use measures. Ms. Nunn added that health information management professionals are also able to explore applications on their own and conduct their own types of data analyses.

Like most IT systems, even cloud computing isn't immune from outages, although EHRs on the cloud are close to accessible 24 hours a day. If a provider wants maximum "up time" for a cloud, they will have to pay for it, and it's important to spell these things out in the service agreements, Mr. Nussbaum said.

One of the more contentious points with cloud computing and EHR data involves ownership. Who exactly owns the data once it's in the cloud: the vendor or the provider? "This has been an issue in healthcare since people relied on a service provider," Mr. Nussbaum said. "I tend to be on a side that says the vendor can't aggregate my data because that's my best way to ensure my protection, but this needs to be addressed in the contract."

Mr. Orenstein says patients and providers need not be skeptical and think data is being sold for marketing or research purposes. He says if a vendor does something with data aggregation, it's going to improve their service or their client. "Data monetization is a red herring," Mr. Orenstein said. "Everybody thinks their data is going to be used for some profit enterprise, and it's just not the case."

Regardless of ownership status, Ms. Nunn says with so many EHR vendors rushing into the cloud service marketplace, a hospital or health system has to choose a vendor that is least ambiguous for their needs. "You want somebody that has a proven track record and shows business practices for transparency," Ms. Nunn said.

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