Understanding Cloud-Based EHR Platforms and Their Benefits

ON-PREMISE VERSUS CLOUD-BASED EHR SYSTEMS

On-premise EHR systems are hosted locally and managed within healthcare facilities. These systems, also known as client-server EHRs, often require high initial hardware and software costs that can strain a healthcare organization's budget.

On-premise EHRs also require ongoing costs for maintenance and support. Healthcare organizations leveraging on-premise EHR systems must hire on-site health IT professionals to maintain and oversee hardware and software, including regular updates, security, and system troubleshooting.

Additionally, scaling on-premise EHR systems to additional locations or users typically involves adding more servers and infrastructure, which can be complex and costly.

Then, there is cloud computing. Generallycloud computing is a term for anything that involves delivering hosted services over the internet. A cloud can be public or private.

In the ;public cloud model, a third-party cloud service provider (CSP) delivers a cloud service to an organization. CSPs sell public cloud services on demand, usually by the minute or hour. However, long-term commitments are also available. Customers only pay for the central processing unit cycles, storage, or bandwidth they use.

The use of the public cloud in healthcare has grown in recent years. According to Forrester's State of Cloud in Healthcare 2023 report, 73 percent of surveyed healthcare organizations use multiple public cloud vendors. Cloud decision-makers at healthcare organizations are spending $9.5 million annually across clouds on average, researchers found.

A private cloud serves the needs and goals of a single organization. Through the private cloud, an organization is responsible for building and maintaining its own underlying cloud infrastructure. This model offers the versatility of the cloud while preserving on-site management and security.

BENEFITS OF CLOUD-BASED EHRS

Cloud-based EHR systems provide several benefits compared to traditional in-house systems, according to experts.

First, cloud-based EHRs eliminate the need for significant upfront hardware and infrastructure investments. Instead, healthcare organizations pay a monthly subscription fee, which reduces initial costs. Some cloud systems allow users to pay a subscription fee as low as $100 per month.

Because of this cost model, many small hospitals are opting for cloud-based EHR systems. According to Black Book survey data, 83 percent of small healthcare practices surveyed named cloud-based EHR implementations as the most meaningful business decisions they had made over the past several years.

Additionally, cloud-based tools allow healthcare organizations to easily expand or contract their health IT infrastructure based on changing needs. What's more, cloud EHRs are well-suited for healthcare systems with multiple locations, as data can be accessed and updated seamlessly across disparate facilities todrive interoperability.

SECURITY CONSIDERATIONS FOR CLOUD-BASED, ON-PREMISE EHRS

Maintaining system security is paramount for EHR systems, as medical records contain valuable patient information, including names, addresses, social security numbers, lab results, and dates of birth. According to experts, cloud-based EHRs are more secure than in-house EHRs.

"Cloud service provider data centers are typically highly secure and well protected against outsider and insider threats using administrative, physical, and technical methods implemented and maintained by expert professional staff," according to the Cloud Standards Customer Council (CSCC). "Cloud services can offer sophisticated security controls, including data encryption and fine-grained access controls and access logging."

Cloud-based EHRs also support compliance with federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA).

According to HHS, cloud services providers (CSPs) that store, receive, maintain, or transmit protected health information (PHI) for covered entities such as health plans, providers, or healthcare clearinghouses must enter into a HIPAA-compliant business associate agreement (BAA)to become contractually liable for HIPAA compliance issues related to the protection of PHI.

By entering into a BAA with a CSP, healthcare organizations can maintain PHI security and HIPAA compliance when storing patient data in the cloud. However, because healthcare organizations that use the cloud do not directly manage their data storage, organizations must trust in the security of a CSP or health IT vendor's data centers.

If a data center is compromised, healthcare organizations can face days of EHR downtime that may negatively affect patient data access, appointment scheduling, and care delivery.

For instance, cloud-based EHR vendor NextGen reported a data breachbetween March 29 and April 14, 2023, that involved the theft of over one million patients' names, dates of birth, addresses, and social security numbers.

However, healthcare organizations with on-premise EHR systems are not immune to EHR downtime either. CommonSpirit Health reported a cyberattack in early October 2022 that impacted multiple facilities within the health system. The ransomware attack resulted in appointment cancellations and forced some facilities to take EHR systems offline as a precautionary measure.

The shift from on-premise EHR systems to cloud-based solutions underscores a fundamental transformation in health IT. While on-premise systems have been the backbone of healthcare IT for years, cloud-based EHRs offer cost-effectiveness, scalability, and security that can significantly benefit healthcare organizations and ultimately improve patient care.