There has been a lot of talk in recent years about moving everything from email and websites to databases and desktops to “the cloud.” Much of this conversation has been heavily biased one way or the other. I’ve seen many accounts of moving to the cloud being the best thing that ever happened to a healthcare organization, while from others perspectives it’s close to the worst. How can these individuals be talking about the same thing with such mixed results? Why are some sources biased? And what does this mean for your organization?
To jump right in to it, I don’t think there is any inherent problem with cloud hosting. It’s a wonderful idea in so many ways and will probably be the 5-10 year future for EHRs and every other ERP solution. However, what I do find to be a serious problem is the way that many EHR vendors seem to be going about cloud hosting.
How can they be talking about the same thing with mixed results?
The simple fact of the Internet age is that people will lie in reviews. I’ve been offered money for favorable reviews in the past — in fact most of my peers with a significant online presence have. CBC made a whole episode about it a couple years ago, but digging deeper than that, there are plenty of other reasons why you might not be able to take others experiences as what you should expect to be your own.
In rural Kentucky, access to high speed, low jitter and low ping internet is hard to find, and an absolute must for having a positive experience from your hosted EHR solution. This, however, is something that many monetarily motivated organizations will fail to mention in the pursuit of getting a signature on their contract. If you want to have a good experience with your hosted solution, you NEED a rock solid WAN uplink. We recommend at least a 10×10 fiber optic connection, for offices that have less than 5 providers and that you scale up with that as you increase your provider count.
That said, the next biggest hurdle is you need to compare apples to apples, a hosted solution in companies basement is never going to be as good as if it is hosted by a team of IaaS professionals, which ties us in to our next point.
Why are some sources biased?
Most information that users have about their options when it comes to could hosting comes straight from their EHR vendor and this can be bad for many reasons.
One vendor for example appears to be only using a single company for all of their hosted EHR solutions. A small amount of research revealed that this EHR vendor has a significant stake in a certain small cloud-hosting provider and has been referring all of their customers to them. By charging a premium that would allow their clients to, for the same money, use any of the established hosting solutions, they only present the one they own.
In what from the outside looking in must be (as their website states it) a bid to foster that company in to: “The place for cloud hosted EHRs.” The only problem with that being there are very high barriers to entry in the world of cloud hosting. You need to buy/build redundant data centers all over the world (or at least the country) to be able to compete with companies like Amazon and Microsoft on the reliability front.
What does this mean for your organization?
In effect, this effort would be like a vaccine company – maybe the very best vaccine producer in the whole world, catching wind of how profitable the toll road business can be, and in response to this realization, deciding to only offering free shipping for their products to users that have paid for a toll road to be built all of the way from their facilities to yours. Sure it could make them a lot of money, but only through ridiculous duplication of effort at best, and in all likelyhood by driving customers away and in to the open arms of others who see the value in reliable established infrastructure.
Amazon, for example, has been doing this for around a decade now in literally every market. They have a branch of services for HIPAA complaint cloud hosting which would be perfect for EHRs. If I the decision maker, calling the shots at this EHR company, I would make a pay-per-month Elastic Cloud Instance and call it a day. I understand their point. It’s tempting to want to try to do it all yourself and thus make all the money, but ultimately that means that their customers pay more than what they should for the value their products deliver – a lot more.
I’m of the opinion that if you don’t treat your client’s right, eventually someone else will. Speaking of which, if your organization is in the market for any of the cloud-based staples like moving your phone system to VoIP, Hosted Exchange, or custom cloud hosted solutions (for example moving your EHR to AWS), NeKY RHIO’s IT services are the go to resource for small to medium-sized healthcare practices. We can even help negotiate lower rates for those required high quality internet connections.