Trent Peters
What is Cloud Computing?
There are plenty of buzz words flying around such as “Cloud” “Web-Based” “Off-Site” “Hosted” “Co-located” “SasS” “IaaS” “ASP” Etc. However, cloud computing is essentially accessing an application and data over the Internet (as opposed to a local area network). You’ve likely been using some form of cloud computing, for example Hotmail, GoogleApps, are commons forms. Many of you are already (unknowingly) running your EMR systems as a form of cloud computing if you have a centralized data center and use it across multiple office locations. In healthcare “cloud” EMRs are typically used as an alternative to having an onsite “server” based EMR.
Official Wikipedia Definition: “Cloud computing is a model for enabling ubiquitous, convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction”
Why is Cloud Computing beneficial?
•Agility improves with users able to rapidly and inexpensively re-provision technological infrastructure resources.
•Cost is greatly reduced and capital expenditure is converted to operational expenditure and is pay-as-go.
•Device and location independence enable users to access systems using a web browser regardless of their location or what device they are using.
•Peak-load capacity increases dynamically.
•Reliability improves through the use of multiple redundant sites, which makes it suitable for business continuity and disaster recovery.
•Security is often as good as or better than traditional systems, in part because providers are able to devote resources to solving security issues that many customers cannot afford.
3 General Types of EMR System Delivery Architectures:
Client / Server – Traditional Model where the Server and EMR Application are hosted on premise. Requires network and server hardware, licensing, and maintenance by IT Resources.
Hosted Client Server – The EMR vendor or 3rd party hosts similar Client / Server systems in a data center. The EMR application is deployed to the healthcare organization via some technology like Citrix or Terminal services. While it may seem like Cloud Computing, it is not because the system was designed as client-server and is not dynamically scalable, basically moving the server from on premise to a datacenter.
Cloud Based – True cloud based offering, typically hosted in the EMR Vendor’s datacenter that delivers a rich EMR application to many devices, from anywhere, without the need for a Server on premise. The EMR was created using multiple tiered architecture and specifically designed for use over the Internet and is very scalable. It’s important to note that while the EMR application may be “in the cloud” other technologies may still require server(s) on premise as well as computers, printers, switches, firewalls, etc.
Cloud Based EMR Systems Advantages:
- Low Upfront Cost – No servers to buy. Operational expense instead of capital expense.
- The Future is the Cloud – rest assured it’s not a fad.
- Accessibility – Connect from Anywhere
- Easy to Deliver / Implement – many server based EMRs require complex technical environments
- Easy Maintenance / Upgrades –Software and hardware upgrades are manage by the EMR vendor
- Business Continuity Built-in – The EMR hundreds of miles away and is replicated to multiple SAS-70 certified datacenters
- Security / Privacy – can be increased and the EMR Vendor may have more resources dedicated.
- Established Vendors Offerings – More and more EMRs are offering cloud solutions
- Less HIPAA Concerns – as the data is stored elsewhere and managed by the EMR Vendor.
Cloud Based EMR Systems Concerns:
- Long-term Cost (Subscription Based) – Like leasing a car, often it make more sense to purchase it outright. Long-term TCO (Total Cost of Ownership) analysis should be performed.
- More Users, Higher Cost – The Pay-as-go is great, but not as scalable. Higher TCO in the long run.
- Less Control of Data – The EMR Vendor will control your data. Getting is back could be difficult and hope they don’t go bankrupt.
- Bandwidth Intensive – ISP charges can be expensive and the “pipe” may need to be upgraded. For this reason many rural locations “Cloud” offerings are not a possibility yet.
- Customizability Limitations – The databases could be shared or limited in a way where customization may be limited.
- Vulnerable to Internet Disruptions – Ask yourself how many times you Internet has gone out.
- Cloud Imposters – 3rd party vendors offering a “Cloud” solution when really it’s Server based solution hosted in datacenter
- Complex Licensing Options – Per Chart, Per Physician, Per Claim, Per User, Per Month/Week/Day – it’s all out there!
Additional Resources:
Cloud Overview Video: http://www.umbrella-ms.com/resources/videos/
Cloud Definition: http://en.wikipedia.org/wiki/Cloud_computing
EMR and HIPAA Blog: http://www.emrandhipaa.com/
