Cloud Computing & EHRs

After the Large vs. Small EHRs Debate I participated in last month (see last’s month blog) someone recently asked if I think that programs like Practice Fusion, Amazing Charts, CareCloud, and others will take over EMR in healthcare due to low price, the cloud, and other Web 2.0 features (like Google, Twitter, and Facebook have taken over the Web)?

First let me clarify that Amazing Charts is a client/server model and isn’t hosted in the cloud (aka web based) as is PracticeFusion or Allscripts-Mysis MyWay.

Of course I’m biased, but I believe that physicians should maintain their data locally. While, in theory, the web-based “ASP,”"Saas”, or “cloud” model sounds good, the reality is that your charts are only accessible if your Internet is working and the company continues to offer it. Can you imagine if your office charts were locked up, and there was just one key, and the person with that key was – rare as it may be – late or out for a day? The disruption would be significant and frustrating.

Now think of the times you’ve been unable to connect to the Internet, or experienced bizarre unexplained web page loading issues – rare as it may be - and you will get a taste of having a remote EHR database.  Anecdotally, we’ve had clients switch to us after using PracticeFusion and other cloud-based EHRs. Their biggest complaints have been that the delay to open the screens and jump from window to window is significant and makes use in a busy practice not practical.

There are two other serious issues of having your patient data in the cloud. First, just by its very nature, the cloud is more accessible to hackers than your computers behind a router. Even if the cloud security is more robust (and that is not necessarily the case), there is just a much larger number of hackers from around the world who will be trying to hack their way in. There are many fewer hackers who know your computer is sitting behind your router’s firewall and thus fewer who will be trying to hack in. 

The other issue is that your data and EHR will exist only so long as the vendor decides to support it.  Unlike most client/server software, if the EHR vendor goes out of business, you can still start up and use your EHR. If the data is in the cloud that is not the case. For example, in June 2002, GE sent a letter to physician’s using their web-based Encounter EHR giving them three months notice that the product would be shut down (read the news article at http://www.ama-assn.org/amednews/2002/08/19/bisa0819.htm).  Users had to scramble to get their data and to find another system, and many users from that time (who now use Amazing Charts) have told me they would never use a cloud based system after that experience.

To read more of my responses to reader’s questions from the debate click here: http://www.hcplive.com/technology/articles/bertman_questions

What are your experiences with SaaS-type EHRs and cloud computing?