Cloud-based EMRs Clear Skies Ahead

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 - Cloud-based EMR
Cook Children’s Health Care System in Fort Worth, Texas, uses a cloud-based EMR to populate bar-coded patient information into the patient’s cloud-based record.
Remote hosting of clinical applications via cloud computing could become all the rage in the health IT realm as it shows promise to reduce operational costs and maximize quality improvement initiatives in the healthcare continuum. But, is the technology ready for prime time?

If Harry Shuman, MD, MPH, CMIO at Cook Children’s HealthCare System had been around when the Fort Worth, Texas-based provider handpicked its EMR technology in 2009, he would have thought the decision to choose a cloud-based EMR was “ludicrous.” While both the decision to select a cloud-based EMR and hire Shuman as the system’s CMIO occurred in 2009, the EMR decision was made before he stepped in.

Simplicity is an asset

When Cook Children’s cloud-based system went live in February 2010, the system proved to be pediatric-friendly. For example, a weight-based dose calculator was incorporated into the EMR where stored vital signs, weight and medications are calculated to check dose range to ensure a patient is not under- or over-dosed. “This is critical in the pediatric world,” says Shuman.

The cloud-based system is used in all of Cook Children’s outpatient facilities (primary care and 10 pediatric subspecialties including pulmonology, surgery, cardiology and genetics), as well as inpatient facilities for review of patients outside the system and medication reconciliation.

“The cloud-based EMR system recognizes that, in 2012, not everyone is on an electronic system and you need to communicate with outside people,” says Shuman. For those communicating through fax outside the Cook Children’s system, the cloud-based EMR, as a service, will automatically populate bar-coded patient information into the patient’s cloud-based record.

One main advantage with a cloud-based system, according to Shuman, is that implementation is much simpler. With the EMR he implemented before arriving at Cook Children’s, Shuman was still building content a year into the program. Cook Children’s operates more than 60 pediatric medical and specialty clinic offices throughout the state. The entire system-wide implementation at Cook Children’s was completed in November 2010, eight months after the initial go-live date.

Another cloud-based EMR feature that Shuman likes is  the ability to make changes to assist documentation and workflow more quickly. “If someone told me he or she wanted a button in a corner in a regular EMR, I would write a code, get it tested and upload the feature in a couple of days,” says Shuman. “Now I pride myself on implementing the changes in the same day.”

Plus, the cloud-based system doesn’t require Cook Children’s to hire a team that dedicated to server support, Shuman adds. In the first year, the total downtime of the system was less than 90 minutes.

A new buzzword?

While a spotlight has been shining on cloud-based computing in recent years, some believe it to be a new wrapper on an old idea. “Cloud-based computing is really just a new buzzword for remote hosting,” says Maureen Gaffney, RN, CMIO and senior vice president of patient care services at Winthrop University Hospital in Mineola, N.Y. “Because of the availability of offsite data centers and privatizing public cloud storage, the technology has taken on a new life.”

According to Gaffney, the 590-bed hospital has been using cloud computing services for close to 10 years. The facility uploaded its cloud-based clinical information system in 1996 and upgraded that to an EMR system in 2005, so Winthrop’s clients can tap into the hospital’s servers to access patient information.

Reports of cloud computing adoption are somewhat hazy. According to Symantec’s “2011 State of Cloud Survey,” which commissioned 5,300 organizations representing 38 countries on cloud computing adoption, 73 percent of respondents have adopted or are adopting a cloud service. The top cloud services being adopted include email services, security management and web and information management security. However, less than 20 percent reported complete implementation of each of the cloud focus areas and 25 percent of organizations are currently in an implementation phase.

Security questions loom

The survey found several security issues with cloud computing. Organizations rated security as a top goal and a top concern. Eighty-seven percent of respondents stated that moving to the cloud will not impact or will actually improve their security. However, achieving security for cloud environments is a top concern for these organizations, which cited potential risks including malware, hacker-based theft and loss of confidential data.

“Cloud-based technology with respect to EMRs should not be something to enter into just because it’s a new technology, but shouldn’t be precluded because it’s scary,” says Adam H. Greene, JD, MPH, from consulting group Davis Wright Tremaine and former senior health IT and privacy advisor at the Office for Civil Rights (OCR).

Examining the trend for large data breaches (affecting 500 or more individuals), 50 percent are due to theft—yet only 2 percent of large breaches reported to OCR have been attributable to an EMR from September 2009 to September 2011, Greene says. Fifteen percent of breaches were due to a loss and 7 percent to a hacking/IT incident for the same time period.

The largest media type for large breaches was paper-based records (26 percent). “Entities should keep in mind that as they move toward an electronic system, they need to properly handle the paper records and not underestimate the inherent potential security risk,” says Greene.

As of press time, 372 large breaches have been reported to OCR since September 2009.

“You have a responsibility when using cloud services, especially with applications you’re accessing, to meet HIPAA security standpoints,” says Gaffney. Because Winthrop is using certified EMR technology, they will be able to attest for meaningful use within federal fiscal year 2011, she says.

From a usability standpoint, Gaffney says that if organizations settle into their system with no fuss, they are doing something wrong. Cloud-based services need to be tweaked, enhanced and customized after listening to physicians. If the time is not taken to appropriately match the technology with physician workflow, there is potential for patients to get hurt, says Gaffney.

Optimization is one way to get ahead of potential workflow errors. Because every clinician looks at patient data differently, Winthrop adds hyperlinks into the EMR system so clinicians can select patient information they need in the moment, allowing for integration in a meaningful manner. “It’s about matching clinical workflow to the way clinicians want to view the information,” she says. By matching workflow to functionality, cloud-based systems could be set to act as a powerful tool for physicians seeking to launch quality improvement initiatives.

As cloud-based EMR technology continues to improve, additional organizations are likely to tap into these systems to better patient care and enhance workflow.