Credit: Davor Milicevic (IT Project Manager of Nevada HIE)
This post is targeted toward those that are familiar with the government incentives that are provided to health care professionals when they adopt EHR systems. Cloud based electronic health record (EHR) systems (also referred to as SaaS EHR) are becoming a standard solution for the migration from paper to electronic records by health care professionals. The question to ask is: What effects does the increasing use of cloud based electronic health record systems have on providers and the health information exchange (HIE) landscapes; particularly, what are these systems’ effects on interoperability, meaningful use requirements, reliability, security and privacy?
In 2014, stage 2 meaningful use requirements, as outlined in Title XIII of the American Recovery and Reinvestment Act (ARRA) of the Health Information Technology for Economic and Clinical Health Act (HITECH), will take effect. These new requirements will necessitate increased functionality in EHR systems. To that end, cloud-based EHR systems will facilitate easier updates via batch updating many providers at a time instead of doing it one by one. A concern that health care providers should keep in mind when selecting their EHR software is the ability their vendors will have in meeting added requirements. For this reason, a trusted vendor providing SaaS solutions should be considered.
Interoperability, for the purpose of enabling health information exchange, is the major theme of meaningful use stage 2 and the requirement that will be most challenging to meet. Due to the fact that interoperability standards are continuously restructures, using standardized updates on a cloud based level instead of updating multiple individual instances facilitates the seamless adoption of interoperability standards. To explain, SaaS EHR systems are run in a multi-tenant model, which means that there are many instances of the EHR software that share one set of hardware resources. In relation to the aforementioned facilitation of seamless updates, SaaS based EHR systems will enable a sustainable approach to interoperability. This should be another factor to consider when selecting an EHR system.
Although using a cloud-based EHR system will put the safeguarding measures of protected health information (PHI) in the hands of the EHR vendor, the health care provider loses the power of having it in his/her hands. According to a paper published by the American National Standards Institute (ANSI), a health care provider is just as liable for electronic protected health information (ePHI) in the cloud as if the PHI was stored in a traditional in house EHR. To alleviate the risk and uneasy feeling of having a third party handling security measures, HIPAA security rule specifications can be stipulated to in a service level agreement (SLA) contract between the health care provider and the vendor.
A cloud-based EHR system is accessed through a web browser or web service client. Consequently, there is the issue of reliability that a traditional, in-house EHR system does not face. What do you do when your Internet connection goes out? Depending on the level of redundancy that a health care provider deems appropriate, I recommend either one or two backup connections.
With these factors considered and the overhead cost savings of cloud EHR systems, it is my strong recommendation that a cloud-based solution be taken into consideration when selecting an EHR system.