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No Cloud Based Hospital EHR of Note…Yet?

Posted on April 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Scott Mace offered this interesting intro to his article “Cloud Adoption Gains Traction” in Health Leaders Magazine:

While no cloud-based electronic health record software of note for hospitals has yet to emerge on the scene, cloud-based ambulatory EHRs continue to gain traction, storage remains a strong cloud option, and intriguing new analytics options are tapping the versatility of cloud technology.

A look at hospital EHR market share and the main EHR companies (Epic, Cerner, MEDITECH, etc) are not cloud based EHR systems. Sure, some of them might have their client server installs hosted in the cloud, but that’s not a true single database EHR cloud.

What’s fascinating to me is why cloud EHR hasn’t taken off in hospitals like it’s taken off in the rest of the world (even ambulatory EHR as the article notes). It’s worth noting that athenahealth is working on a cloud based hospital EHR. However, there still at least a couple years out from even being in the conversation when a hospital considers selecting an EHR. The small SaaS Hospital EHR vendors don’t even make a dent in the market share.

Here’s why I think cloud EHR hasn’t taken off in hospitals:

Early Adopters – Many hospitals adopted some form of EHR really early on. They made the investment before cloud was really a decent option to consider (ie. before high speed internet was ubiquitous). Now they’re stuck with a legacy investment and they’re still paying off that investment

Switching Costs are High – Switching EHR in the ambulatory world is hard. Doing so in a hospital is infinitely more difficult. If I’m a CIO at a hospital, do I want to put my organization through that process? It takes a really visionary CIO and a supportive CEO to make the change.

No Great SaaS Hospital Alternatives – Once hospitals decided they needed one all in one system, that narrowed the number of EHR options to very few. We still have yet to see a SaaS software expand their offerings to cover the full gamut of software that’s required by a hospital. For example, even Epic which has been around forever (and is not a cloud EHR for the record), still gets complaints from hospitals about their lab software. Now apply that to 100 departments in a hospital and SaaS software just hasn’t been able to provide the full suite of software a hospital requires.

Fear – I think most hospitals are still afraid of the cloud. There are plenty of reasons why they should be less afraid of cloud than their current set up, but there’s still very much fear surrounding cloud. Somehow having the servers in my data center, on site where I can touch them and feel them makes me feel more safe. Reality or not, this fear has prevented most hospitals from even considering a cloud based EHR. I think they’re starting to get past it since every hospital now has something in the cloud, but that wasn’t true even 5 years ago in many organizations.

I’m sure there are other reasons you can offer in the comments. Of course, Scott Mace’s article linked above goes into a number of the benefits of a cloud EHR. However, that’s not yet a realistic option for hospitals. I’m sure one day it will be.

The Often Missed Benefit of SaaS EHR

Posted on December 12, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across a great article by Geoffrey Moore on LinkedIn talking about “SaaS’s Real Triumph.” He suggests that the “greatest contribution of SaaS is to free the enterprise from the tyranny of the product release model.”

This is a really interesting concept. Far too often when we talk about SaaS EHR software we talk about the payments being spread out over time as opposed to a big lump sum payment up front. Plus, we love to talk about how that means you can leave that EHR software if you don’t like it. The former is an important consideration for every CFO. The later usually doesn’t play itself out as nicely since you often have to sign a contract for a certain number of years. However, at least if there are major issues you still hold most of the money.

I think Geoffrey is right about this rarely discussed benefit of SaaS. As he acknowledges, SaaS EHR software does have some level of ongoing disruption that must be dealt with, but it’s nothing like the disruption that occurs with a major product release form an enterprise software like an EHR. In fact, I think these major release updates are likely going to be the eventual downfall of the major EHR systems we know today. It won’t happen until after meaningful use, but it will present an opportunity for a scrappy startup. We’ll see if the current EHR companies will be able to adapt.

I’m sure many of you reading this have stories and experiences you can share on the topic of enterprise EHR upgrades. I look forward to reading them in the comments. Of course, I bet there’s just as many stories about hospital IT leadership being afraid of SaaS as well. The clash has begun.

Healthcare Cloud “dos and don’ts”

Posted on June 28, 2012 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While the cloud has become an increasingly important part of consumer computing — see Apple’s cloud product and Google’s plans to transform Documents into Google Drive — healthcare organizations are rightfully waiting just a bit before moving ahead.

If you’re wrestling with cloud issues, you might find some of the following cloud “dos and don’ts” tips to be of use. These are my favorite of the recommendations Mariano Maluf, CTO of Atlanta-based GNAX, shared with Healthcare IT News:

* Assess your environment and capabilities for short-term and long-term opportunities for cloud use, then prioritize. Which would you implement first?

* Be aware that there are some apps that probably shouldn’t be migrated to a private cloud initially, Maluf suggests. Hybrid models, secure multi-tenant public clouds and enterprise-grade cloud storage may be first-line choices.

* Don’t forget to look into the effects of cloud installations, such as architectural dependencies. Also analyze the impact of refresh cycles and application latency tolerance.

* Do develop an integrated cloud strategy, with a related roadmap, Maluf advises. “Focus on incremental value by emphasizing infrastructure delivery and management simplification,” he told HIN.

* Do benchmark your application performance today. Otherwise, it will be tough to know how the cloud has affected app performance, and then it will be tough to establish SLAs with vendors.

I really like these tips because they dig into application performance, rather than going off on a fishing expedition as to what security breaches could possibly happen. (Security is certainly important, but once you establish a security baseline the discussion must inevitably move on to performance.)

Do you have any other tips on cloud implementation to add?  Do you disagree that we should table security as the primary discussion around the cloud?  Is it too soon to do that yet?

What Are the Health IT Trends Working in Favor of Small Hospitals?

Posted on September 20, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Given their limited resources, small hospitals must search for a health IT solution which presents a low barrier to implementation, ease of adoption, is low cost to maintain, and places minimal IT support burden on the client.

Many solutions marketed specifically to critical access hospitals are integrated clinical/financial platforms. The rise of remote-hosted web applications as a delivery model promises to reduce the total cost of ownership, mitigates IT staff turnover, and places the IT burden back on the vendor.

Some large hospital Health IT and EHR vendors (Cerner, Allscripts) are moving downstream into the community hospital space, but they have yet to make a material impact in the critical access market. The enticement of these offerings is a proven track record of clinical functionality. This means that current vendors specializing in marketing to small hospitals will need to enhance their offerings and accelerate clinical adoption in order to help their clients meet Meaningful Use requirements in the face of competition from sophisticated large hospital health IT solutions.

Next up, I’ll look at which EHR and Health IT vendors seem to be doing well in the small hospital space.

Chris O’Neal is Managing Partner at KATALUS Advisors. KATALUS Advisors is a strategic consulting firm focused on the healthcare vertical. We serve healthcare technology vendors, hospitals, and private equity groups in North America, Europe, and the Middle East. Our services span growth strategies in new and existing markets, M&A due diligence, market analysis, and advisory services. www.KATALUSadvisors.com