BUSINESS: technology

Considering the Cloud?



Considering the Cloud?

A tech-savvy O.D. answers common questions about cloud-based EHR.


This month’s column is a conversation with Lorie Lippiatt, O.D., about cloud-based EHR systems. Dr. Lippiatt has consulted with an array of EHR software companies and is currently president of The Salem Eyecare Center, Inc., in Salem, Ohio.

Q: What is the difference between a cloud-based solution and cloud-hosted EHR?

A: Probably the biggest difference is accessibility. Cloud-based systems are available through an Internet browser, eliminating local servers and software installations. Cloud-hosted technology requires software installation on the computer or device that will be accessing the system.

Another difference between the two is software upgrades. These occur automatically with cloud-based systems. Manual upgrades (i.e. installing the latest version of the software) are required by cloud-hosted technology.

Q: Are HIPAA violations a concern with cloud-based EHR?

A: If the cloud-based EHR’s vendor is HIPAA compliant and meets government standards for data transmission and storage, the answer is “no.” You want to ensure your vendor has separate databases for each user, data centers secured with a number of physical controls to prevent unauthorized access and monitoring capabilities to prevent unauthorized access to its data centers and infrastructure.

Q: Can cloud-based EHR securely back up patient data?

A: Yes, but again, this depends on the quality of the vendor. Ask vendors: What is your back-up and disaster-recovery strategy? How often do you test your back-up and recovery infrastructure? How often are incremental backups made? How many copies of my data do you store, and where are they stored? For example, most cloud service vendors back up their data in at least three places and have a written policy describing back-up redundancy, fire protection and disaster recovery. You should ask for a written guarantee and service agreement for protection, should your data be compromised.

Q: Does the vendor own the data once you use their cloud-based EHR?

A: You want to make sure your vendor has a policy and agreement surrounding data migration. That way, if you choose to leave that vendor, you retain immediate access to your data. Also, ask the vendor what would happen to your data if they go out of business or choose not to certify for ongoing Meaningful Use. For example, if your vendor goes out of business, would your data become the property of the creditors?

Q: Do you believe the cloud is the way to go?

A: There are positives and negatives to cloud-based EHR. The positives: It takes away the worries of your server going down and data storage and back-up, maintaining your infrastructure, downloading software and maintaining updates. In addition, it eliminates a lot of IT costs and allows for accessibility no matter where you are in the world. The negatives: You may need a new Internet provider to achieve optimum connection speed and an additional means of Internet connection through a “hot spot,” for example. Also, you’ll have to pay a monthly software-licensing fee, which is comprised of all or a portion of the Internet services for which you currently pay.

It’s up to each practice to weigh these pros and cons. I will say this: If you decide to go with a cloud-based EHR, be sure to ask potential vendors the questions outlined above, so you can be confident in your decision. OM

Dr. Jasper is a Vision Source Administrator and in private practice in West Palm Beach, Fla. E-mail her at, or comment at