Meaningful Use and Beyond with the Cloud

W. Reed Liggin
W. Reed Liggin

Guest post by Reed Liggin, founder and president, RazorInsights.

Since the Health Information Technology for Economic and Clinical Health (HITECH) Act was signed into law in February 2009, rural, community and critical access hospitals are turning to electronic health record (EHR) systems to receive significant incentive payments based on meeting meaningful use regulations. However, the impact on workflow makes achieving a return on investment (ROI) after implementation challenging. Additionally, the burden is placed on these hospital’s small IT departments to meet federally mandated deadlines such as meaningful use.

According to a 2014 HIMSS Analytics survey, 83 percent of healthcare providers are using cloud services. Compared to server-based networks, the cloud is especially beneficial to rural hospitals because of the lower upfront, implementation and maintenance costs, resulting in increased ROI. The cloud system’s pay-as-you-use method removes the need for expensive hardware, and the accessibility and security of patient records improves efficiency and patient care, allowing hospitals to prove they are meaningfully using EHR technology.

Implementation and Maintenance

Because of budgetary restraints, rural hospitals typically have outdated technology and some areas do not even have computers. Recently, I visited a hospital with only one computer on each floor and no EHR system in place at all. Because of this, these hospitals must implement user-friendly healthcare technology that is easily implemented across the network– even for clinicians with limited or no experience in a high-tech environment. This type of easy-to-use EHR systems not only improves patient care, but also helps hospitals qualify for federal incentive payments. However, time is running out. Hospitals only have one more year to receive incentives for being MU compliant. After this timeframe they not only won’t receive payments, but they will be penalized financially for not meeting regulations, which is especially detrimental to smaller hospitals.

Cloud-based solutions allow hospitals to deploy EHR systems quickly and at a lower cost. While server-based EHR systems can cost $40, 000 or more, a cloud network does not require any hardware to be installed on-site. Therefore, upfront, implementation and maintenance costs are much lower than a server-based solution. Less hardware means less opportunity for failure – thus, maintenance costs decrease drastically as the lifespan of a cloud-based system is much longer than a physical server solution.

In addition, when using the cloud, system upgrades can be made across the network remotely at one time, reducing costs and increasing productivity, as there is no need for an administrator to manually update each system. The cloud vendor manages upgrades, support, and maintenance remotely, which is especially important to hospitals with a small IT staff.  Moreover, these updates can be scheduled during off-peak hours so there is virtually no downtime – meaning patient care is uninterrupted. Cloud-based systems can quickly accommodate and respond to a rapid increase in users, even when these users are working remotely.


Physicians, especially those is rural hospitals, are unable to be tied to their computer at all hours of the day. Because there are fewer doctors at small community hospitals, they are much busier and often need access to clinical and financial information on the fly. Accessibility is one of the biggest advantages of a cloud-based EHR system.

For example, most rural or community hospitals own a clinic – whether it is a trailer on the same property or an office down the street. The doctors that work at the clinic also have rounds at the hospital, so they can remotely admit patients to the hospital from the clinic. This way, the hospital staff knows the patient is coming, and the patient does not have to show up early to answer medical history-related questions, since this information has been updated in the system.

A cloud network allows physicians and referring providers the ability to access a complete history of the patient whenever and wherever the user has an Internet connection. This results in better patient care, as they can view a patient’s longitudinal history, diagnoses and treatments even if the physical documents are lost or compromised. Patients also benefit from this availability, as they would not have to pay for the same tests multiple times if they visit different facilities and referring specialists.

Increasing demands for physicians’ time often requires them to review patient records even when they are not at the hospital. This is only possible if the physicians can access these records online. The web-based availability of clinical and financial information not only allows for timelier care, but also provides the entire care team with a complete patient profile for better care.


Cloud solutions also allow hospitals to only pay for services they are actually using, making deployment of an EHR system much easier and cost efficient– and the solution can easily grow as the hospital grows. With a server-based EHR system, hospitals are forced to buy expensive hardware that rural hospitals simply do not need. Instead of growing with the hospitals, server-based solutions require upfront costs for hardware and ongoing capital outlay. If a hospital reaches server capacity, then additional hardware will be required.

Cloud-based EHR systems are provided through Software-as-a-Service (SaaS) contracts, allowing for a pay-as-you-go method on a low monthly subscription basis. As a hospital grows and requires more functionality, additional IT capabilities can easily be added remotely. Expensive on-site hardware becomes a thing of the past, as does the requirement to monitor and maintain the application.


With the increasing governance of medical records and rise in encryption standards, security is an important factor when implementing an EHR system. Because online storage is the main reason hospitals implement cloud computing, hospitals need to ensure that their data is encrypted, backed up, and adheres to the standards in place.

Cloud-based systems are HIPAA compliant and are more secure than on-site client-server solutions. This ensures data is backed up on a network of highly redundant servers in a secure data center. Other security advantages to a cloud-based system include enhanced confidentiality and traceability of data access.

As hospitals are turning to EHR systems, the trend is clearly in the cloud. Particularly beneficial for rural, community and critical access hospitals, a cloud-based EHR solution allows providers to not only improve patient care, but also qualify for federal incentive payments, such as meaningful use compliance. As hospitals race to meet compliance before the incentives cease, it is important to note that hospitals will continue to experience increased ROI after deploying a cloud-based EHR system and, of course, not suffer penalties for failing to meet HITECH standards.

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