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Larger Physician Groups Eye Cloud-Based EHRs

May 28, 2015
by David Raths
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Speed of upgrades, new services start to outweigh security concerns about cloud

“We are not driving a 4-year-old model car anymore. We are constantly driving the newest and coolest as far as technology goes.”
-- Andrew Aronson, M.D., Privia Medical Group’s chief medical officer

In January, the federal Centers for Medicare & Medicaid Services (CMS) rolled out a new fee schedule for providers taking care of patients with two or more chronic conditions. Within weeks, Privia Medical Group, a 310-provider multispecialty medical group based in Arlington, Va., had electronic health record (EHR) templates for the documentation and coding requirements as well as a 20-page tutorial with screen shots.

To Andrew Aronson, M.D., Privia’s chief medical officer, that responsiveness is one of the key reasons the group chose to work with the Watertown, Mass.-based athenahealth for its health information technology needs. “Any update or rollout of new information goes on behind the scenes and is pushed out to all our offices,” Aronson says. “It is released quickly and we are off to the races in implementing the new revenue stream. We are not driving a 4-year-old model car anymore. We are constantly driving the newest and coolest as far as technology goes.” He adds that having each physician office purchase and support its own hardware and EHR software is an “antiquated approach.”

Privia is not alone among midsize and large physician groups and independent practice associations in taking a second look at either an application service provider (ASP) remotely hosted EHR from a vendor such as eClinicalworks or a software-as-a-service (SaaS) model from vendors such as athenahealth or Practice Fusion. (The SaaS model involves a single, integrated database that is delivered as a service to multiple customers simultaneously via the Internet. In an ASP model, the EHR is delivered over a secure Internet connection but involves multiple separate instances of an application, and customers could be on different versions of the software.)

The Orem, Ut.-based KLAS Enterprises has done ambulatory EHR perception reports for almost 10 years, and has seen the pendulum gradually swing from almost no cloud adoption to much stronger interest, notes Erik Bermudez, a KLAS research director. “Ten years ago they would say if they got angry at their EHR, they felt better if they could kick a server in the basement,” he says. “They were at peace knowing it was all behind their four walls.” But that perception has gradually changed. Although many doctors may not understand the distinction between ASP and SaaS models, when KLAS has asked physicians about the umbrella term of remotely hosted EHRs, practices ranging up to 100 physicians are now open to it, he said, “although name recognition and a vendor’s size and reach continue to be important criteria for large practices. Practices with hundreds of physicians that have a CIO tend to have an interest in keeping data in-house,” he adds.

Derek Kosiorek, a principal consultant with the Medical Group Management Association (MGMA), believes that cloud-based EHRs are going to become more prominent and widely used. He sees the healthcare software industry as behind those in other industries in developing cloud-based offerings. “You don’t see software in other industries developed in this client/server manner anymore,” he said. “The mentality that the cloud is a new thing is curiously specific to healthcare.”

Concerns about data security might be misplaced, Kosiorek added. People tend to correlate moving records to another company as a point of fear. But security in the cloud provider’s environment is most likely better than in your own office, he says. Cloud-based systems have a vested interest in keeping things secure. If they have a breach, it will impact their reputation forever. “Small to medium-size practices have limited means to invest in security, so they are trusting their IT staff to have all the bases covered with security,” he said, “and the smaller the staff, the tougher that is to take on.”

Rodger Prong, executive director of Oakland Physician Network Services (OPNS) Inc., a 425-member Michigan independent physician organization, notes that many of its members are adopting the free (with advertising) or low-cost cloud-based Practice Fusion EHR.

“I had a lot of suspicion of this platform at first,” Prong admits. “I ignored it for two to three years. The old saying is you get what you pay for. But then I saw several positive independent surveys of doctors. What creates traction is what interferes with physicians the least,” he said. Prong said the process of migrating data to Practice Fusion from other EHRs has gone well.

The OPNS doctors using Practice Fusion have interfaces to an organization-wide registry and data warehouse. “We like the fact that they do enterprise-wide changes. It helps us not have downstream problems with interfaces,” he says.

Prong said that with some EHR vendors, interface costs are exorbitant. “If they don’t make enterprise-wide changes, then we have different versions out there and every time they change something for a doctor we wind up incurring additional cost to get the interface operational,” he says. “Practice Fusion gave us one price per interface for our entire group. We only pay them once and it works for everybody.”