With more and more clinical systems moving to the cloud, a small but growing number of healthcare organizations are also moving their core e-mail messaging systems to the cloud. According to the Cambridge, Mass.-based Forrester Research, the main players in the cloud email space are Google Apps, Microsoft’s Exchange Online, Cisco’s WebEx Mail, and IBM’s LotusLive Notes.

Legacy System Problems
When the Westminster, Md.-based Carroll Hospital Center started experiencing reliability and performance issues with its e-mail, alternatives to its legacy Novell GroupWise messaging system needed to be investigated. Slow e-mail, even slower servers, and increasing amounts of monthly maintenance were becoming too much for the 195-bed hospital to handle.

Hunt Regional Healthcare, which has a main 202-bed hospital in Greenville, Texas and a 24-bed critical access hospital in Commerce, Texas, was previously using IBM’s Aptrix messaging system. The hospital had a hybrid system, an outward Internet facing e-mail and an internal exchange server for personal health information (PHI). “Either possibly with a case of ignorance or maliciousness, the capacity of some user to be able to send unencrypted PHI was just looming greater and greater on the horizon, so we had to do something,” says Joe Hartley, director of information systems at Hunt Regional. Hartley also cited that outages before and after Aptrix’s acquisition by the Cambridge, Mass.-based IBM as another reason for moving to the cloud.

Efficiencies in the Cloud
Those interviewed named many efficiencies with using the cloud for their messaging service. Jon Roenick, systems engineer at Carroll Hospital says his new cloud-based messaging system has more storage than the legacy system, and e-mail doesn’t have to be deleted as regularly. “Just switching over to Google, got the servers out of our data center and into the cloud, means less administrative overhead for email and more time to spend on the clinical applications that we maintain here,” he says. Carroll Hospital was also able to get rid of the BlackBerry (Research in Motion; Waterloo, Canada) server, and save approximately $100,000 yearly with the switch.

“I don’t have to worry about backing up the e-mail server, which was a daunting task in the first place,” says Roenick. Backing up the old e-mail server could take up to 20 percent of the IT team’s daily work.

For legal purposes Carroll Hospital retains e-mails for 10 years. Doing this in the cloud with Google’s Message Discovery tool makes compliance much easier and more cost-effective, according to Kim Moreau, assistant vice president of information systems. With 11,000 accounts to migrate, Moreau said there were only a couple of blips along the way. To avoid any foreseen problem, she set up tables for “lunch and learns” to educate her users, but many of them were already familiar with Gmail’s functionality.

Hartley notes that for hospitals with small staffs, like Hunt Regional’s, who are trying to meet meaningful use it’s difficult to expand computer systems and support physical servers, which makes hosted e-mail an attractive idea.

Jamie Grandfield, systems analyst at Hunt Regional, mentions that the transition from the legacy system to the new one was made easier by its cloud migration services company Cloud Sherpas. He also cites Google’s tons of canned documentation as helpful for when his users had questions. “One of the other things we liked about the Google platform is there’s lots of good documentation and very good support,” says Grandfield. Grandfield and his seven-person IT team have been transitioning their 300 users, many with individual migrations and trainings, since September.

Hartley notes another major boon of the cloud platform is the ability for the board, senior management, physicians, nurse to collaborate on the same document, as in Google Docs, all in a real-time fashion.

Counterpoint
Matt Green, director of information systems at Methodist Healthcare, a seven-hospital system based in Memphis, Tenn., feels cloud-based e-mail is not the best solution for his organization right now. “At this point in time from our research, there are not a whole lot of healthcare organizations using cloud-based solutions, so I think it’s going to take some time before those solutions are ready for a regulated environment like healthcare,” he adds. His organization is, however, using the London-based software-as-a-service email management company Mimecast for e-mail archival and disaster recovery.