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What’s Involved In Getting To EHR 2.0?

Posted on September 22, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While the current crop of EHRs have (arguably) served a useful purpose, I think we’d all agree that there’s a ton of room for improvement. The question is, what will it take to move EHRs forward?

Certainly, we face some significant obstacles to progress.

There are environmental factors in play, such as reimbursement issues.

There’s the question of what providers will do with existing EHR infrastructure, which has cost them tens or even hundreds of millions of dollars if next-gen EHRs call for a new technical approach.

Then, of course, there’s the challenge of making the darn things usable by real, human clinicians. So far, we simply haven’t gotten anything that solves that issue yet.

That doesn’t mean people aren’t considering the issue, however. One health IT leader that’s stepped up to the plate is Dr. John Halamka, chief information officer of the Beth Israel Deaconess Medical Center and CIO and dean for technology at Harvard Medical School.

In his Life As Healthcare CIO, Halamka lays out the changes he sees as driving the shift to EHR 2.0. Here are some of his main points:

  • Regulators are shifting their focus from prescribing certain types of EHR functionality to looking at results technology achieves. This supports the healthcare industry’s movement from a data recording focus to an outcomes focus.
  • With doctors being pulled in too many directions, it will take teams to maintain patient health, this calls for a new generation of communication and groupware tools. These tools should include workflow integration, rules-based escalation messages, and routing based on time of day, location, schedules, urgency, and licensure.
  • With value-based purchasing gradually becoming the norm, EHRs need new capabilities. These should include the ability to document care plans and variation from those plans, along with outcomes reported from patient-generated healthcare data. Eventually, this will mean the dawn of the Care Management Medical Record, which enrolls patients and protocols based on their condition then ensures that patients get recommended services.
  • EHRs must be more usable. To accomplish this, it’s helpful to think of EHRs as platforms upon which entrepreneurs can create add-on functionality, along the lines of apps that rest on top of mobile operating systems.
  • Next-gen EHRs need to become more consumer-driven, making patients an equal member of the care team. Although existing EHR models do have patient portals, they aren’t robust enough to connect patients fully with their care, and they don’t include tools helping patients navigate their care system.

As far as I can tell, Dr. Halamka has covered the majority of issues we need to address in transitioning to new EHR models. I was also interested to learn that regulatory bodies have begun to “get it” about the limitations of demanding certain functions be included in an EHR system.

I’m still left with one question, however. How does interoperability fit into this picture? Can we even get to the next generation of EHRs without answering the question of how they share data between one another? To me, it’s clear that the answer is no, we can’t leave this issue aside.

Other than that, though, I found Dr. Halamka’s analysis to be fairly comforting. Nothing he’s described is out of reach, unless, of course, vendors won’t cooperate. I think that as providers reach the conclusions he has, they’ll demand the kind of functionality he’s outlined, and vendors will have no choice but to pony up. In other words, there might actually be light at the end of the EHR tunnel.

Xerox Files Patents For Blockchain-Based Tech With Healthcare Applications

Posted on September 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

According to a site focused on blockchain technology, Xerox has filed patents for technology using blockchain to securely revise electronic documents. The patent application was filed in February of last year, but the move became news this month when it was reported by Coin Telegraph.

According to the site, the patent filings propose a network of nodes that can create and update documents and share data using blockchain technology. The system can be used by regional hospital organizations to exchange electronic health records, Xerox says in its application.

In a more-recent blog post, Xerox India’s director of global document outsourcing, Ritesh Gandotra, asserts that the use of blockchain can offer unique benefits.

“Historically, EHRs were never really designed to manage multi-institutional and lifetime medical records,” he writes. “…Adopting the blockchain structure to EHRs will help manage authentication, confidentiality, accountability and data sharing while allowing medical researchers to access insights into medical treatment.”

Xerox is hardly the first organization to take an interest in blockchain’s potential as a backbone for health data management. Not only that, but leaders in the industry are developing what look like practical models for using blockchain in this manner.

For example, my colleague John Lynn recently shared an infographic outlining a use case for blockchain in healthcare. You’ll probably learn more by clicking through and looking at the infographic yourself, but in summary, the model outlines a process in which:

  • Health organizations direct administrative information to the blockchain via APIs and track clinical data in parallel using existing health IT
  • The blockchain stores each transaction with a unique identifier
  • When they need information, healthcare organizations query the blockchain
  • Patients share their identity with healthcare organizations, using a private key that links their identity to blockchain data

Not only that, high-profile industry thinkers like John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, have developed their own models for the use of blockchain in healthcare. (In a Harvard Business Review article, Dr. Halamka describes a system for managing EHRs using blockchain which he and his co-authors call “MedRec.”)

What’s striking here is that while Xerox may have filed some patent applications, it probably doesn’t know anything we don’t. The applications it describes for blockchain in healthcare document management certainly sound fine, and may be the basis for something great in the future.

If you look around the web, however, you’ll see that virtually anyone with an interest in health IT is out there making predictions about its applications for healthcare. What will really be interesting is when we get beyond ideas — as intriguing as they can be — and pilot some real, concrete technology.

In the meantime, let the blockchain games continue. Obviously, Xerox won’t be the last company angling for a piece of this market. There’s little doubt it will come to something eventually, and the rewards will be great for the company that helps to shape its future.

Shake the Flu Off Video

Posted on October 28, 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.

You know that I can’t resist a good healthcare parody video and so I had to share this parody video of Shake It Off that was done by Beth Israel Deaconess Medical Center. I love the message of the video and I love how videos like this bring an organization together in a really cool shared experience. What do you think?

Here’s the lyrics for the song:
I’ve got body aches
I got a fever and the shakes
So what was my mistake?
Did I forget to vaccinate?

Was it that guy who shook my hand?
Is that where it began?
I just don’t understand
Just don’t understand

I had the blues and
Doc said “it’s the flu, man”
She said, “I’ve got some news here –
My advice – if you wash, it’ll be alright.”

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra-cra, cra-cra, cra
Then shake ‘em off, shake ‘em off
There’s no reason to delay, lay, lay, lay, lay
Get your flu shot right away, way, way, way, way
And show off your Band-aid, aid, aid, aid, aid
Then shake it off, shake it off

Now I’m squeaky clean
The soap dispenser fiend
I’m the Cal Stat pumping queen
I’m the Cal Stat pumping queen

Take your time, it’s not a race
Don’t wanna leave a trace
And please don’t touch your face
Please don’t touch your face

Cover up your cough, man
Sneeze into your sleeve, man
Stay home if you’re sick, and
My advice – if you wash, it’ll be alright.

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra, cra, cra, cra, cra
Then shake ‘em off, shake ‘em off
If you think they look Okay, kay, kay, kay, kay
You should wash ‘em anyway, way, way, way, way
Get your flu shot right away, way, way, way, way
Then shake it off, shake it off

Hey, hey, hey
Just think while you were getting sick
And spreading all
Those dirty dirty germs everywhere
You could have just avoided getting
Sick… this… week…

My best friend put the flu to an end
Cuz she pumps going out
And she pumps going in
For the patient over there
With the hella good hair
You could wash a little more
And then you shake, shake, shake

There’s a rule you must obey, bey, bey, bey, bey
To keep the flu away, way, way, way, way
Gotta wash ‘em like you’re cra, cra, cra, cra, cra
Then shake ‘em off, shake ‘em off
If you think they look Okay, kay, kay, kay, kay
Wash ‘em anyway, way, way, way, way
And make sure to vaccinate, ate, ate, ate, ate

Then shake it off, shake it off

Patients Want Access To Physician Notes Despite Privacy Concerns

Posted on October 4, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While privacy concerns remain, patients’ desire to access their medical records online seems to outweigh those concerns, according to a study reported in iHealthBeat.

The study, which was published in the Journal of Medical Internet Research, included 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center. Each of these institutions implemented OpenNotes, a portal which allows patients to read the notes written by their doctors following office visits, e-mail correspondence and phone calls. The patients were able to view the notes via the portals where other parts of their medical records are stored.

Researchers interviewed patients at baseline, prior to their using the OpenNotes portal. They were interviewed again after a one year period during which they were able to use the OpenNotes portal to review the notes doctors made during their visits.

Privacy remained a concern throughout the study period, iHealthBeat noted. At the study’s outset, about 33 percent of OpenNotes project participants reported having concerns about privacy;  meanwhile, almost 37 percent said they were concerned about privacy after the one year period of using the portal.

After using the portal  for a year, 15.5 percent of patients said they were more concerned about privacy, while 12.7 percent said they were less concerned about privacy.

That being said, study participants were still very enthusiastic about having access to the notes. In fact, at the study’s end, 99 percent of participants said they wanted continued access physician notes, despite their initial privacy concerns.

In April of last year, when I first wrote about this project, I  predicted that patients would become very attached to the level of intimacy OpenNotes would offer with their providers.  It seems that this has come to pass. If 99 percent of patients want to continue with the project despite having privacy concerns, that’s a ringing endorsement of the concept. Now, I’m curious as to whether other institutions will get on board.

Geisinger Opens Doctors’ Notes To Patients

Posted on May 15, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Geisinger Health System is kicking off a new program under which more than 100,000 patients will have access to their doctors’ notes. Patients will access the notes through the secure MyGeisinger online patient portal, reports Healthcare Informatics.

The initiative grows out of a pilot, funded by a $1.4 million grant from the Robert Wood Johnson Foundation. The OpenNotes project, which lasted 12 months, brought together 105 primary care doctors with more than 19,000 of their patients, in an effort to see how both patients and physicians were affected by the sharing of doctors’ notes after each encounter, according to Healthcare Informatics.

The study group included 24 Geisinger primary care docs and 8,700 patients.  The rest of the patients and doctors  were drawn from Harborview Medical Center, Seattle, Wash., and Beth Israel Deaconess Medical Center.

Results from the pilot, which were published in the October 2012 Annals of Internal Medicine, showed that patients strongly favored seeing their physician’s notes.  Also, tellingly, no doctors asked to opt out at the study’s end.

Findings showed that patients did indeed read their notes and felt more a part of the care process when they did. Roughly 11,200  patients (or about 82 percent) opened at least one note found in their EMR.

Of patients who opened at least one note, 77 to 87 percent across the three study sites said that OpenNotes made them feel more in control of their care.  Doing so also helped them adhere to their medication regimens, the magazine said. Only a few patients reported higher levels of worry, confusion or offense due to seeing the notes.

Patients liked having the notes access so much that 85 percent reported that it would influence their choice of providers in the future.

It seems that opening up a patient portal isn’t quite the pandora’s box that some thought it could be.

Adding “Social Documentation” To EMRs

Posted on March 11, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While EMRs store key clinical information, a vast amount of clinical communication goes on outside the system, via instant message, text, e-mail, fax, phone and social media.

Most health IT managers don’t concern themselves much with the chatter outside the EMR, other than to see that — where possible — it takes place in a secure manner. But according to John Halamka, MD, chief information officer for Beth Israel Deaconess Medical Center, this communication is too important to be ignored.

Rather than let these conversations stream on without ever entering the EMR, he argues that it’s time to begin mining these discussions and integrating them into the EMR.  As he sees it, smart devices, the cloud, instant messaging, SaaS and social networking should be combined to create what he calls “social documentation” for healthcare.

Just what is social documentation?  Here’s his definition:

I define “social documentation” as team authored care plans, annotated event descriptions (ranging from acknowledging a test result to writing about the patient’s treatment progress), and process documentation (orders, alerts/reminders) sufficient to support care coordination, compliance/regulatory requirements, and billing.

So, in social documentation, the various channels clinicians are already using to connect with each other go from ancillary information to key ingredients in a team approach to care. But Halamka breaks it down further. Social documentation, he says:

*Incorporates data input from multiple team members, reducing the documentation burden for each participant
*Eliminates redundant entry of the same information by different caregivers (nurse, pcp, specialist, resident, social worker)
*Supports Wikipedia like summaries (jointly authored statement of history, plans, and decision making)
*Supports Facebook/Twitter like updates i.e. “Patient developed a fever, ordered workup, will start antibiotics”
*Incorporates data already present in the EHR such as orders and results without having to re-describe them in narrative form

I don’t know about you, but to me this makes enormous sense. As Halamka himself concedes, creating a new modular architecture that can support such documents might be “burdensome” but it’s still something to bear in mind as we move forward.

Beth Israel Deaconess Asking Patients To Opt In To HIE Data Sharing

Posted on July 9, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

One of the less-obvious, but critical, issues in rolling out an HIE is how management handles patient consent for widespread use of the data.  Providers who don’t ask for detailed permissions as to which HIE partners may use patient data when may someday find themselves at the barrel end of a high-caliber lawsuit.

To avoid such entanglements, Beth Israel Deaconess Medical Center (BIDMC) CIO John Halamka, MD has announced that it will require its 1,800 affiliated ambulatory care providers get patient opt-in for data sharing among clinicians on their case.  The permission slip Halamka wants patients to sign will cover not only care within BIDMC but also care provided by outside clinicians.

The process BIDMC has developed is quite interesting, both in what it demands from clinicians and how the IT department is involved:

*  Doctors who have a need to see patient info for treatment, payment or operations can electronically request a view from a community practice.  To make the query, doctors hit what BIDMC is calling a “magic button” which works as follows (info below from Halamka’s blog):

1.  The clinician clicks on a button inside their EHR.   This click launches a query containing Name, Gender, Date of Birth, and Zip Code to a responding EHR.    The physician does not need to respecify the patient or log in to a separate portal since the patient identity information and security credentials are sent from the querying EHR automatically.
2.  The responding EHR checks the security, looks up the patient, and responds with a medical record number if the patient is found.
3.  The querying EHR sends a new query incorporating the returned medical record number.
4.  The responding EHR launches a web-page which displays clinical data for that medical record number.
5.  All transactions are audited in the responding EHRs.

* Doctors can only get data for patients shared between the two organizations

* All requests will be audited

* There will be no “break the glass” feature allowing clinicians to override patient preferences

* Patients can opt-in later if they choose not to now

The audit aspect of this is especially interesting.   How often? By whom? What protocols are in place to respond when something seems to be out of order?

But I must say the whole thing is intriguing.  It seems to me that BIDMC is making the right choice, but anything involving consumers has a bunch of fail points that don’t pop up at first.  I wonder how consumers will feel about this plan six to twelve month after it’s enacted.  Much to learn here.

Will “Open Notes” Change EMR Design?

Posted on April 26, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.

Modular Software Unleashes Innovation – Major EHR Developments Per Halamka

Posted on September 23, 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.

In my ongoing series of Major EHR Developments from John Halamka (see my previous EHR In The Cloud post), his second major EHR development from the Technology Review article is: Modular Software Unleashes Innovation. The following excerpt from his article sums it up well:

Until very recently, innovation in medical IT has depended upon the development schedules of a few very large vendors who sell hospital systems with $100 million price tags. In the future, electronic health records will become increasingly modular, similar to the online app stores where consumers download games or programs for their phones.

The idea of modular healthcare IT has been around for a long time. I think I first saw this concept when I learned about a group called the Clinical Groupware Collaborative. I haven’t heard much out of them recently, but every once in a while I see that they’re still working to make Halamka’s comments about modular EHR software a reality.

I’m certain that Judy from Epic would argue that such modular EHR software is a risk to the healthcare industry. She’s probably right. There are risks to modular software. However, there are even more risks and disadvantages associated with a monolithic EHR vendor that won’t interact with other modular clinical software. I believe that one day this will come back to bite Epic as new CIO’s who weren’t part of the $100 million hospital software purchase will start to embrace a more modular strategy.

Turns out that I think providers will actually be the strongest proponents of the modular strategy. They’re already buying mobile devices with money out of their own pockets and so they’re going to start using apps that will help them provide better care. Hospitals will have a hard time controlling it and they’ll eventually realize that the best way to control it is to embrace it.

The most unfortunate part of this EHR development is that it’s going to take a long time for this development to become a reality. However, little by little we’ll get there.

EHR In the Cloud – Major EHR Developments per Halamka

Posted on September 14, 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.

As most of you know, John Halamka is publishing content everywhere. In fact, maybe I should see if he’ll publish some here. Halamka is really smart and respected by many for good reason. So, I was intrigued to find an article in the Technology Review (an MIT publication) where Halamka higlights what he considers the major EHR and healthcare IT developments over the next five years.

I’ve been doing a number of series lately on EMR and EHR & EMR and HIPAA and since people seem to really like them, I decided I’d make Halamka’s major EHR developments into a series as well.

The first Major EHR Development is: EHR In the Cloud

In the article above, Halamka offers some interesting comments about doctors being doctors and not tech people, the issues of privacy in the cloud and hospitals leaning towards “private clouds.” Let’s take a look at each of these.

Doctors Don’t Want to be Tech People
While there are certainly exceptions to the rule, it’s true that most doctors just want their tech to work. They don’t want to spend a weekend installing a server. There’s little argument that a SaaS EHR requires less in office tech. This fact will end up being a major driving force behind the adoption of SaaS EHR software over the client server counterparts.

Certainly, many doctors will still feel comfortable with their local IT help doing the work for a client server install. Also, many still feel more comfortable having their EHR data stored on a server in their office. This issue will continue to fester for a long time to come. At least until the SaaS EHR vendors provide doctors a copy of their data which they can store in their office. Plus, SaaS EHR are much faster today than they were, but there’s still a few things that a client server can do that is just flat out faster than client server.

I still see the ease of implementation and “less tech” helping SaaS EHR software to continue to gain market share.

Privacy in the Cloud
The biggest problem here is likely that doctors aren’t technical enough to really understand the risks of data in the cloud or not. Plus, I think you can reasonably make an argument that both sides have privacy risks. Most people are becoming much more comfortable with data stored in the cloud. I expect this trend to continue.

Private Clouds for Hospitals
Halamka claims that he, “estimates that moving infrastructure and applications to my hospital’s private cloud has reduced the cost of implementing electronic health records by half.” Of course, we have a lot of possible definitions of “cloud” and I’m not exactly sure how Halamka defines his private cloud. However, anyone who’s managed client installs of EHR software, including client upgrades, etc knows some of the pains associated with it. I’d be interested to know what other savings Halamka and Beth Israel Deaconess Medical Center get from their “private cloud.”

Cloud and EHR
There’s one thing I can’t ever get out of me head when I think about EHR and the cloud. Someone once told me (sorry I can’t remember who), “The cloud has always won in every industry. It will win in EHR too.” I hate when people use terms like always and every, but I haven’t (yet?) found an example to prove that person wrong.