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Do You Trust the Cloud for EHRs?

Posted on May 26, 2011 I Written By

A blog post today by Microsoft’s Dr. Bill Crounse got me thinking again about the cloud.

Crounse cited a new CDW poll showing that 30 percent of healthcare organizations could be considered “cloud adopters,” and for good reason. “The flexibility, scalability and lower costs associated with moving certain line of business applications to the cloud are compelling, especially for an industry like healthcare. After all, the primary focus of hospitals and clinics is caring for patients, not running an IT empire. There’s not a CIO, CFO, CEO, COO, CNO, CMIO, or CMO who wouldn’t love to shift some of their IT spending to delivering better care to the communities they serve,” Crounse wrote.

They were more likely to turn to the cloud for “commodity” services such as e-mail, file storage, videoconferencing and online learning. “Moving your ‘commodity’ applications to the cloud is an excellent place to start,” Crounse said. “I’d suggest first reaching out to your health industry peers and professional organizations to get a better sense of who’s doing what. I think when you’ve learned about some of the best health industry practices in cloud computing, you’ll be ready to explore what might be possible in your own organization.

But the fact that 30 percent of healthcare organizations use the cloud means that 70 percent do not. I suspect a lot of hospitals and physician practices still run aging, legacy client-server management systems in-house, just because that’s how people did things when those systems were first installed. As they replace their legacy technology, expect more healthcare organizations to opt for cloud services for these commodity-type services.

And what about clinical services?

At HIMSS11 back in February, Athenahealth honcho Jonathan Bush, a longtime fan of the cloud, told me he wanted to lead the “Cloud Cavalry” into Las Vegas (there’s no better place for an over-the-top spectacle, of course) next winter for HIMSS12. (See the second video for that.) Athenahealth, which has a certified, cloud-based EHR, straddles the line between clinical and administrative, and it’s not alone. I can’t think of a single ambulatory EHR vendor that doesn’t offer at least a cloud option if not a full-fledged SaaS product.

But is the cloud truly reliable for critical applications such as inpatient EHRs? In the wake of April’s Amazon EC2 cloud outage, I can imagine more than a few CIOs, practice managers and, especially, physicians are a bit skittish now.

What do you think?

Interview with Allscripts President and Xerox Executive VP About $500 Million Hosting Services Contract

Posted on April 29, 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.

Many of you probably already saw the announcement of the $500 million contract that was signed between Allscripts Healthcare Solutions and ACS, A Xerox Company, to provide hosted IT service for the Allscripts’ Sunrise Enterprise Suite. Considering the size of the contract, I thought it would be interesting to do an interview to learn more about the Allscripts and ACS (Xerox) relationship.

The following is an email interview with Lee Shapiro, President, Allscripts and Chad Harris, Executive Vice President and Group President, ACS Healthcare Provider and IT Applications Solutions. They duck a few of the questions, but provide some information about their relationship that I think’s useful and interesting.

Lee Shapiro, president, Allscripts

What percentage of Allscripts Sunrise Enterprise Suite customers use the hosted model vs. in-house servers?
There are approximately 50 remote hosted clients.

Why did Allscripts choose to outsource the hosting after having the infastructure in place?
As the payment paradigm in healthcare shifts and our clients’ growing and complex needs around new regulatory requirements continue to evolve, ACS, A Xerox Company will support Allscripts as it scales to deliver service levels required for diverse healthcare settings.

Immediately ACS will begin to focus on standardizing and optimizing our operational processes, help to manage our Service Level Agreements on system availability and enhance our recovery and security capability.

This alliance also helps us deliver faster client case resolution. Longer term, it will enable us to deliver a richer toolset, broader set of monitoring capabilities, access to geographic data centers and new services. Allscripts will still have a remote hosting business and will continue to manage all aspects of the alliance and client relationships. Data is always available whether it is remotely hosted or not.

Do you expect to outsource the hosting of MyWay and other Allscripts hosted EMR products to ACS down the road as well?
Allscripts is always evaluating options to provide the best service support for its growing and diverse customer base.  Right now, our ACS alliance is the best solution to meet current and projected needs.  We will continue to evaluate.

Are you concerned that customers will have issues with having to work with two large companies?  Instead of “one neck to ring” they will have multiple companies that can point the “proverbial finger” at the other.
Allscripts is excited about this partnership and the response has been overwhelmingly positive. We will continue to manage the client relationship at every level, including sales and support and will also provide our healthcare industry domain expertise in partnership with ACS’s world class remote hosting infrastructure.  This is a single solution for our clients.  It is an exciting combination.

What share of the 96 providers using these remote hosting services are hospital versus ambulatory?
Allscripts has not entered to an agreement with ACS on ambulatory.


Chad Harris, executive vice president and group president, ACS Healthcare Provider and IT Applications Solutions

Describe how the transition of hosting will occur for existing customers.
The transition of hosting services will be seamless for Allscripts customers. From a governance perspective, Allscripts will continue to have a direct relationship with hosted clients, handling overall client relationship management activities including fielding service requests and projects, reporting, invoicing, and sales support.

ACS, A Xerox Company, will run and maintain the current systems by assuming responsibility for day-to-day technical delivery and data center operations, and supporting Allscripts in its continued service of new and existing hosted customers.

As part of the arrangement, ACS maintains the existing Allscripts data centers under what is commonly referred to as a facilities management agreement.  ACS will optimize the data center footprint and technical environment overtime under a structured long term plan involving no impact to the clients.  Additional capacity will be provided to support growth and expansion via ACS’ global data center and operations network.

ACS will introduce industry standard best practices, new tools and other forms of automation, as well as additional services including advanced recovery to improve service excellence, performance and reliability of the hosting operation.

Will Xerox be bringing their expertise in printing and scanning to this relationship as well or only their hosting operations?
While Xerox technology is not specifically part of the current hosting engagement, ACS is investing in a Healthcare Innovation Lab for Allscripts to evaluate integration of new technologies, cloud computing solutions and  client-specific deployment and testing initiatives. In addition, ACS and Allscripts will form an Innovation Council to evaluate future technologies and work processes that will help Allscripts support the changing needs of providers.

After the recent Amazon cloud hosting outages, what’s ACS and Allscripts doing to make sure similar outages don’t occur?
The Allscripts application environments are critical patient care systems and as such require an architecture that supports a very high level availability and performance. Under the new hosting partnership, ACS will work with Allscripts to maintain and improve application uptime and operational resiliency through a high availability architecture and advanced recovery capability. High availability is achieved through the deployment of failover technology, or methods, that ensure system availability and transaction protection. The most common configuration utilizes the active/passive clustering approach.

The Sunrise Clinical Manager (SCM) application is cluster aware and is configured in a clustered environment. ACS utilizes the high availability clustering supported by SCM application servers to ensure that all single points of failure are resolved and the application can quickly return to service after a loss of the primary server