AWS Public Sector Blog

EHR in the cloud: The elastic health record

Today, healthcare organizations must manage an ever-growing data center footprint. Health system leaders have shared with healthcare teams at Amazon Web Services (AWS) that their electronic health record (EHR) systems require continual feeding of new hardware compared to other systems. EHR vendors produce new features designed to deliver improved clinician and patient experiences. Sometimes, the new features can introduce IT challenges. Technology vendors release new solutions to address these challenges. Healthcare IT teams may see these new solutions as cutting-edge, risky, and difficult to implement. They want to get comfortable with a new technology, often piloting it for one or two years before trusting it with their EHR.

This creates a cycle: new features launch to better support clinician experiences but create IT challenges that lead to new IT solutions—and this cycle not only repeats, but its frequency is also accelerating.

EHR vendors now deliver new features quarterly or faster. Healthcare IT and EHR vendors guess at what infrastructure might be needed in two years, even before new EHR features have been released. They estimate high because guessing low could lead to poor application response times for caregivers. IT teams can no longer wait a year or two to get comfortable with the new technology these features might require.

To address these challenges and provide continuous, superior patient care, there’s an opportunity to think differently about the electronic health record. A patient’s health is not static, and a health record system is not static. The system grows—with new features, new applications, new government regulations, new acquisitions, and new clinical relationships. Healthcare leaders should consider shifting the underlying words of EHR from “electronic” to “elastic,” embracing a record that is always in motion. AWS can help support this elasticity.

The EHR’s evolution

In the past, caregivers accessed the EHR using text-based video display terminals, also called dumb terminals. They were a direct, digital representation of a paper chart. It was straightforward for IT teams to deploy and operate. They had a central database, a serial network, and inexpensive terminals. Clinical staff used it to look up information but rarely entered data directly into it. After an office visit, the physician spoke into a handheld recording device, replaying the details of the office visit. At the end of the day, the recordings were sent to a pool of office workers equipped with playback devices, keyboards, terminals, and foot pedals to transcribe the recordings into the system. It wasn’t a joy for caregivers to use.

EHR vendors knew they could do better. They built a graphical user interface (GUI) in front of the EHR database. Now, caregivers could view data visually, with growth charts, pathways, and flow charts. Clinicians could annotate images. While physicians could still dictate into the system, the EHR provided documentation shortcuts that templatized common observations, diagnoses, and treatments. Physicians started using it more, as it provided a better clinician experience.

The new GUI-based EHR created IT challenges. IT teams were required to replace serial networks with more complex ethernet and token ring networks. The $300 dumb terminals were replaced with $3,000 personal computers, including a high-resolution monitor, keyboard, and mouse. The EHR now needed to be deployed and updated. The practice of taking floppy disks to each personal computer to install or update the software on the workstation became known as “SneakerNet.” While upgrading 30 to 50 PCs in an afternoon was acceptable for small clinics, it did not scale well for larger healthcare organizations with tens of thousands of workstations.

To solve the software deployment challenge, technology vendors created software deployment systems. To solve the personal computer cost and the software deployment challenges, IT teams started using application virtualization platforms and installed the EHR application on servers in a central data center. Clinicians accessed the EHR on less expensive thin-client end-points, helping to reduce IT costs.

Today, with reliance on data center infrastructure, IT teams may struggle to keep up with EHR vendor release cycles and make sure their infrastructure can support the updates. They are often constrained by their hardware and locked into this cycle.

The elastic health record on AWS

Now, consider the elastic health record, which can grow at the pace and magnitude that patients, clinicians, and businesses demand. Using native AWS services like Amazon Elastic Compute Cloud (Amazon EC2), Amazon Elastic Block Store (Amazon EBS), Amazon Elastic File System (Amazon EFS), Elastic Load Balancing (ELB), Elastic IP Address, AWS Elastic Disaster Recovery, and Amazon Elastic Container Service (Amazon ECS), organizations can transform their EHR into an elastic health record. It expands when you need it and contracts when you don’t.

A patient’s health record is more than what is stored in the EHR system. It includes data from the entire digital health ecosystem, including radiology imaging systems, picture archiving and communication systems (PACS), document management systems, coding systems, lab systems, blood bank systems, and historical records from previous EHRs, all glued together with interface engines. With the elastic health record, you can run these applications in the cloud as well, making them fast, reliable, and secure. Including these applications as part of your elastic health record on AWS allows you to join the ranks of the thousands of leading organizations in healthcare and other industries that run on AWS, such as banking, finance, manufacturing, governments, and even the military, and continue to vet and trust AWS Cloud services.

An elastic future

The future of healthcare is in the cloud, and a key component of that future is elasticity. Our health is not static, our patient-provider interactions are not static, and our healthcare technology is not static—neither is our EHR. It is time to reconsider how we think about EHRs and embrace the elastic health record in the cloud.

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