Our Head's in the Cloud: Here's Why Yours Should Be Too

News | February 20th, 2020

Cloud Services and FHIR Help Solve Health IT Problems Once and For All

You see a lot of common refrains when you read clinician feedback regarding their software tools. Sometimes electronic workflows do not match clinical workflows. Sometimes the model of care is outdated. Sometimes, it’s just too many clicks or too much duplicative data entry.

There is a simple explanation for these complaints. Many electronic medical record platforms are not intended to natively enforce workflows, or models of care, or keep them up-to-date. Instead, they can be understood as bundles of configurable components. High-tech Legos. Configuring a hospital’s software into a workable system – converting components into workflows and care models – is often done in-house, at each hospital, by large, incredibly hard-working IT teams. You bought a Ferrari, but there is assembly required.

As other industries centralize, healthcare IT has remained distributed, performed on premise. And yet, across the country, the increasing clinical demands and especially the regulatory demands on healthcare software have stretched this industry model to the breaking point. Hospital IT teams need a massive efficiency boost, relief from tedious build and maintenance, and the chance to seek innovative solutions from the broader market. They can reach this goal by incorporating centralized, cloud-based services into their digital ecosystem.

Building the same thing, over and over again
Consider the situation in which a health system desires to incorporate the Stanford Anesthesia Emergency Manual within their electronic medical record. This is a big win for their Perioperative clinicians - not only are these guidelines now immediately accessible within their workflow, but clinicians would no longer need to calculate medication dosages by hand as the digital tool can pull in basic biometrics from the patient record. After several months of IT analyst build time, validation, quality control, change control, and clinical input, the tool is complete - a tremendous build including dozens of configurable EHR components - views, rules, calculations, and clinical logic. It is a success, and every other hospital system wants this tool.

The EHR is able to make the build less painful for copycat implementations across their customer base but still, several weeks of analyst time are required for the build, validation, quality control and change control. Many other problems remain. Upgrading to the latest version of the manual is a distributed effort, to be handled at each site individually. Duplicative effort is ultimately more error-prone, and especially risky when medication dosage guidance is involved. Site-by-site custom enhancements then generate further entropy among the distributed deployments of what was once the same package, making it so each site must now rely on their own clinicians and their own IT staff to manage and update guidelines that are not even theirs in the first place.

We need to stop solving the same problems.
Hospital systems need to adopt some cloud-based services in order for their software systems to keep up with the pace of innovation and discovery today. Productivity in the IT department needs to increase without adding to the massive research, development, implementation, training, and QA burden that IT departments currently face. EHR system upgrades need to be simpler, and reducing the responsibility of maintaining and updating home-built features puts your system on the right track.

Centralized, cloud-based services allow third party organizations with highly specialized staff to handle product development tasks once at the core product level, and then rapidly distribute validated content to all sites. Hospital IT teams spend less time building and configuring their EHR and more time functioning as architects of their health system’s technology ecosystem. Well-understood models of care such as diabetes medication management, and standardized best practices such as published emergency guidelines represent the needs best met by centralized services. Prior to building such features in-house, IT directors and architects should ask themselves, “are the needs of my system better met with software or with managed services?”

Meanwhile, healthcare thought leaders, best practice organizations, regulatory bodies, and models-of-care innovators need to connect their expertise to practicing clinicians. In order to make the latest recommendations and guidelines readily available and up-to-date, these groups should partner with existing cloud providers, or build their own cloud infrastructure leveraging modern standards and frameworks to deliver content directly within EHR-dominated clinical workflows.

Modern Standards and Frameworks

Most EHRs have invested in ways to enhance their standard offerings by partnering with cloud-based services. Sharing EHR data and EHR workflows with cloud services has only been possible in the last few years due to the following projects:
  • FHIR (Fast Healthcare Interoperability Resources) sets the standard for how EHR Application Programming Interfaces (APIs) present and structure data. By supporting FHIR, cloud services can be health system agnostic, and even EHR agnostic to a large extent.

  • The Argonaut Project - The “Argonauts” includes EHR stakeholders in an integrated future. EHR companies that are a part of this group have established partnerships with various third party cloud services, and help connect your EHR instance with cloud services that your healthcare organization wishes to partner with.

  • SMART-on-FHIR - by establishing a standard for embedding cloud services within EHR workflows, clinicians can interact with cloud services in a seamless manner. No new tabs, windows, or credentials to enter.

  • CDS Hooks - a standard just now finding adoption within leading EHRs, CDS hooks allows insights from a health system’s digital health ecosystem to reach clinicians proactively, directly within their workflow.

Why reinvent the wheel? Bringing the cloud into your hospital's technology portfolio allows for deeper collaboration with peers, and quick transitions from ideas into action. We believe that when we build together, we can make healthcare simpler, cheaper and better.

Let's Connect at HIMSS20
As an early pioneer of SMART on FHIR, Rimidi has built its cloud-based provider-facing apps to work directly within your EHR - no separate sign in, no workflow disruption, better clinical efficiency. Rimidi combines patient-generated health data from connected devices or patient reported outcomes measures with clinical data to drive patient-specific clinical insights and actions through clinical decision support cards, all while working within the existing clinical workflow.

If you'll be at HIMSS, stop by booth #1213 to learn how our platform can help your practice or health system deliver a more efficient cycle of care and vastly improve your clinical workflow. If you're interested in a demo, contact a member of our team, or schedule a meetingwith us at HIMSS.