How a game-changing app in the cloud signals new life for Electronic Health Records

If you walked into the Frances Mahon Deaconess Hospital in Glasgow, Montana, during an internet outage, you’d never guess the IT team was in crisis mode. With just one internet service provider (ISP) — Nemont Telecommunications — serving the farming community with internet access, a severed fiber optic cable could be life-threatening. 

But the hospital is prepared for these moments. When the internet is down, their electronic health records (EHR) system automatically switches over to the wireless network, providing secure and uninterrupted access to a cloud-based copy of patients’ medical records, allowing doctors and nurses at the hospital to continue caring for patients. 

“It happens more often than you’d think,” says Marcie Sannon, Director of Informatics at the hospital. “Backhoe season,” as it’s affectionately referred to across rural parts of the U.S., is any time farmers or construction workers are digging in the ground and accidentally knock out the internet. ”And they don’t usually have an estimated time for when it’ll be back up,” adds Sannon. 

Rural areas have complained for years that slow, unreliable, or simply unavailable internet access is restricting their livelihoods—and quite literally their lives in the case of accessible healthcare. The pandemic gave new urgency to those concerns, and President Biden’s infrastructure plan — which includes $100 billion to improve broadband access — has raised hope that the problem might finally be addressed.

Dr Andrew Burchett, Chief Medical Information Officer at Avera Health, isn’t waiting around for the government to solve the problem. He is responsible for 37 hospitals, 215 primary and specialty care clinics, and 40 senior living facilities across the Upper Midwest. The health system serves a population of approximately one million people scattered across South Dakota and surrounding areas of Minnesota, Iowa, Nebraska, and North Dakota. And like the Frances Mahon Deaconess Hospital in Montana, many of those areas are at the mercy of one ISP. “There is no redundancy built into the networks,” Burchett says. “Connectivity is a challenge in all these places.” 

To address the issue, both Avera Health and Frances Mahon Deaconess Hospital rely on a cloud service from their EHR provider, MEDITECH, called High Availability SnapShot. It provides uninterrupted access to critical patient data in the event of planned — or unplanned — downtime. 

“Every 15 minutes we write to the cloud,” says Avera’s Burchett. The backup copy, or snapshot, is not the entirety of the chart, but it does have all the essential information “to connect the dots about the patient and continue to safely administer care,” Burchett says. Your history —diagnoses, allergies, medications, recent physicians notes, and vitals, are all there. It reduces unnecessary stress on the clinical team and is safer for the patient, he says. 

There are other reasons to like cloud-based EHRs too. The Emergency Care Research Institute (ECRI) put cyber attacks as the most pressing technology issue facing health providers in 2022. “The cloud brings a degree of security that’s unprecedented in conventional IT,” according to John Moore, CEO and Founder of Chilmark Research, a global research firm specializing in healthcare IT solutions. He says one of the reasons for the increase in cyberattacks on healthcare providers is because healthcare data lives in antiquated systems on-premises, keeping hospitals as proverbial sitting ducks for data breaches and cyber attacks. In a cloud-native world, security is built into new applications and technologies as they are developed, rather than added on as an afterthought. This tight integration with the underlying cloud platform makes it easier to detect misconfigurations and/or anomalous behavior. And the cloud can recommend security fixes or even execute them automatically for you. 

This resonates with Sannon at Frances Mahon Deaconess Hospital who says staying up-to-date with new technology and finding IT people skilled in the latest security practices is practically impossible in rural Montana. “Cloud-based services let us focus on treating patients, not worrying about cybersecurity scares,” she says.

Cloud technology that puts patients first

In the electronic health records business since the 1960s, MEDITECH knows the “death by a thousand clicks” stigma associated with EHR systems. They were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and even save money. The reality is very different. A recent Mayo Clinic study showed that physicians spend one to two hours on electronic health records and documentation for every hour spent face-to-face with patients. The study found the hassles of navigating electronic health records has contributed to burnout among doctors.

Scott Radner, VP of advanced technology at MEDITECH describes early EHR systems as “an accounting tool” built to automate the workflow of each department in the hospital to generate a bill. “They were never designed to be a patient care tool; collecting interesting clinical data was a side effect,” he notes.

MEDITECH is addressing these challenges with a variety of options for health providers using its EHR. Meditech-as-a-Service (MaaS) is a cloud-hosted version of its existing EHR software. And MEDITECH Cloud Platform is an emerging suite of new, cloud-native applications. High Availability SnapShot was the first of these, launched in 2018. “It was thrilling to see it work and was a springboard to doing more,” says Radner. “We realized it was possible to transform our business using this model.”

So far, MEDITECH Cloud Platform includes four applications:

• Expanse NOW - notifies clinicians of messages, refill requests and tasks that need to be acknowledged when not in the office, through a mobile app.

• High Availability SnapShot - provides clinicians access to pertinent patient information, such as Problems, Allergies, Medication and Immunization (PAMI) data, during EHR downtime.

• Virtual Care - lets patients conduct video visits through the website.

• Patient Connect - provides bidirectional, real-time messaging to keep patients and clinical care teams connected to confirm, cancel, or reschedule appointments.

The company is well on its way to transforming its business for the cloud. And in Google, MEDITECH has found a partner equally obsessed with organizing information and making it accessible and useful—Google’s mission since its founding. 

Data interoperability improves patient care

Data drives the healthcare world now more than ever before. The pandemic threw statistics, data, and analytics into plain sight. Everyone and anyone that touched COVID-19 data, from healthcare providers to government organizations to the media reporting on the pandemic, was heavily scrutinized on the source of their data, collection methods of that data, and its analysis. Now everyone is experiencing pressure to continue in that vein with accurate, streamlined, and scalable data analytics.

Marcie Sannon at the community hospital in Montana is feeling it. As the pace of fracking and oil drilling has picked up in North Dakota, it’s brought hundreds of oil workers into the area. There are accidents at the well sites, she says. “We see those patients, but have no way to query their medical records.” Having visibility into patient data across EHRs is crucial to improving patient care, she says.

The exchange of healthcare data was fraught with challenges before the pandemic; then COVID saw a massive influx of venture capital into the sector and hundreds of new digital health companies claiming to solve the problem.

“Now there’s a thousand point solutions that do one thing neatly but don’t interoperate or combine to actually give the patient a good experience,” says Adam Gale, CEO of KLAS Research, a health IT research firm. “They don’t share data well,” he says. 

The notion of data exchanges and interoperability is a sore point for the Centers for Disease Control and Prevention, which said recently that its staff must improve how they collect and analyze health data. “We’re reaching a point where anyone that’s not sharing [data], that’s not adopting open standards,” will be left out, says Gale. 

What the doctor ordered

Health data presents some interesting interoperability challenges. It is incredibly complex — often siloed across different information systems and in different formats. It can be almost impossible for clinicians to find the external, legacy data they need quickly to care for patients. To address this, MEDITECH is integrating Google Health’s Care Studio clinical search and summarization software with its cloud-based EHR to better unify healthcare data. 

With Google Health’s search functionality embedded into the EHR, clinicians will be able to find salient information faster and highlight critical information directly in the EHR, according to Radner. “A key piece of this is inserting Google’s capabilities into existing clinical workflows,” he says.

And there, ultimately, lies the promise of cloud for EHR systems and the physicians and patients that use them: not just as a salve against backhoe season, or to encourage data sharing, but giving back time that physicians can spend with their patients, and helping them make the best possible decisions and diagnoses. 

For information on how to unify your data in the cloud and use advanced analytics and machine learning tools to improve patient care, check out Google Cloud for Healthcare and Life Sciences. To learn more about MEDITECH's work transforming Electronic Health Records and its collaboration with Google Cloud check out this video.