Read More About Healthcare Moving to Cloud:

In part-one, True North ITG CEO and CISO Matt Murren discussed the general landscape of healthcare moving to the cloud, especially the challenge of shifting legacy on-premise tools and apps to the cloud.

Here in part-two, Matt will examine the advantages and disadvantages of using the cloud to manage your electronic medical records (EMR)/electronic health records (EHR).


Advantages of Using Cloud-Based EHR



Today, I’m joined by Matt Murren, CEO and Founder of True North ITG, a healthcare cloud and managed IT services specialist in the United States.

Matt, one of the main things that jumped out at me was the movement of electronic medical records or electronic health records (EHR) towards the cloud. I imagine a hospital’s EHRs are either all in the cloud, organized through a hybrid deployment or still on-premises.

Can you compare and contrast having EHR in the cloud instead of an EHR server?

Matt Murren:

EHR Redundancy

Well, when you look at a cloud infrastructure, you really have to look at is the different layers of failover and redundancy. So a lot of environments have a dedicated server on-prem and a lot of times – let’s say it’s your database server – there’s not a second clustered database server to failover to in the event that you have a hardware failure.

Whereas in a cloud configuration –  we use VMware for instance – those workloads and servers transfer seamlessly between different servers, discs and so on. Hence, you inherently get some level of redundancy just at the server level that you may not have it in a physical, dedicated server chassis.

Cloud-Based EHR Options

If you go to a rack space, they certainly have different redundant configurations, but there’s a lot of dedicated server-hosting companies that duplicate the same you thing you do on-prem and you basically buy a dedicated server that’s in a rack somewhere in a data center.

Basically, you still have to buy a second server and configure it in a way that allows for that kind of failover and redundancy. Not to say that on-prem environments completely lack failover, because in many cases people have certainly configured those environments correctly.

However, we do see a lot of single points of failure out there on servers that are on-prem simply because budgets don’t allow for complete redundancy across every service and server. In a cloud configuration however, every server we deploy has the ability to failover to another piece of hardware.

Read More about the Advantages of Using Cloud to Host EHR:


It seems to be that failover and data protection are major benefits of a cloud-based EHR system. What are the other advantages of using a cloud-based EHR system?

Matt Murren:

Affordable Cloud Security

First, maintaining security. Recall when I was talking about scale in part-one: it’s much easier for a cloud provider to provide layers of security at a lower cost than an organization can on-prem.

The reasons for this stem from a scalability perspective, but when many of the necessary features are designed into the fabric of the offering, your internal IT staff no longer have to worry about maintaining, monitoring, babysitting or patching those systems that protect data.

Disaster Recovery as a Service

Second is data protection, which would fall into disaster recovery and backups. A lot of IT departments spend time babysitting backups and making sure the data is protected by either snapshotting or offsite replication.

These are just examples of managed cloud services baked into the delivery offering. These are obviously two critical concerns we observe for any organization: Is my data secure? Is it backed-up and protected?

Do speed of delivery and other performance aspects matter to an EHR system? Or are these considerations secondary (i.e. not a major concern)?

Matt Murren:

Speed and performance are certainly very important. It’s almost assumed. That said we don’t develop the software. Different systems perform at different levels based on the software and how the software was designed. For instance, you may have a software – perhaps for EHR or another application – that requires more resources as you grow.

Dynamic Resource Management

The key advantage in a cloud-based environment comes through where instead of turning-off a server and adding more discs or memory to compute, increasing performance is something that we (the cloud provider) can do dynamically.

If a software gets hungry and needs more resources – which equates to performance – the ability to do that seamlessly via a cloud provider is much more available than would be otherwise.

Disadvantages of Cloud-Based EHR


With all the advantages of having your EHR hosted in the cloud, what are the disadvantages of having a cloud-hosted EHR system, if any?

Matt Murren:

There are a couple disadvantages, but I would say that those disadvantages are only disadvantages based on how the EHR system is architected.

Are You Losing Control in the Cloud?

For example, IT directors tell us – at least from their perspective – losing control of the system is a disadvantage. They want to ‘be able to turn the knobs themselves and jump in’ and so their fear is losing that granular control. They ask, ‘am I going to be able to respond to my end users as fast as I am already using on-prem?’. That would be more of a perceived disadvantage.

Designing a Custom Cloud EHR System

But it depends on the cloud system that you’re using. In our environment, we expose every single tool as though you’re running VMware onsite. Hence, there’s nothing you cannot do as an IT director that you wouldn’t otherwise be able to do if you’re running the virtualized platform on-prem.

Limited Internet Connectivity

That said, if all of your servers and systems live in your local network, you’re not dependent on a connection between your location and where your cloud environment lives, which is a genuine disadvantage.

For example, you’re in a very rural area and – while there are technologies that can certainly resolve this issue – you have low bandwidth capacity from the carriers in your network that could impact the performance and your ability to leverage a cloud platform.

Neutralizing Barriers to Cloud-Based EHR

Using Private Connections

In most cases, we resolve that by making sure that we’re using private connections with enterprise-grade bandwidth to our data centers in a redundant configuration. So if you lose one circuit, the other circuit comes online and you’re able to continue operating.

This would be the same disadvantage for internet-use and outside connectivity if you had it on-prem. However, the difference now is if you have your critical applications hosted, you have now a dependency on a point of failure by a provider that you may not have had before.


In essence, even though you might lose access to the internet which might prevent you from connecting to the cloud, you would have redundant systems in place that would mitigate that risk regardless of where that healthcare organization was on your cloud?

Matt Murren:

We rarely see this becoming a major disadvantage. We’re able to procure enterprise-grade circuits all over North America. Even when you enter some of the rural community house centers, technologies like SDWAN (Software Defined Wide Area Network) provides compression on a latent circuit.

But, it ultimately comes down to design. If an organization is unwilling to spend the money on a redundant enterprise-grade configuration, then we’ll advise them that maybe the cloud isn’t for them. Because that’s essentially just an extension – as if their data center was in a remote location.

In part-three, Matt will outline how healthcare organizations ready to migrate to the cloud can do so in an optimal and cost-effective manner.

If you’re maintaining an increasingly resource-hungry and risk-prone EMR/EHR database on-premise, then explore True North ITG’s EMR Hosting Services as the solution to those constraints.