It's a great feeling to head home without worrying about backing up your data.

Cloud-based servers aren't pie-in-the-sky methods for storing patient information, floating in the ether and accessible to anyone with an Internet connection. No, the cloud — offsite data storage provided by a software vendor — is a reliable information management solution grounded in cost-savings and worry-free recordkeeping. Our multi-specialty facility transitioned to cloud computing last year and hasn't looked back. Here's why.

1Economy
Good software vendors will assess your case load, the type of data you need to store and equipment requirements to tailor customized solutions. Our cloud provider showed us the significant savings we'd realize by switching to electronic records and cloud-based storage in terms of hard costs, paper products that we'd no longer use and employee time savings.

When does cloud computing make good financial sense? During our research and consultations with software vendors we learned, based on the data being stored per surgical case, that cloud based electronic recordkeeping is ideal for surgery centers performing fewer than 600 cases per month (or about 7,000 annually). Once that threshold is exceeded, it may make more financial sense to host your servers in-house. However, busier surgical centers might still benefit from cloud data computing after factoring in the costs of server maintenance and software upgrades.

For example, the initial capital outlay for keeping servers in-house is what originally drove us to the cloud. You'll spend at least $10,000 to $12,000 for a server, and will need a dedicated, climate-controlled space to house it, which can be a waste of valuable surgical real estate. The next expense to consider is the electronic health record software. Our software vendor quoted an upfront price of $125,000. That doesn't account for the expense of purchasing subsequent software upgrades — ours has been upgraded 3 times since going live in October, which gives you a sense of how often software upgrades can occur. With in-house computing, centers have to pay for each of these software upgrades, which involve additional tech support, downtime and the expense of implementation.

You must also consider the maintenance costs to keep a server up and running. In addition, you will need to deal with the constant threat of server failure, which often occurs without warning, and the investment of upgrading the server every 3 to 4 years. You'll need to pay an IT professional — in a consulting role or as a full-time employee — to manage the server and troubleshoot any issues that arise. Because of direct and indirect costs such as the initial capital investment, installation time, maintenance expenses, IT support and software upgrades, moving to cloud-based computing was an easy decision for our organization.

There is a start-up cost for connecting to the cloud. We paid between $20,000 and $25,000 for a one-time licensing fee to use the software (we don't own it) but, in turn, the vendor is responsible for handling all the software upgrades and maintenance. We also pay low monthly and per-case fees. In all, we realized an initial 20% to 30% savings by opting for the cloud.

2Reliability and security
Has your home computer's hard drive ever crashed, taking personal documents and photos down with it? As irritating as this occurrence can be, it's potentially devastating if it happens at your surgery center and patient records are involved. Fears of losing our data to potential computer malfunctions prompted us to look to the cloud for secure, reliable data storage.

ESSENTIAL ELEMENTS
Cloud Computing Requirements

HIGH-SPEED LINE The cloud must be accessible from every corner of your facility.

• High-capacity bandwidth Internet provider
• Redundant Internet connection
• Desktops, laptops and/or tablet computers
• Facility-wide, reliable wireless Internet service

— Bruce Nadro, DO

Cloud-based servers are large information silos protected at offsite facilities that perform redundant backups. The offsite companies managing cloud-based servers are totally responsible for data encryption, security, and any HIPAA-related issues. This is a significant aspect of record storage that you won't have to worry about. On the other hand, you're responsible for ensuring that all records stored on in-house servers remain HIPAA-compliant. A single violation for the unlawful release of private patient information could cost you as much as $50,000. Your IT professional managing the data might also be held responsible for a violation in the event of a security breach.

Worries that data stored on the cloud are less secure than on in-house servers are unfounded. Most HIPAA violations occur when laptops and disks containing private patient information are lost or stolen. No data are stored on any of the computers used by our staff, so there's no physical way for them to move any patient information to the computers' hard drives. We've even added encrypted passwords to log into each computer before logging into the cloud software. This basically makes it impossible for non-staff members to gain access to our laptops and tablets, and renders the devices unusable even if they go missing.

POINTS TO PONDER
7 Benefits Of the Cloud

GOING PAPERLESS Cloud-based software frees up valuable storage space within your facility without the hassles of in-house servers.

• No need to purchase in-house servers, which cost at least $10,000 each.
• No need to build or maintain a data center, which must be properly ventilated and cooled.
• No software packages to purchase, which can cost $125,000, depending on the amount of required customization.
• No software upgrades to purchase or perform. In-house servers, on the other hand, must be replaced as often as every 4 years.
• Decreased expense of in-house IT staff.
• No security- or HIPAA-related concerns.
• No need to replace faulty server equipment.

— Bruce Nadro, DO

3Stress-free startup
Working with a software vendor to get the cloud up and running is relatively painless. The only item on your to-do list is ensuring you partner with a high-capacity bandwidth Internet provider. Installing T1 fiber-optic cable lines is not enough. Redundant backups using cable or DSL connections will keep you linked to the Internet even when an unlikely failure of the T1 lines occurs.

The importance of a reliable wireless network throughout your center cannot be overstated. It will ensure that your staff and physicians can access the cloud from every corner of your facility. We had an IT consultant to maintain our billing department's small in-house server, so about a month before we connected to the cloud, we asked him to survey our center and ensure we had adequate wireless coverage. Don't wait until your go-live date to test the wireless network. Use it as much as possible with your software vendor's practice server. Run it with more computers than you expect to use on your busiest day to test its reliability and bandwidth capabilities.

4Daily peace of mind
Expect the cloud provider to offer 24-hour support and system monitoring to ensure issues are avoided or quickly resolved. The provider should also back up data at the end of each day, which takes another worry related to in-house servers off your plate: Backing up data on in-house servers requires storing it on hard drives or tape drives. Who's going to ensure data is backed up daily and the drives are properly maintained and stored? It's a great feeling to head home without worrying that your server has captured the day's electronic records.

COMPUTER LIBRARY Surgical team members at Oak Brook Surgical Centre pick up laptops or tablets to use throughout the day.

You'll need to decide what equipment to purchase, based on your specific needs. You'll most likely need a combination of laptops, desktops and tablets for your staff to access the cloud. Your software vendor and its cloud services will provide quick implementation of the software, and a secure connection to your servers and your wireless network. The software vendor should spend time with your Internet provider to ensure it meets your needs and meshes with the cloud-based server.

Thinking ahead
We're ahead of the curve when it comes to implementing cloud computing and in good position moving forward because we've been using the technology for almost a year. A uniform platform doesn't yet exist that would let multiple unrelated facilities communicate and share patient data, but the technology continues to evolve and will eventually match the interconnectivity of the Internet. We'll be ready when that happens.