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  • Writer's pictureAmir Gilboa

Where is the right place to store electronic health records - in the cloud or on a local server?

The question of the right place to store electronic health records (EHR) has many aspects. When the EHR systems were first implemented there was no question, a local server was established in the clinic on which the system was installed, and for many years that was the only way to go about it.


Today, along with the development of cloud computing, the possibility of installing the system on such servers has appeared. However, the possibility of installing the health records on local servers, of course, still exists. Therefore, in order to make a more informed decision, we will try to better understand the meanings behind each of these options.

Before going into specifying the differences between the different options, it is important that we learn a few terms that will help us to better understand and ask the right questions when examining the different systems.


First, it is important to understand that not every system that works using an internet browser is a “cloud” system. We must distinguish between Web-Based systems, which are full internet systems, and Web Enabling systems that allow a display through an internet browser, however, they are based on technologies that are not internet technologies.

In addition, when speaking about cloud computing, the important thing to distinguish is a “cloud” which is a central server from a real cloud. A central server - usually refers to servers that are identical to the ones installed in a local installation. The difference is that they are located at a central server farm and not physically in the clinic or the health organization offices.

A real cloud, on the other hand, is a collection of computing services that can be installed with software systems, information security, backups, etc. The leading companies providing cloud services are Amazon, Microsoft, and Google. There are other ones but those are the main ones that are often used and located all over the world.


Infrastructure and maintenance

The main difference between a local installation and a cloud installation is the need to take care of their computing and maintenance infrastructure. Using local installation, the organization needs to deal with purchasing servers, protection information and security products, backup products, and more. In addition, it must take care of the ongoing maintenance of the computer equipment, update software versions of the operating systems, etc. When using cloud services, there is no need to deal with any of the infrastructure issues, no need to acquire actual servers or replace them. The cloud service provider takes care of updating the infrastructure and all that it entails.


Connection to the system and remote work

In locally installed systems it is possible to work within the organization however as soon as you are searching for remote work, there is usually the need to install a secured connection, and sometimes it is a process that may be a bit complicated and cause problems for the system users. On the other hand, a local system doesn’t require an active internet connection and it is enough to connect the internal clinic network. Working in the cloud usually allows a built-in connection from anywhere. Of course, the connection must be made securely and following the cyber security requirements. When there is no internet connection, it is usually not possible to work with the cloud systems, that being said, there are systems that allow an Off-Line operation, and will later sync the information to the cloud system once the internet connection is restored.


Options for connecting to additional systems and adding features

When thinking of growth and development options, in locally installed systems there is usually the need to upgrade physical infrastructures if needed, for example increasing memory or storage in the system. When using cloud options (considering that the system was programmed properly) increasing the storage is made with a click of a button, and sometimes even automatically. Another example is adding functions and features to the system. With locally installed systems there is usually the need for a version update which risks being a long and complex process. When using a cloud, most services allow a gradual and fast addition of new features and developments without having to wait for a version update. That also applies to security updates or a quick fix of bugs found in the system.


Finding the best match for the organization and the users

Eventually, when wishing to make a decision regarding the correct placement to store electronic health records, each organization must examine the model that best suits its work process, the users using the system, and the long-term development plans of the organization. It is also important to weigh the financial component for each of these possibilities, not only in the short term but also in the long term.

There are other aspects that can be discussed more deeply in order to better understand the differences, advantages, and disadvantages of each of these options. For those interested, attached are two links to articles where you can deepen your understanding and receive additional information.







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