EHR migration to the cloud

What are some of the biggest challenges clients face when it comes to EHR migrations?

If you’re planning to migrate your electronic health records (EHRs) into a cloud platform, obviously you need to keep the current system running while you move the EHRs to the cloud. That gives you what we call a “double bubble,” in that you’re paying for both platforms at the same time, so that can be a challenge.

Some entities also struggle with ensuring they have the skill sets needed to learn and operate the systems. In health care, many organizations are still new to the cloud. EHRs are the most critical system in an office, and some tend to struggle with having the necessary in-house skills to manage the system.

We also see clients who have challenges around selecting the actual cloud provider. Many of our clients’ challenges have been around performance and the question: Can I actually do this on the cloud? The narrative has now changed to: How can you quickly get me to the cloud? I feel confident about the ability to do it on a specific cloud provider. I feel confident in an adviser like Deloitte to help me get there.

They see that the cloud value is beyond just simply a TCO (total cost of ownership) or a business case for their EHR software, and more about an entire transformation. They can use our platform and leverage a solution that can help them to be truly transformative.

What are some common questions, hesitations, or misconceptions about EHR migration to the cloud?

It used to be performance and security of the cloud, given it was relatively new technology to health care, and there wasn’t a lot of evidence to show it was effective for health care. That’s changed significantly in the last two to three years as more cloud-based EHRs are in place.

Four years ago, we probably did one implementation a year. This year, we’re already on our eighth.

The culture has changed in health care, and folks are seeing the value of cloud-based EHRs. A lot of those misconceptions have fallen by the wayside with folks seeing how they work in the real world. More clients have moved to a cloud EHR, and their performance is better.

They can see measurable performance metrics that demonstrate the case. That seems to quell any lingering hesitation or concerns.

What makes Deloitte’s approach to EHR migration different or stand out?

We’ve been at it the longest. We did our first migration in 2019, and it was the first ever migration of an EHR to AWS globally. We went on to do our first full migration in 2022. Since then, we’ve continued to dominate in the space.

Half to maybe even 60% of the worldwide implementations have been touched by Deloitte, so our reputation in the market and our reputation with AWS is well known. When someone wants to move EHRs to AWS, we often get the first call. It’s our market reputation based on our past performance.

What does the future of EHR migration look like, and how is Deloitte planning for that future?

We’ve spent a lot of effort and resources on automating the migration process. This has paid off for our clients.

The first implementation, to get the client off the ground, took about six weeks. And with our current automation and using our EHR Migration Assistant solution, we’re now doing that, in some cases, in six hours.

The investment in automation is something that we see will continue.

We’re now going through a rewrite of that automation to include a broader swath of the technology landscape, as well as making it easier for operating services to integrate tools, such as configuring logins in certain ways, adding services to support firewalls, and load balancers, and things like that.

How does the Deloitte migration process protect patient information?

Our reference architecture that runs in an EHR system, and the automation that we’ve built throughout our migration process, starts with a security posture that’s built around security frameworks, including the National Institute of Standards and Technology (NIST) and the Health Insurance Portability and Accountability Act (HIPAA).

We use automation to enforce encryption controls to protect client data in all cloud systems and to prevent public access to data stores.

There are almost 100 different controls that are deployed and enforced automatically to prevent an accidental opening of an S3 bucket or creating a disk that’s unencrypted.

The reference architecture has all necessary compliance and high trust requirements needed in health care.

What are some advantages of using Deloitte’s EHR Migration Accelerator?

Our clients come with various levels of maturity when it comes to the cloud. Some have zero cloud presence, some have some cloud presence, and others have been working in the public cloud space for a very long time.

Our solution is designed to be adaptable to those varying scenarios so that we can help them to accelerate the migration and do it in a consistent format as it relates to the client outcomes.

The EHR Migration Accelerator is something that we’re looking to use for an increasing quantity of migrations. So far, only one or two clients have not used the Accelerator, given where they were in their cloud presence. But our solution is being developed to be adaptable to that scenario as well.