Electronic health records (EHRs) and other healthcare technologies are slowly, but surely, migrating to the cloud in New Zealand and across the world. The benefits of cloud-hosted systems are well documented, but there are some advantages that are particularly relevant to the New Zealand market that deserve deeper consideration.

Typically, the benefits of cloud-hosted EHRs are summarised into the categories of scalability, cost efficiencies, disaster recovery and data sovereignty. These have all been well represented in Altera Digital Health’s partnership with the Gippsland Health Alliance rollout of a cloud-hosted EHR covering the entire Gippsland region of the Australian state of Victoria. The Gippsland Health Alliance (GHA) comprises 11 hospitals and six bush nursing centres across 50 sites spanning 41,500 square kilometres and serving a population of more than 300,000 people. GHA was established in 1998 as part of the Victorian Government’s Rural Health Alliance strategy.

In an effort to improve the accessibility of its existing EHR system for clinicians across the Gippsland region, GHA chose Altera (then the hospital and large physician practice business unit of Allscripts) to deploy its Sunrise™ EHR clinical suite on Microsoft Azure. It is a first of its kind system in Australia that connects regional centres of the Alliance—which include Latrobe Regional Health Service, Central Gippsland Health Service, Bairnsdale Regional Health Service West Gippsland Healthcare Group and Bass Coast Health—to one EHR.

From a scalability perspective, GHA has seen tangible benefit. In the planning phases of the implementation of GHA’s EHR it was initially envisaged that the system would accommodate approximately 200 concurrent users, but by the time the system had rolled out to several Health Services, there were more than 700 concurrent users. In a system defined by physical on-premise infrastructure, this may have necessitated the management, purchasing and installation of additional servers, but with cloud-based system, this change in scope can be accommodated in a less complicated and costly manner. Likewise, the system offers enhanced flexibility, enabling the addition of temporary users in a safe and timely manner, such as is required in the healthcare sector when external physicians and clinicians are brought in on a temporary basis for a specific purpose.

GHA is also realising the cost benefits of the Sunrise on Azure platform as it eliminates the significant outlay associated with the purchase, delivery, installation and maintenance of hardware associated with infrastructure-based systems. Similarly, when hardware associated with the system is upgraded, this can be accommodated within the cloud-based EHR.

The benefits of a cloud-hosted EHR from a cybersecurity, disaster recovery and data sovereignty perspective is also measurable. In 2019, GHA was the victim of a sophisticated cyberattack that could have had far more disastrous consequences for an on-premise-based system. The attack blocked access to major systems, including financial management. However, despite the severity and wide-ranging nature of the attack, there was no indication the hackers accessed personal patient information. The attack forced GHA to detach several systems for quarantining purposes but the resilience and security of GHA’s cloud-based system meant that there was no net loss. Data sovereignty is also achieved with backup and disaster recovery sites situated in Australia, enhancing business continuity benefits.

The lesser-known benefit of cloud-hosted EHRs – Operational efficiency through talent recruitment

As regional and rural healthcare providers switch from paper-based to digital healthcare systems, the need arises for the recruitment of appropriately skilled and experienced staff, such as clinical coders. All hospitals employ clinical coders and a host of other IT professions to manage and document the hospital’s service to patients. Clinical coders manage and process patient service delivery by assigning codes with corresponding valuations to services provided. And in doing so, this enables the hospital to quantify its outputs to assist with budgeting and financial performance management.

In modern healthcare settings, clinical coders require IT skills that are less commonly attainable in the smaller cities and towns outside of Australia and New Zealand’s major centres, and Gippsland was no exception. Thankfully, this wasn’t an inhibiting factor because GHA’s clinical coders didn’t need to be local. In this instance, GHA’s cloud-based EHR is enabling clinical coding to be done remotely, avoiding the challenges of recruiting clinical coders with the appropriate IT skills. Therefore, rural or regional healthcare services need not be concerned that a lack of local technical or IT skills will derail efforts to join the world of digital healthcare.

Whilst there is no need for clinical coders to be physically onsite and remote workers can be recruited to fill key roles, this needn’t be a permanent scenario. As access to local IT job opportunities increases due to the digitisation of the healthcare sector, so will the pool of appropriately skilled and experienced people in regional areas, and new career paths will be created for future generations.