Cloud Computing


A transformation for the health care industry.

By David McMullan, PT, and Leigh Langerwerf, PT, DPT

Cloud adoption is accelerating in the health care industry due in part to greater acceptance and willingness of patients to use portals and other cloud-based applications. Because people have become accustomed to doing things online, from email to banking and much more, patients are more confident in trusting the internet (and the cloud). As a result, cloud computing is quickly transforming the health care industry.

Historically, acute care hospitals expected therapy and rehab practices to only allow their systems to be hosted in the hospital’s information technology (IT) infrastructure. Today, hospitals are asking practices about cloud options as that is their first preference because it means their IT departments will not have to worry about hosting and managing additional systems. With cloud computing, there is less disruption and increased ease of use in accessing services and transferring data between hospitals and therapy practices. The many advantages and benefits to physical therapy and rehab practices are helping to drive cloud adoption.

Physical space constraints and lack of IT staff limit the ability for practices to house and maintain a data center, which makes cloud computing a more desirable option. The cloud also offers a high level of data security while allowing for remote access. Remote access is a convenience practice that staff members are quick to take advantage of as it allows them to review and sign off on patient data even when they are away from the office. Because cloud applications shift IT operations out of a facility and into a secure virtual environment, all stakeholders are given access to business and clinical applications from their laptops or tablets. This also is helpful in case of an onsite outage as data is safely stored remotely.

Cloud deployments enable practices to get up and running quickly with reduced upfront investment as the only thing needed is an internet connection. IT resources are provided for practices, removing the burden and costs associated with purchasing, monitoring, and maintaining the applications and servers and finding the IT staff needed to manage it. Vendors are responsible for managing all the patches, upgrades, and backups, which allow practices to focus on patients and not on technology. Security risks are better managed in the cloud as well, which relieves a huge burden and overhead for private practices given the increase in Health Insurance Portability and Accountability Act (HIPAA) scrutiny and the Patient Protection and Affordable Care Act. With the cloud, practices only have to manage internet connectivity and PCs/tablets, the rest is taken care of by the vendor, who needs to set up a business associate agreement. (Be aware of what the vendor is liable for as well as what you are liable for.)

The advantages associated with cloud computing are numerous. With cloud pricing continuing to drop and patients expecting online convenience, more and more practices are deploying this technology. To ensure the best possible experience, consider the following during your search.

A practice’s data is somewhere. When random acts of God occur—hurricanes, tornados, earthquakes, fires, floods, or power outages—it is important to know what redundancies are in place to ensure a practice is back up and running in the shortest time possible. Ask vendors about their back-up plan in the event a disaster occurs. Furthermore, because maintenance needs to be performed, ask about true uptime including the frequency at which maintenance is completed. Ask about uptime service level agreements and redundancy—how often is data synched between sites?

Databases grow. When a practice manages data in-house, storage capacity is limited by the size of the hard drive. Cloud-based solutions typically have unlimited storage, and additional capacity can be instantaneously added when needed. Most vendors provide a reasonable amount of storage right out of the box. It is not uncommon for software vendors to charge a minimal fee when storage capacity is increased. Ask your vendor in advance about possible fees.

Interoperability in the post-acute care world is critical. To successfully partner across the health care continuum, excellent interoperability is essential. Enabling patient data to be shared electronically with referring providers makes it easier for patients to go from one provider to another. Interoperability can also make a practice a more desirable partner as there is less set-up time. When considering a cloud-based solution, inquire about interoperability. Some software vendors offer the platform as a service, where vendors can plug into another vendor’s platform even if the vendors have competing platforms, which delivers the ability to more easily exchange data. Good interoperability eliminates the need to pay for or build interfaces in order for the software to communicate with other software platforms.

Proper planning and asking the right questions makes cloud-computing success easy to attain.

Butte Premier Physical Therapy’s Cloud Success

Prior to moving to the cloud, staff at Butte Premier Physical Therapy in California relied on a desktop program for clinical documentation. While the system itself worked well, there were inconveniences and limitations. Because the clinical system was only accessible via PCs, staff utilizing MAC systems were forced to carry two laptops; shuffling between the two systems was not an ideal situation as it was very cumbersome. Furthermore, the expense associated with purchasing and maintaining computer notebooks for the center’s large staff was adding up quickly. The ability to cut costs by moving to the cloud, which would enable the center to purchase cheaper laptops as well as allow therapists to use their own computers (without having to shuffle between systems), was very appealing.

Even though they were aware of the many additional benefits typically associated with cloud-computing, including the cost and time savings related to not having to upgrade and maintain a technology infrastructure in-house, there was still some apprehension about making the move to something unfamiliar. Having an application on a desktop with a physical icon was something staff were comfortable with while the cloud represented the unknown. Utilizing the cloud would require staff to go through a website to enter their documentation. While this new way of doing things took a bit to get used to mentally, the move to cloud is one the staff members at Butte Premier Physical Therapy are glad they made.

Feedback from staff has been very positive, especially now that things are much more portable. Therapists are no longer tied to the clinic and a single wireless router. Today therapists have the ability to securely log into the system from their own homes to sign off on important notes and other documentation they were unable to get to during the day. In terms of portability, things are much easier, without the worry of violating HIPAA regulations.

Two of the practice’s biggest cloud concerns, security and HIPAA compliance, have also turned out to be a nonissue. The onus is on the vendor partner who must ensure security and HIPAA compliance are taken care of or they will lose customers quickly. Working with a vendor partner of Butte Premier, the security processes were able to be clearly outlined. For example, data security is addressed by ensuring the vendor’s cloud maintains a professionally managed data center which is monitored 24×7 with redundant power systems, multiple communication networks, automatic fail-over to backup equipment/co-location servers, and fire suppression systems. Furthermore, because there are two logins that separate users from patient documentation, there is an added degree of safety.

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The cloud-based clinical management system interfaces well with the practice’s other software. All of the reporting is the same, so it wasn’t much of a leap from a desktop version to a cloud-based version, with the exception of the new portability and easier access to information. Now, if the internet goes down in the practice’s office, staff members have the ability to easily switch to a hot spot without missing a beat.

Significant cost savings have also been achieved since moving to the cloud. Upgrade and maintenance costs are eliminated and there are no additional infrastructure costs such as routers or higher end PCs. It is also easier and more affordable to get licenses for student therapists. Students access the system from their own laptops and clinic staff can simply delete the software from their systems prior to their departure.

While the move to cloud computing was initially driven out of desire for greater convenience, the benefits have been far-reaching. For other practices considering a move to the cloud, it is important to remember that just because it is something different does not mean it is something to fear. The many benefits of cloud computing, including lower IT costs and increased security and accessibility, make it worth consideration.

Leigh Langerwerf, PT, DPT,is the owner and founder of Butte Premier Physical Therapy. He can be reached at

David McMullan, PT,is a PPS member and vice president and general manager of Therapy Division, SourceMedical. He can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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