Table 1.

Implementation of desirable EHR qualities with the cloud computing model

Quality	Description	How cloud computing could implement the quality
Economical	System's price should fall within a range that would permit its inclusion in the budget of most practices that could benefit from it	Cloud computing can be less costly than buying traditional in-house EHR systems through more efficient use of computing resources like networks, servers, storage, applications, and services, which are shared among clients, and can be rapidly provisioned and released
Interoperable	System should allow electronic exchange of data with other EHR systems without the need for expensive custom data conversion libraries or third party EDI clearinghouses	An EHR system offered by a SAAS or PAAS provider could feature membership in the NHIN, and implementation of the CONNECT5 networking functionality, including a variety of data exchange mechanisms with other NHIN members
Useful, agile	System should facilitate and be responsive to changes in business requirements and workflow	The PAAS model could supply a basic, generic EHR system to clients, while offering the tools to quickly customize it as needed to accommodate local requirements
Secure, compliant	System implements effective mechanisms to protect data integrity and confidentiality at the host, network, and application levels, and complies with government regulations	An EHR system offered by a SAAS or PAAS provider would have to implement all HIPAA requirements, and specify them in business associate contract with clients (table 2)

EDI, electronic data interchange; EHR, electronic health record; HIPAA, 1996 Health Insurance Portability and Accountability Act; IAAS, Infrastructure-As-A-Service; NHIN, National Health Information Network; PAAS, Platform-As-A-Service; SAAS, Software-As-A-Service.