The use of "the cloud" to deliver technology and services—including a cloud-based EHR—is expanding across a wide array of industries, and becoming a part of the individual consumer experience on the Internet (people with Apple or Amazon accounts already use cloud computing to store purchases and create lists, among other activities). As a recent Harvard Business Review article reported, "Over time the economics of building and running a technology infrastructure will favor the cloud over on-premise computing."¹

What exactly is "cloud computing"? Put in simple terms, it's accessing and working with content available housed at a shared online location, rather than on a personal disk drive or local server. All software and information is stored exclusively on an online network (referred to as being "in the cloud") with the Internet as the point of access for all users. The nature and number of users who can access that software and information in the cloud is securely controlled.

For a cloud-based EHR, all software and clinical data is stored, shared and updated in the cloud, providing medical practices with benefits that traditional EMR software systems can't deliver. With a conventional software platform, information is "siloed," usually limited to users that are in the same physical location as the software and servers. (The National Institute of Standards and Technology [NIST] provides a definition of cloud computing, as well as the platform's service and deployment models.)

Compared to conventional solutions such as installed software, cloud computing is uniquely defined by these characteristics:

• On-demand self-service: Any resources, from vital business functions to basic e-mail, are available to all users at practically any time
• Agility: Upgrades can be made and applied across the network on one instance of software
• Broad network access: Availability is ensured, since access is not dependent on location and can be done via a standardized device, like a PC or tablet
• Resource pooling: Many can use the network at one time, accessing the same tools and functions
• Rapid elasticity: Compared to a traditional computing infrastructure, a cloud-based network can easily scale, accommodating and responding to a rapid increase in the number of users and spikes in demand

The federal government has recognized and promoted the benefits of cloud computing, announcing in early 2011 a preferential "Cloud First" policy as well as a Federal Cloud Computing Strategy