Remember the news about an EMR outage at Fletcher Allen Health Care in Burlington, Vt., from August? A new, $57 million installation was rendered useless for hours following a power loss and subsequent failure of battery backups. Fortunately, the health system had a plan in place to revert to paper records during the unscheduled downtime. "This went smoothly because our staff still remembered how to document and write orders on paper, as it hadn't been that long since we'd gone electronic," Chief Nursing Officer Sandra Dalton says in a For The Record feature story on dealing with EMR and EHR downtime.

This problem was figured out nearly a decade ago, but my numbers might be a little off. There are very few reasons to have a local server run your EMR program. Perhaps you should configure your EMR to work locally if the internet slows or is briefly disrupted.... BUT as soon as the connection is restored you return to a cloud based operations/storage solution. This is a no-brainer, and a non-starter for platforms that insist on residing locally... even with redundancy built in.