Comparing Cloud vs. Traditional Server-Based EHR/RCM Systems

Comparing Cloud vs. Traditional Server-Based EHR/RCM Systems

March 13, 2012 2:00 pm

(Save to cal)


Join us for an educational webinar on cloud computing vs. traditional server-based EHR (electronic health records) and RCM (revenue cycle management) systems on March 13, Tuesday 2 P.M. ET.




Guest Speaker: Satish Malnaik, CEO of NextServices 
Moderator: April Sage, CPHIMS, Director of Healthcare Vertical
When: March 13, Tuesday 2 P.M. ET

As the healthcare industry picks up momentum toward meaningful use, practical implementation and HIPAA compliance questions have risen to the forefront of consideration. Should new systems be hosted in-house? Do I outsource just the EHR/RCM system or the entire solution as a platform? Are clouds safer or riskier for PHI security? What about for PHI availability?

During this free educational webinar, Satish Malnaik, CEO of NextServices, and April Sage, Director of Healthcare Vertical for Online Tech, will compare cloud vs. traditional server-based EHR/RCM systems.

Questions and discussion points are encouraged and welcomed from webinar attendees in advance and during the webinar.

April Sage: Good afternoon everyone and thanks for joining us for today’s webinar. We’re pleased to have Satish Malnaik joining us who is the CEO of NextServices. Today, Satish and I will be talking about comparing cloud and traditionally hosted EHR/RCM systems. Welcome Satish.

Satish Malnaik: Thank you, April. Glad to be here today.

April: Why don’t you give us a little bit of background on what NextServices does, then we’ll proceed with our webinar content for today.

Satish: Certainly. NextServices is primarily a Revenue Cycle Management firm (RCM). We are in the business of what we call seamless healthcare delivery. Especially with what is happening in the healthcare arena and how delivery of care, information and data is being managed. We have added to our solutions and now we present a fully integrated practice management revenue cycle management and EHR solution all on the cloud (appropriate, because I’m here to talk about cloud versus traditional services), but that is what NextServices delivers to a variety of practices and medical facilities all over the country in multiple states.

April: Well let’s dive right into our webinar today. I want to invite our listeners to go ahead and submit any questions or comments using the chat or questions window. We will try to answer them as we go if they are relevant and we will reserve some time at the end of the webinar as well.

Satish: Thank you, April. I’m going to take some time and walk through slides and information. I’m going to try and keep things at a very high level to try and get a broad understanding of what’s happening in the market place and where current offerings stand for someone like you. Whether you represent a medical practice, consulting company or someone responsible for hosting and managing data, etc. So I thought I would take a step back and really dive in on where things are today, where they’re going in the future and some opinions. As most of you know, traditionally the hosted solution is at the center of our conversation. Server-based and accessible through remote connections and VPNs. Which is still the norm in many parts of the country. Data works, revenue cycle management and support was primarily handled in house as a function, which obviously came at a higher cost.

Claims management systems used to be traditionally done between payers, providers facilities and hospitals. They were fairly simple, and I say this in a relevant way, because the process is still the same but a lot of requirements have changed. Patient encounter documents and payer rules were less complicated. Everything was less complicated. Every year more rules are put into place which makes the entire system and its management a little more needy.

April: It doesn’t seem like that trend is changing anytime soon.

Satish: No, not any time soon. It’s probably going to be at least another three to five years before we settle down to what we would consider the new standard of where pretty much everyone will be. Some of the other elements with legacy systems are nascent security technology for web based products that really were not out there. They weren’t fully developed. No one really knew how to handle web based applications. Of course the biggest factor, which accelerated everything towards the cloud, was the fact that internet access is easily available for most of the country. Speeds are sufficiently high enough that you can actually run pretty graphic and data intensive content, whether it’s video or just pure text back and forth which makes it accessible.

April: That certainly wasn’t the case several years ago.

Satish: Absolutely. I’m sure for some of you who carry an iPhone or iPad know what that means in today’s totally mobile connected world. Some of the market is fairly open knowledge putting a healthcare spin on it. The biggest factor has been meaningful use compliance and EHR incentive programs that have accelerated the move towards an electronic system of records as well as pushing compliance to the forefront.

Compliance was always required, but it was never really fully enforced, but the enforcement piece has really made it a requirement now. The other element that is going to make a big difference why clouds work over servers, is the fact that future reimbursements are going to be dependent on quality and more electronic data being admitted to the payers. Especially Medicaid and Medicare. Part of the reasons incentives are in place, is because they expect all of this data to be transmitted back and forth.

Interoperability. It’s sort of one of the biggest buzz words these days. Anybody who was at HIMSS knows that interoperability is probably going to be a very large conversation topic and a big reason for a lot of activity in the future. Regulations will enforce that data sharing between systems. It is a requirement and not just an option, whether you go directly from system to system or whether it’s via HIE’s or other private networks. It is going to become a requirement in the Stage 2 meaningful use and further. Integrated revenue cycle solutions have latched on to both the EHR and the cloud based computing offer services at much lower costs, which is always music to everybody’s ears most of the time.

Web based platforms are obviously now the norm and very mainstream. Applications have become very user friendly and very easy to use. Before there was always this fear about interfaces and how well you can train somebody to use it, web based applications are easier. And since it’s integrated into the daily life of every person out there, cloud based systems are a natural yes just because you are using the web for pretty much everything else you do these days whether it’s online shopping, banking, etc.

April: It gives a little more context, a little more credibility. People are starting to get a little more comfortable.

Satish: Yes, most of the fear is gone although there are parts of it that are still left. Mobile devices are probably an area, if I had to pick one, where a lot of changes will happen in the next few years. The usage of mobile devices is going to go up drastically, which I think is on most people’s radar. That to me is also going to directly lead into why and how your solutions are hosted and managed.

April: Satish, help us connect the dots between the meaningful use requirements, the consensus behind that and how that motivates providers to implement EMR and CRM systems. Are you finding that the majority of the providers are looking at EMR implementation to make their lives easier, or to benefit from the incentive programs or is it a combination of both?

Satish: It’s a combination of both. I would definitely agree that if the incentive programs had not been in place it’s likely that the pace of change would have been much slower. It has accelerated significantly at the higher levels. There are physician practices interested in being where they are when it comes to electronic records.

Ultimately the goal of EMR is to improve quality of care, securing patient data. The simplest case scenario, where a patient is going from a primary care hospital to a specialist, or is traveling in another state, their records don’t become tied to just a single system in an office or health system. It needs to become portable. Part of the focus of HIPAA is portability, but then portability got lost in the accountability portion. However, it has definitely helped accelerate the process. I think both are contributing factors today. There are groups that are very interested in having and using these kinds of systems for better quality and delivery of care.

April: I know you have pros and cons for us here. Why don’t we take a look at the good and the bad.

Satish: This is meant to show some of the things you should consider when you are looking at cloud based requirements. I’m sure a lot of you have heard about cloud based systems and that is part of the reason why you are here. Now looking at the cloud environment, I’m going to list a few pros and then balance them out with cons.

One of the biggest pros is that you have a lower capital investment. You do not have to buy equipment and maintain it by the shelf-life of the equipment and replacing it. That is a big, big benefit.

When you look at the customer segment from all of the buyers of EHR segments, ideally for small to mid-size practices groups and facilities this makes the most sense without any doubt. I think they should consider a cloud based option before they even consider a traditional based option. Sometimes the ROI would make sense that they keep it in house, but that is certainly not the case in all scenarios and it’s changing.

April: Touching on the life of their systems and what kinds of human resources they have to keep up with all of the maintenance and security.

Satish: Absolutely. Even the larger groups are giving serious consideration to cloud based systems. They are easy to access which is a very large benefit of cloud based systems. You don’t have to deal with VPN or remote desktops. For most applications these days you can access them via tablets or laptops, and given 3G and 4G speeds, it works quite well. As long as you have your applications and a wireless signal, it can be done throughout the country. It’s much better than even the broadband speeds we had a few years ago.

Security and data protection compared to servers where you are physically locking up the server and access to it and maintaining an audit trail is a lot easier when you have those functions out in a cloud based environment. Most cloud based environments are very large data centers that are very professionally run. They are managed extremely well with almost no downtime, because availability is extremely high, which is what you want for a cloud based solution.

You have meaningful use compliance which is a very big factor. When you look at most users of the systems, or those that use the systems. Proving meaningful use compliance is two fold. You have to have a meaningful use compliance system and then you have to have activities that demonstrate that you are using them meaningfully. To eliminate a big portion of that requirement of meaningful use by having a cloud based solution that is already compliant, gets you half way through that process anyway. And that is something you will have to continue to do in the future it’s not just a one time deal.

April: So when you are going with an EMR system that has the benefit of being certified or you know that it has met meaningful use requirements, at least it is going to get you over one of the largest hurdles. Then it’s up to you and hopefully your work flow isn’t impacted so you can actually have adoption of it with the users.

Satish: Absolutely. The other big benefit is the compliance end of meaningful use. Compliance shifts to your provider versus you having to do that every six months to a year with having all of those internal processes and supports in place. That burden shifts to the vendor and in all cases a vendor with credibility in the marketplace, they are going to do everything to ensure that they are always compliant and documenting them as well.

Scalability is a very large factor with cloud based solutions. Now that you’re not tied to having to grow systems, whether it’s by capacity or any other element, with cloud based systems adding 10 or 20 people to the system or opening a new location for the practice becomes easy. All you need is a decently powered computer with a stable internet connection and you’re ready to go. All setup and implementation happens in the backend.

April: So for every facility you don’t have to invest in this huge infrastructure of the physical security and the resources to manage the servers structure. It almost seems that as you grow, you get more leverage for the dollars that you’re spending on the cloud infrastructure.

Satish: You are taking the whole fixed cost right out of the system. You are now operating in the Software-as-a-Service cloud based platforms. It’s subscription, so you’re basically paying as you go. Which also keeps you on your toes, because you are always current and not lagging behind which is what used to happen with server based systems. Upgrades were painful to do. We walk into medical facilities all the time that have not changed or updated things for 10-12 years.

April: Well, when it works why break it?

Satish: That’s true, but they carry a tremendous amount of risk, because if it doesn’t work there really is no one available to fix it or the capability to fix it. That’s what makes it harder.

We talked about mobile access earlier. With cloud based solutions, mobile access is a lot easier to run applications on an iPad and Android tablets just because of their architecture itself and the architecture used to design these applications. It’s designed to be very light so it can work on the internet versus heavy applications that are more resource intensive.

We also mentioned improved availability with the cloud compared to traditional systems. And uptime and downtime being taken out as an internal risk.

April: This actually speaks to a question that someone submitted. Here we start to tease out the availability of the application and knots of the differences between the cloud itself, cloud hosting and the networking. So the question is, how is a web based solution going to compare to the server client model and uptime? For example, our company has a 99% uptime in servers and internal networks and only about 70% uptime in internet connection during business hours.

Satish: If I’m reading that question right, I think they are referring more to the internet connection being the problem versus the application or the hosting environment. In most environments, especially if it’s mission critical like EHR and EMR, the problem is with your service provider for the internet connection. We suggest that most environments have at least redundancy in their internet connection. That way you have two different providers coming in, because even with basic back-up on the internet site you can at least keep your core applications running and have access to your medical records and EMR in a cloud based environment. We have not seen that to be too much of an issue.

We have evaluated some customers and clients and per year, they have had maybe two points in time that was down time and internet based that they couldn’t fix through their provider. And that was considering downtime to be more than an hour long. It’s possible that you’re having more uptime in your internet connection, but it could also be a spyder issue. And I think location is a factor. In rural areas we can’t guarantee that kind of uptime. I would say cities are going to have the best uptime and outreach to internet connection. Most of the providers do guarantee 99% uptime. Picking a provider that guarantees that is definitely a factor to consider before getting an internet based application.

April: Sounds like you want to make sure and understand your SLA with your internet provider.

Satish: Right. 70% is considered slow, generally speaking and based on market averages. That is much lower than what you should be agreeing to with your ISP.

Let’s move on and take a look at some cons, because in all fairness we have to evaluate those as well. One of them being, referring back to the question we just had, being your dependency on internet and speeds offered by regional internet providers becomes a factor. Meaning it is something you also have to consider very seriously before you decide on a cloud based solution.

Slower response time due to latency or lag, especially when you get into imaging files for certain specialties, such as radiology, or instances where you are doing a lot of imaging and it needs to be sent back and forth. That is something that will need to be benchmarked and can be benchmarked before you make a complete decision on a cloud based solution. You should test it for an hour uploading and downloading images to see how it performs.

April: That’s where I think having a really good understanding about how your users are really using that system and what key points would really introduce issues that are important so you know which issues are critical and which ones to benchmark.

Satish: It is a very good point in time to take a really good, hard look at internal usage of those applications. Especially EMR and where the peaks of usage goes up quite a bit and can it be spread out during the day or week. Making sure that you are marking the highest and lowest points of your environments for bandwidth as well.

Loss of control is a very obvious one. It’s an environment we’re getting used to today. We’ve been used to an environment where we wanted everything inside our doors and offices and be able to physically see where your data or server used to be. Those days are definitely going away and if I have to take a look at the future I would be surprised with not many systems being on a truly internally hosted client-server model in the future. Just because it’s usually not core to an organization having to maintain that infrastructure and having to support the staffing required to maintain that kind of infrastructure That infrastructure is really not a part of what most businesses do and to have that in house just increases the complexity and cost.

One of the risks is non-compliance by the vendor. It is very important that you look at the vendor and ensure that they are in compliance with the requirements. Whether it is security compliance, data compliance or HIPAA compliance (especially when it comes to healthcare) ensure that you are getting that kind of compliance documented and confirmed before you decide to go with a particular vendor. I know there are many providers out there, but very few are actually compliant top to bottom as they should be.

April: So how do you measure that?

Satish: The measurement of that requires a little bit of both an old school and new school approach. You definitely need to have agreements in place and you also definitely need to require the audits that they should have conducted on both their internal and hosted facilities. They should be able to provide those audit certifications to you. As far as HIPAA policies are concerned, the storage of data and how it is stored, who has access to the data, the audit trails, access to the data are especially important when we start talking about a breach. What sort of policies and procedures are in place?

There are a bunch of factors you can consider when looking at compliance. More than likely most facilities should have been audited and if they have not then that is definitely a red flag. If they are audited, look at the reports and the certifications and see how it’s laid out. What kinds of services are guaranteed, what sort of data protection services are guaranteed and how is your data is stored.

April: I know at HIMSS this year it was interesting to hear what sorts of audits people were requesting and asking for. I’ll pick on your minute, Satish, only because we were picked on by our auditors, audits don’t result in certification they result in independent audit reports. It was interesting, because we had a few people come and ask us about SAS 70 audit reports which expired last year. Then we had a few asking about the SSAE 16 report, which those are done by the AICPA, but they measure financial controls. So now you get into this whole mess with SOC 2, which is the first step in the right direction for measuring the controls around server uptime, security and availability.

Then there’s this whole odd zone of HIPAA compliance and what it all means. Is there anything that is HIPAA certified? And does PCI count for HIPAA? It’s interesting all of the proxies that are out there. One of the things that we always recommend to our clients is to ask them for the independent HROC, ask them for that independent HIPAA report on compliance and read through it yourself. Because you’re right, a huge advantage is that you can delegate some of those physical security and operating systems management and patch management and outsource that type of stuff, but you have to know what is happening. You can’t just sign that BAA and let your signature be the do diligence. You actually have to read about the controls and really make sure that your vendor understands all of their obligations under the HITECH act. That has been a big learning curve.

Satish: I think even in relation to HIPAA and cloud based systems, the clarity around certifications is still not completely crystal clear. It’s still evolving. I think what one can try to do is to see the whole process of their provider or vendors system and what they do. It becomes clear when someone is trying to stay compliant and get all of the certifications possible. One of the things I also suggest is requesting a report from your vendor provider, whether you do it quarterly or every six months. Regardless of the presumption that things are running great and everything is fine. Proactively request a report and keep that as part of your do diligence file and make sure you are always in compliance.

An episode I ran into at HIMSS was where a particular facility had a data breach on PHI, they were then audited and HHS came in to audit them as well. The problem that they had was that it was an intentional breach, an external breach. They had taken all of the steps to make sure that they were compliant.When the breach happened they did everything they could to fix it immediately, that was their core focus. What they failed to do was to maintain a trail of everything they did while trying to fix it. So it wiped out some of what had happened and there was no audit trail to figure out what caused the problem and what needed to be done in the future. So having the capability to ensure that everything is audited, maintained and available is important.

April: Everything needs to be logged, stored, archived and protected.

Satish: I think requesting a report from whoever you work with is not unsubstantiated. It would be good to have that available.

April: You make a good point on requesting that on an ongoing basis. By asking for it today, things could change in a year.

Satish: I know the tendency generally is that unless there is a fire in the house, no one really goes to check that there is a fire extinguisher available. We are all guilty of that I’m sure. So don’t wait for the fire to start before finding out whether you have a fire extinguisher available.

HIPAA does not currently clarify ownership rights on data in a cloud based system so that is one of the cons to consider. Having said that, HIPAA penalties continue to be very stiff on PHI data breaches. The requirement to report the breach within a certain time frame is specified and you have to make sure that you do that and it has to happen very quickly. Assuring that these policies are in place.

April: You want to be convinced that cloud vendor feels the same sense of urgency and knows all of the documentation.

Satish: Absolutely. When you’re talking about policies and procedures you need to know who communicates what, what time it is done, what the requirements are of the individuals responsible for doing it and the systems that are required to do any sort of automated communication. That all needs to be figured out before something happens.

To support the conversation we have had so far in terms of looking at what’s happening and where the trends are, there is certainly a dependence on cloud based systems. Most applications, at least future applications, are all being designed for the cloud and not client servers. That is an additional trend that is reflective that you are going to look at in the future that has everything pretty much running off of the web and cloud based systems.

April: It’s been interesting the last 12 months watching the shift in our client base go from the in-house server to having apps run in a colocated agreement and now moving from that outsourced colocation to cloud. And anyone who has started recently is going straight for cloud. It’s interesting to see that the cloud has really gained traction and confidence over the last six months.

Satish: I think the confidence part has been developing and so has the comfort level in terms of applications. There are a fair number of systems that have been up and around for some time now. Whether you consider Amazon the world or not, they are a very large and robust system that have millions of transactions every minute. These are the data center environments that are now hosting most cloud based systems.

A few criteria I wanted to lay out that will be helpful for everyone in their evaluation process, I have put in both technical and non-technical terms. With access to cloud based systems, make sure that authentication and secure access are key elements of it. Do not transmit data that is not secure or authenticated. Most EHR/EMR applications, at least good ones, provide that level of authentication and security. There needs to be very specific login and timeout policies so that you can maintain the audit trail so that records are not at risk for any sort of breach. Especially in web based and cloud based systems when applications are open like that there is higher risk.

In terms of network in relation to the storage of data, that goes back to your cloud storage vendor. How they store the data, how it’s backed-up and what sort of physical and network based security is in place. Once again, the intention when it comes to HIPAA is to define the safety of PHI. As long as the measures are being observed, the policies are in place and the procedures are being adhered to, then when and if something does happen you are still in an okay position as long as you have done everything in your power and understanding.

April: But the do diligence is key. It’s interesting that, I think this is starting to dissipate, but initially people thought that if they don’t admit that they are a business associate, then they are safer. As we’ve seen from the penalties, nothing could be further from the truth and every indication is that the responsibility of business associates is only going to increase. Health and Human Services is not at some point going to limit their inquiry to the covered entities.

Satish: That is absolutely right. I think you proactively make providers, including solutions like ours provide that kind of compliance ahead of time and not wait for HHS to define how far they can reach out and go after us.

So again, disaster recovery, backup and access to the data and ensuring, if required, that access to the data is available in an emergency situation. If you ever ran into a situation where you have to change the vendor, whether you’re changing EHR/EMR systems or changing hosting providers, you still need to ensure that there is access to the data and you can make that happen in a fairly easy and fluid way. Usually we don’t think that far ahead, but it’s good to keep in the back of our minds.

Some of the non-technical pieces to evaluate include making sure there is documented HIPAA security policies and rules as we discussed earlier. Certifications are not completely in place and as more certifications fall into place and are clearly defined, the clarity around a party’s responsibilities when things do go wrong and who is responsible for what has to be in place and laid out in a document. Both parties need to be very clear on what happens if and when something happens.

April: That’s why it’s important to understand your Business Associate Agreement.

Satish: That’s right. Notification policies are very key, because when things go wrong that is where the focus tends to be. What actually went wrong, what happened after, how were notifications done and how the breaches were handled are just as important as ensuring that you’re getting into a system that will be compliant.

Even though it is something that has not become available across the markets just yet, I’ve seen interest in insurance coverage. Especially for very large entities that want that security for liability and data privacy breaches. Any time there is a liability, insurance usually comes up with something. It isn’t something new and it isn’t something that’s required, but there are a few facilities that are looking at that as a security policy just, because the penalties are pretty hefty.

April: I know we sleep a lot better at night knowing that we can cover the cost of notifications, we can cover the cost of any remediation and that we are not going to be putting that burden on our clients. When you compare the costs of that type of coverage with the cost of a breach, it makes that decision a lot easier.

Satish: Referring back to what April mentioned earlier, requesting independent audit reports or actually having one done is worthwhile. It’s a pretty wide topic with a lot of detail and it’s not something that is going to be saturated anytime soon. There are going to be more changes expected with Stage 2 compliance requirements coming out. With more certifications being defined it is evolving and change will be there, but without a doubt cloud based systems are here to stay. If anything the usage of cloud based systems is escalating at a rather dramatic speed for some of those factors we were talking about. The pros outweigh the cons right now so that is why you are seeing a higher acceptance rate versus traditional server models.

In most facilities we walk in to, the very fact that they don’t have to worry about upgrades or support is like taking a huge weight off their shoulders. That makes the business case many times, but of course you have to consider all other factors as well.

April: Well if you’ve got a good degree of confidence in your cloud vendor, then that will allow you to focus more resources on providing care. It’s a win-win for everyone and there is do diligence there and you have a common understanding of responsibilities.

Satish: We have our own EHR system being used right from a solo providers practice to a group at a surgery center and surprisingly as we have rolled them out, we thought there would be a small level of resistance, they have been very well accepted. And the usage in terms of the user base has been fairly painless. I think we are underestimating how easy it would be to implement and how cloud based systems actually work out well.

April:I’m sure that’s not the case everywhere. I’m sure you guys have the cleanest and best workflow interface (at least out of the few that I have seen). So kudos when you can get a good user face going to support the workflow that they are actually doing.

We have a couple of questions here, let’s see if we can answer these.

As a compromise to get people more comfortable with client-server deployment, could web-based systems give nervous customers a copy of their own data, copy it to their cloud as a value added service at a minimal cost?

Satish: Absolutely. I don’t really foresee that as being an issue with any of the cloud based systems. Now, when you go to very large enterprise systems that may or may not be possible, only because they are very tight about their way of doing things. And when you are looking at very large enterprise systems, surprisingly they are not purely cloud based yet. They are doing a simulation model. But yes, and I in fact think that will almost become a given as time goes on. In our own policies and in our own practices with our customers, we guarantee them that data and if they want a copy of it to be stored at another cloud based services, absolutely. The very fact that it’s cloud based, makes it easier to make copies of the data and move it. That helps makes the task and requirements a lot easier.

April: That’s a huge advantage I think we are seeing almost every cloud platform get better at improving the way you can copy and distribute those images between client and vendor or between remote facilities. It seems like an area that is progressing very nicely.

Thank you everyone for joining us today. Satish, thank you for your insight.

Satish: Thank you. I hope it was useful and if you need any more questions you can contact April or myself and we’ll do what we can.

April: If anyone has any follow up questions feel free to contact us and we’ll get those answers to you. Thanks everyone!


Satish Malnaik, Chief Executive Officer, NextServices
Satish Malnaik is an entrepreneurial enthusiast, CEO and Co-Founder of NextServices, a company that enables seamless healthcare delivery by providing an innovative platform that blends technology, healthcare analytics and knowledge-based services for medical facilities and providers.

These days, he is fascinated with the change and evolution of the development of healthcare technology as well as cloud-based platforms that focus on better capturing, transporting, integrating and managing data. Prior to co-founding NextServices, Mr. Malnaik worked in various E-business, ERP and technology initiatives for Fortune 100 clients, such as Thomson Healthcare (Thomson Reuters), and consulting with firms such as BearingPoint (formerly KPMG Consulting).

Mr. Malnaik received his MBA from the University of Michigan Ross School of Business and he also holds a master's degree in Engineering (MS) from the University of Toledo, Ohio. Prior to that, he completed his undergraduate degree in Engineering (BE/ BS) from The University of Mumbai in India. Satish is currently serving in an advisory role on the Strategic Advisory Board at N-Squared Growth Capital (NY) and on the Advisory Council at DDW (AGA). Previously, he also served on the Advisory Board of Billing Services at ADP®AdvancedMD and as a mentor at the Ross School of Business on Financing Research Commercialization practicum for new technology and innovation.



April Sage, CPHIMS, Director Healthcare Vertical, Online Tech 
April Sage has been involved in the IT industry for over two decades, initially founding a technology program in the pre-Windows era teaching DOS, WordPerfect, and FoxPro. In 2000, April founded a bioinformatics company that supported biotech, pharma, and bioinformatic companies in the development of research portals, drug discovery search engines, and other software systems.

Since then, April has been involved in the development and implementation of online business plans and integrated marketing strategies across insurance, legal, entertainment, and retail industries until her current position as Director Healthcare Vertical of Online Tech.


Webinars    |    Online

Get started now. Exceptional service awaits.