Author: Chandresh Shah

I spent half an hour with a Physician last evening who is starting a brand new practice. At his previous ‘group’ practice, they used eClinicalworks. He was quite happy with it in the sense that he knew it inside out, he had been using it for many years, and so was his new staff.
eCW had even offered him a very reasonable price for his new practice.

But, he was ‘EMR Shopping’- why?

The answer kind of stumped me.  Here’s what he said:

He wanted a web-based EMR because he did not want to invest in servers etc. Fair. But why not eClinicalworks? He wanted a good certified system that could get him started ASAP. At the very minimum, give him access to the system so that his staff can start scheduling patients for the practice that will open in the next two weeks.

That’s it – plain and simple.

So, vendors, I know you all are busy raking up sales, but gear up, shape up, or lose sales.

• SaaS EMR – Software as a Service electronic medical record (EMR).  EMR product deployed in a practice in which server(s) are owned by the service provider and hosted remotely (off-site).  The only requirement for accessing clinical data stored on the off-site server(s) is an internet connection/internet browser, regardless of the computer’s location.  The service is a multi-tenant offering.  The vendor installs EMR updates/upgrades at once and these are immediately available to all SaaS EMR vendor clients.
• ASP EMR – EMR data is stored on the server(s) which is hosted remotely.  The clinical data stored on the server(s) is accessed through the internet browser and additional remote access software (i.e. Citrix).  Only those computers with Citrix or some other type of remote desktop/terminal service software installed can access the clinical data on remote server(s).  Data on these EMR products are not to be included in this report.  There exists the “Hybrid” EMR (a mix of both remotely-hosted and client/server EMR models) which is not to be included in this report.
• Client/Server EMR – EMR data is stored on a server(s) that is housed and located within the walls of the physician practice.  System maintenance and updates are conducted in the office.  Data on these EMR products are not to be included in this report.

A very thought-provoking post this morning by John.
http://www.emrandhipaa.com/emr-and-hipaa/2012/07/05/what-saas-ehr-users-can-learn-from-the-megaupload-takedown/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+EmrAndHipaa+%28EMR+and+HIPAA%29

Everything is relevant, including all the concerns.

Isn’t everything pegged against cost? One reason why we choose web-based EHR is because we don’t want the headaches. Why do top Fortune 50 companies choose Salesforce.com?

Data backup is a kind of ‘insurance’ policy that can be bought. I don’t see a reason why not. The question is, how much are you willing to pay?

I do agree that SaaS EHR companies should offer that ‘insurance’ of data backup and allow customers to decide if they want to buy.

An article posted on Physicians Practice talks about increasing the likelihood of a Good hire.
http://www.physicianspractice.com/blog/content/article/1462168/2087151

In addition to all the points mentioned,

• Don’t succumb to time pressure
• Clearly define requirements and expectation
• Give candidates a picture of your requirements and expectations

I would add one more thing – the employee must be willing and able to work with EMR systems. If you have one already, test them for their technology savvy, and if you are planning to get one, make sure they are not going to be a drag. You need a 100% buy-in from all employees to implement EMR and get the most out of these systems. With help from employees, it can really turn your practice around.

I just read a paper written by R. Hillestead et.al in 2005  and I was intrigued by the topic and its relevance today.
http://content.healthaffairs.org/content/24/5/1103.long

I’m not focusing on the title, although it has relevance – ‘Electronic Medical Record (EMR)’ versus ‘Electronic Health Record (EHR)’. The context is still very relevant today.

I do believe Healthcare IT can significantly transform the landscape, but we are not there yet. What has started is the ‘foundation’. Adoption of EMR is the broad groundwork; primarily because the first goal is to enable change. Change in Provider’s mindsets about the use of technology.

There is one reason why I believe in ‘Web-based EMR‘ or ‘Cloud EMR‘ or ‘SaaS EMR’. That reason has to do with the ultimate goal of transforming healthcare costs. Web-based EMR makes the sharing of data and therefore reducing costs possible.

I leave it to you to decide if we’ve made progress.

A new study published in Health Affairs finds that while 91 percent of physicians were eligible for Medicare or Medicare Meaningful Use programs, only 11 percent of those intending to apply are in a position to take advantage of this incentive. This is irrespective of what kind of EHR they use; web-based EMR or client-server EMR.
Click here to see the study.

Drilling down a bit more, the study says only 11 percent of those intending to apply had enough EHR capabilities to support up to two-thirds of Medicare’s Stage 1 core objectives. This means their EMR system probably does not have the necessary capabilities. Normally Complete EHR systems that are certified should be preferred. If they are web-based EMR systems, or Cloud EMR or SaaS EMR, they have a better chance of having these capabilities, because it is not up to the physician to make sure their EMR system is up to date. The web-based EMR system is automatically updated with the latest capabilities to ensure compliance.

Continue reading “Many Doctors not able to qualify for Meaningful Use”

Patients are one of the most underused resources in healthcare.
The patient knows their health more than anyone else. The increase in the use of EMR Systems, particularly web-based EMR Software, which is also called Cloud EMR or SaaS EMR, allows physicians to interact with patients online.

Patients can access their own records that are made available by physicians by using the Patient Portal portion of their web-based EMR system. This allows physicians to take advantage of patient knowledge to improve the quality of information in their web-based EMR system.

What is Web-Based EMR?

In the past few years, the prevalence of web-based EMR and cloud-based applications in healthcare has expanded rapidly. But, what is cloud computing and how does it apply to the medical practice and EHRs? For practical purposes, web-based EMR describes a situation in which the software you are using and applicable data are accessed via the Internet. Programs or data are not on your computer or local network in your office. Most EHR vendors now offer Software as a Service (SaaS) or Application Service Provider (ASP) versions of their EHR systems as an alternative to more traditional software solutions.

These solutions are gaining traction among practices as they reduce the upfront costs and require less to no technical support than their client-server counterparts. If you are considering or currently use a web-based EMR solution, consider the following:

• You will only be able to access the system and your data when connected to the Internet. While high-speed Internet is now more reliable than ever before, I suggest having a backup.
• Updates and upgrades are managed by your web-based EMR vendor according to a system upgrade schedule. This can be a good and bad thing, considering that while you don’t have to worry about updates, at the same time, you will not be able to uninstall features or upgrades you don’t like from your web-based EMR.
• Understand your Web-based EMR vendor’s terms of use and data ownership policies. Ask who owns the data and if and how you have access to it.
• Some vendors sell patient de-identified data, especially the Free ones. Are you comfortable with it?
• If you switch vendors, will the old vendor give you the data? If so, is it in the contract? What format? Will there be an extra charge? Is this charge established upfront?

Overall, I believe that web-based EMR solutions offer a very effective option for many practices, especially small medical practices. However, ensure that you do your homework.

We’ve been reading about ACO and there’s a debate going on about its pros and cons related to its benefits. There was a great post this morning I want you all to read.
http://www.emrandhipaa.com/emr-and-hipaa/2012/02/29/aco-model-risks-and-rewards/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+EmrAndHipaa+%28EMR+and+HIPAA%29

Irrespective of the outcome all providers, physicians, doctors, and caretakers need to be read.

One way to be ready is to adopt technology that can ensure two things:

1. Good Patient Care
2. Reimbursement for that care

For the second part, current systems – EMR (Electronic Medical Record systems) and PM (Practice Management systems) seem to be quite adequate. I’m not so sure about their readiness related to the ACO model of reimbursement, i.e. incorporating risks and benefits related to quality of care provided to a community. As the article says, bad care = less reimbursement, good care = more reimbursement.

How does one measure good care vs. bad care? These models will emerge and change over time.

It is clear that the pace of change is rapid. Technology needs to adapt.

I think only Web-based EMR systems will be able to keep pace with the rapid change. The reason is that web-based EMR systems can make quick changes, and the benefit of these changes will be available to providers instantly. One more reason for adopting web-based EMR systems.

Here’s a great article about Web-based EMR, SaaS EMR, or Cloud EMR – whatever you want to call it.
http://www.kevinmd.com/blog/2011/05/pros-cons-cloud-based-web-based-emr-systems.html

Dr. Polack has nicely tried to explain the difference between client-server EMR and web-based EMR.

It was interesting from a large vendor’s perspective to see that everyone is moving in the direction of adopting web-based EMR. I quote – Tera Roy, Specialty Director of ophthalmology at NextGen Healthcare, says “With or without stimulus dollars, healthcare is headed to the cloud. Our newest releases are all based in the cloud, like NextGen Mobile, Patient Portal, and Health Information Exchange, and we plan to keep introducing more of these Web-driven alternatives. They will play a critical role in breaking down barriers for small practices to achieve the full benefits of automation.”

Dr. Polack further asks, If cloud-based systems are cheaper to set up, why doesn’t everyone go this route? Mr. Messier points out that, similar to deciding between leasing or purchasing a car, it helps to crunch the numbers. For many practices that commit to a long-term relationship with their EMR system, there is usually a better return on their investment if they buy the EMR system rather than pay a monthly access fee, with a typical break-even time of about five years. Actually, there is another issue to consider when evaluating web-based EMR systems. There is the issue of inertia and fear that web-based EMR may have security issues. We forget that Banks and Sales data of major corporations are all web-based.

The concept of web-based EMR is not unlike that of utilities. We do not generate our own utilities. We ‘tap’ into the ‘cloud’ for electricity, telephone, and so on. Ultimately all technology and software will move towards the web or cloud.