Author: Chandresh Shah

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.