What is Web Based EMR?

Web based EMR’s or Web based Electronic Medical Records systems, are quite the rage these days.  But there seems to be a good amount of confusion as to what exactly constitutes a ‘web based’ EMR and what exactly it should do and not do.  Let us start with a basic definition of a web based electronic medical records system and then look at the various flavors available.

Definition:

1. Should be accessible from any computer connected to the web.
2. Should provide native web functionality, meaning connection through Internet Explorer without having to install remote access software such as PCAnywhere etc.
3. Should be a secure connection to meet HIPAA requirements
4. Should be designed for use on the web, so the full functionality is available on the web
5. Should be reliably available during your workday

That sounds simple enough, but not so fast!  There are actually 3 flavors that you will see that vendors can claim are ‘web based’ but is it really?  Let’s look at them one by one.

Web Access through remote connection software

This seems simple enough.  If you have software similar to Citrix or PCAnywhere installed on your office computer, and your office computer is running, and if you have the same software installed on your local machine, THEN, you can connect to your office computer to run the EMR.  By this method pretty much ANY software can claim to be ‘web based’.  But the problems with this method are numerous.  For a successful session to occur, many things have to go just right:

1. Violates rules 1, 2 & 4 as defined above.
2. Your office computer must have the required software (PCAnywhere for example).
3. Your local computer must ALSO have the same software installed.  This is NOT so easy if you are trying to access your office computer from, say, the computer in the hospital’s doctors lounge.  You most certainly won’t have admin privileges to install any software on that machine, so tough luck, you can’t connect from there.
4. You are connecting from the local computer to your office desktop, which in turn may be connecting to the server.  You are looking at a lot of moving parts here to work together.  Any of these not working just right = no access to your data.
5. You will need to pay additional licensing costs for this to work.
6. You may need to open multiple ports on your firewall as each computer in your office can most likely handle only one connection, so you are looking at one to one connections.  This is a security concern.
7. In almost all cases, you are buying the software outright, paying everything upfront.  This translates to a pretty expensive option.

This solution is most often proposed by vendors with ‘Client-Server’ model software.  But you must be aware of the numerous pitfalls you are likely to encounter in this approach.  This is a sham and should not even be really classified as ‘web based EMR’.  This is the approach with the highest risk of failure.

ASP or Hosted Software

In the early stages of the internet software game, and to some extent today, this is true ‘web based’software.  It absolutely is web based software.  Your program is hosted elsewhere, say you are in Texas, the data could be in Maine, and you access everything through the web.   You still need to setup your computers and local networking and you still need internet access from  where ever you connect from, but if you have this, then you can access your data and the program via the web.  Fine and dandy it seems.  So what’s the downside?

1. Will almost certainly violate rule 5 as listed above.
2. You are relying on your web connection 100% of the time.  Say you have an office full of patients at 11:00 AM and your internet connection just went down.  Yikes!  Think that is far fetched?  How many times have you had trouble checking your email in the last year?
3. You don’t really possess your data.  Sure, the hosting company says you own it in the contract, but if you ever have to leave them, how much will they charge to give you ‘your’ data?
4. Even more scarily – let’s say there is a lawsuit – who gets the subpoena for your data?  You or the hosting company?  And if they do, what will they do about it?  Is this even covered in the contract?
5. What happens if your software vendor/hosting company goes out of business one fine day?  How do you see patients?

There are many more issues around this approach, but just the core issues listed above should give you pause when considering this option.

Locally hosted or Hybrid option EMR

This is the newest option available in the market.  Here you are looking at a web server sitting in your office with the software and data on it.  So you have the software, and more importantly, the data in your possession.  Within the office all the connections are straight to your in-office server, so nothing goes over the web.  When outside the office,  you can connect via internet explorer from any computer with an internet connection, securely and directly to your office server.  So what gives?

1. You do have to buy your own server.  In all the options above, you still have to buy your computers and setup your network, so the only additional cost is the server.  This runs about $2500 for a 1 or 2 doc practice.  Think of this as insurance that  you have a web package where you OWN AND POSSESS your data.
2. You can securely access your software and data from any computer.
3. Even if the office internet connection goes down and 11:00 AM, with an office full of patients, you won’t even notice as your software is running locally!

This is by far the best option available to medical practices today, when considering web based electronic medical records systems. 

That is precisely why, DoctorsPartner EMR, even though originally envisioned as a hosted EMR, changed to this model of delivery.  This provides you every facet of the web based EMR in addition to the peace of mind of having everything locally, in your office.

Feel free to call us and find out what else we have done to meet the high expectations of our customers.

Naveen V.

http://www.emr-electronicmedicalrecords.com/

DoctorsPartner EMR and PM