Electronic Health Records


eCareSoft gets mobile with Nimbo

By Kyle Murphy, PhD

- On April 17, Texas-based eCareSoft Inc.  announced the release of its Android™ app, an ONC-ATCB Certified Complete Ambulatory Electronic Health Record (EHR) called eCS Nimbo™. Nimbo offers physicians and nurses in ambulatory settings mobile software that features streamlined practiced management, EHR, and electronic prescribing (eRx).

As Chief Strategy Office & Founder Jorge Luis Camargo explains, primary care providers in outpatient settings need technology that is as mobile as they are:

In these very small hospitals, the nurses have to go and write everything down on paper when they’re with a patient and then go back to the computer and type everything in.  That’s why it’s so critical for a tablet application they can take with them to the room.

Improving patient care requires that caregivers are empowered at the point of care to make clinical decisions on the fly. “We’re shooting for an application,” continues Camargo, “mimicking what they’re doing day to day.” For the company, Nimbo represents a commitment to working with providers to ensure that their focus stays on the patient, rather than on an EHR technology that leads to disruptions and distractions. “We’re in the market of making tools that make their lives easier.”

The native Android app integrates seamlessly with the company’s previous EHR solution for inpatient hospitals, Cirrus™. Both products embrace the enhanced mobility and connectivity of the cloud, recognizing that the needs of primary care providers are constantly changing. “Every time we do a visit to one of the hospitals using Cirrus already, it becomes more apparent how critical it is for us to move faster providing mobile solutions,” says Camargo.

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Early bird gets the worm


Most often, the launch of an Android app is accompanied by an iOS app for Apple devices, so inquiring minds must be wondering when the latter will appear in the market. Camargo cites the comfort of his developers with Java as what led to the release of Nimbo™ for Android: “We went first with the Android app because it was the choice of the developers. We are a technology-driven company, and it was the platform in which we assessed we could move faster.”

Good news is that an Apple app is on the way.  Apple users can expect an iOS app for their devices in 2–3 months. “We developed in Java and the developers felt very comfortable in that environment, but we’re still working in the iOS for Apple devices,” says Camargo.

And eCareSoft is focused on going mobile with Cirrus as well. Given the complexity of processes within inpatient settings, development of Cirrus mobile involves a different kind of user interface that is equal to the complexity of hospital services.

There are a couple of things with regulation and meaningful use that make interfaces different in Cirrus and in Nimbo. But when we started with the project of going mobile, we thought that Nimbo was the first place where we could make a bigger impact right away. But we’re definitely working on also creating the Android application and iOS application for nurses and physicians for Cirrus in the hospital.

Taking to the cloud

When considering its approach to EHR software design, eCareSoft decided to harness the potential of the cloud to offer providers innovative, forward-thinking solutions for improving patient care. What stands out chief among the capabilities of the cloud is the ability to implement a system quickly:  “The standard for EHR implementation is that it needs a lot of training and it needs a lot of consulting.” For eCareSoft, the cloud could get them in and out the door in less than four months. “For our first six customers here in the US, we were able to take them from being six hospitals that didn’t have any type of EHR system to being able to apply for the meaningful use grants in less than 120 days,” asserts Camargo.

But this doesn’t mean that providers lack support beyond this four-month implementation period. The cloud enables Camargo and company to refine their EHR solutions based on feedback from their users as well as future requirements from the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). With its recent acquisition of Expert Sistemas Computationales of Mexico, a CMMI-Dev Level 3 Software Factory, eCareSoft has readied itself for coming innovation:

We’re improving our solution almost day to day, hearing the customers, hearing what they would like changed, what would they prefer. We do constant updates to our system to adapt to the different requirements from the market. And one of those is Meaningful Use Stage 2, so when the time comes when we need to upgrade our clients, it will be very seamless.

In next few years, innovation centers on the challenge of health information exchange (HIE), something that the cloud is intrinsically able to deliver. eCareSoft’s browser-based systems give users access to information on the go where they need. “One of the benefits that we see of being cloud, all of the data is centralized in a very secure way. That makes it easier to share information and to be interoperable in a very easy way,” says Camargo.

The company’s platform provides a foundation on which communities of exchange can be built.  “What we’re trying to do is build communities or our own HIEs. Our idea is that once we implement our solution in hospitals and hospitals start adopting, then the physicians and the community that work around the hospital can start adopting Nimbo.”

Security in the cloud

Camargo and his team are extremely cognizant of nationwide concerns about the safety and integrity of EHRs in the cloud. eCareSoft looks to the widespread use of online and mobile banking as a sign that users trust in and rely on cloud-based systems to manage prized information, such as finances. “We know it’s a very delicate subject, everything related to health care. And we see ourselves as a bank, in a way. Now everyone feels very comfortable doing banking online.”

To ensure that EHR systems are secure and that the privacy of EHRs remains intact, the company providers layers of protection. On the digital side, Camargo stresses the importance of encryption: “We have one layer for SSL certificate that’s at the browser layer; we also have encryption in our servers where everything that is coming in and out of our servers is also encrypted. And then how we save our information in the database, then again it’s encrypted.”

Allowing users to access information as they need rather than store it locally makes the cloud doubly secure. “It’s actually one of the interesting points about cloud: In some cases, you can become even more secure than when you store the EHR in your facility, because you have to download information and you end up having information in laptops,” says Camargo. Lost or stolen devices do not lead to lost information; storing data in offsite locations means there are no server rooms to be compromised.

Onwards and upwards

The main challenge facing eCareSoft is managing its growth. eCareSoft is currently partnering with providers in Mexico and South America and already has software available in Spanish and  Italian. However, Camargo is staying focused on doing what the company does best: “Our biggest challenge right now is to stay focused and keep on doing what we’ve been doing, so that we can continue shipping very valuable products to the market.”

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