Electronic Health Records


EHR best practices: Choosing cloud or web-based EHR

By Kyle Murphy, PhD

- Nowadays, few resist putting a portion of their data in cloud and accessing their files through a web-based interface. Google Drive is the latest to the scene, but the number of cloud storage services continues to grow: Amazon Cloud Drive, Microsoft SkyDrive, Apple iCloud, Dropbox, Box — the list keeps going and going.

Coupled with the number of cloud storage providers is the increased security made possible by modern browsers harnessing the power of encryption to protect your information over the wire. Welcome the https:// which indicates that a site is using a secure connection, such as transport layer security (TLS), secure sockets layer (SSL). You’ve all seen them in your online banking, and it’s the reason why you always have to log in each time you sign on.

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In short, cloud and web-based services are so ubiquitous as to become the norm. In the third installment of our EHR Best Practices Series, we take a look at what the cloud and the web can do for the adoption of an electronic health record (EHR) system. 

Save money

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A general survey of healthcare providers about the top concern they have when choosing an EHR is the amount of time and resources they will need to come up with to go live with a solution. As Patient Management Officer for Hello Health Steven Ferguson explains, there’s not only the cost of the EHR but loss of revenue from the time spent implementing the system:

The problem is cost — even though it’s not that high, it’s high enough — and then the other aspect is the amount of help that small practices really need in getting where they need to be with the technology. They can’t take efficiency hits to their workload, which is the way new technology has been introduced.

The cost factor is especially high for small practices struggling to afford either expensive monthly fees for the larger online services or the hefty upfront cost for a client-hosted enterprise system.

Two companies in the EHR web-based space have developed solutions that are not only technological but also financial. Practice Fusion, whose name and product has been bandied about for the last several months, offers a free browser-based EHR that connects ambulatory settings with labs and pharmacies by using highly-target ads and marketing which providers can pay to remove (though many choose not to).

Hello Health has taken a radical approach to answering this question, which may be new to healthcare but has been part of the app economy over the past few years:

The business model is that instead of asking a practice to pay $500 per month, for example, we provide everything to them for free. There’s absolutely no cost to the practice. . . . Patients sign up for $36 a year (or $3 a month) to have access to self-scheduling, a personal health record, the ability to see lab results, request prescription renewals, and those sorts of thing.

Save time

The return on investment (ROI) is much improved, but what about the time spent implementing the system. Depending on your goal, the amount of time can vary. Practice Fusion and Hello Health both average two weeks to get a practice up and running. “There’s very little downtime at all because we do put people right on site to help in whatever way we can,” observes Ferguson.

Because of the rejiggered business models, providers have access to the developer’s technicians to configure their network and machines to connect:

In order to get the practice running efficiently on the software, we put someone in the practice to help them with that — we provide training onsite as well as virtual training. And then we help the front-office people educate the patients as they come in to what the practice is now doing as far as patient communications and that the patients now have this portal they can go to.

But what if you’re thinking meaningful use? Texas-based eCareSoft has recognized that adopting an EHR is one thing; it’s another to use it to demonstrate meaningful use.  According to Chief Strategy Office & Founder Soft Jorge Camargo, what stands out chief among the capabilities of the web and 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. “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. When you factor in the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program for Medicare and $44,000 in incentives, it’s an impressive timeline.

Save piece of mind

At the same time that you move your EHR on to the web or into the cloud, you’ve also offloaded the responsibilities of maintaining those systems from an information technology (IT) standpoint.

First, subscription models for these vendors make them responsible for maintaining the systems and updating their platforms. For Ferguson, it leads to a partnership rather than a business agreement: “We come in with a partner approach with the practices. It’s not a vendor relationship where they sign on the dotted line, and then we say, ‘Good luck.’ We partner with them to help with the technology, workflow, implementation, training, and so on.” There are no servers to monitor, no patches or installation packages to deploy, and no hiring of dedicated IT staff.

Secondly, liability is greatly diminished when local storage is taken out of the equation. 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, it some cases you can become even more secure than when you store the EHR in your facility, because you have to download information, you end up having information in laptops,” says Camargo.

Lastly, a cloud or web-based solution prepares providers for the future. This could mean meaningful use requirements like interoperability and health information exchange (HIE). “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,” continues Camargo, “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.” Or it could mean scaling up your practice to include new features like mobile or tablet applications, functionalities that will be dealt with by the developer.

In our next installment, we’ll tackle the enterprise system. Stay tuned.

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