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| Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. |
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| ADA for exchanging data processing standards to the dental services of the health care industry... |
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| Barack Obama: In his Plan for a Healthy America, Obama calls for lowering costs through investment in electronic health information technology systems, acknowledging... |
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Which is better Web based EMR
system or Client /server EMR system?
Unfortunately there is no specific answer. Both
types have their advantages and disadvantages.
Your decision will likely depend on a number of
factors, like size of practice, number of patients,
your initial budget and the type of service you
wish to provide. Let us explore the advantages
and disadvantages associated with each model.
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 |
- Should be accessible from any computer connected
to the web.
- Should provide native web functionality,
meaning connection through Internet Explorer
without having to install remote access software
such as PCAnywhere etc.
- Should be a secure connection to meet HIPAA
requirements
- Should be designed for use on the web, so
the full functionality is available on the
web
- 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: |
- Violates rules 1, 2 & 4 as defined above.
- Your office computer must have the required
software (PC Anywhere for example).
- 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
doctor’s 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.
- 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.
- You will need to pay additional licensing
costs for this to work.
- 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.
|
 |
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. |
| |
- Will almost certainly violate rule 5 as
listed above.
- 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?
- 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?
- 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?
|
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? |
| |
- 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 practices. Think of
this as insurance that you have a web package
where you OWN AND POSSESS your data.
- You can securely access your software and
data from any computer.
- 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.
The Web based system is a remotely hosted software
system accessed via an Internet web browser, similar
to the model used in online banking. This remotely
hosted system is accessed by paying a rental or
service fee. The server is secure and HIPAA compliant
and is not located in your office. A professional
IT company manages all technical aspects of the
server, and you pay a monthly access fee (or per
occurrence fee) for the services of this IT Company. |
|
| Web-Based
Software Advantage |
- No server hardware of software to maintain;
- No software to install or upgrade on your
PC;
- The ease-of-use of a “web page” user interface;
and,
- Subscription or transactional pricing, rather
than up-front licensing.
|
The
biggest advantage to using WEB BASED EMR software
is that it is entirely Web-based. This means that
you can work anywhere there's an Internet connection,
so if you're at home or on the road, you can still
access any information that you need. If your
practice operates in multiple locations, you can
stay connected and updated with all of your offices.
HIPAA Requirement
Security
The Health Insurance Portability
and Accountability Act (HIPAA) was first
conceived in 1996. Its purpose was to regulate
the privacy and security of personal health information
(PHI). Since its official acceptance in August
2003, medical practices across the nation have
been working to make sure that the systems they
use for medical record storage and billing are
compliant to HIPAA.
The
Client / Server model
Client/Server models allow for quicker response
times in the application as the data from the
server to the client is transmitted much faster
(usually 100 Mbits/second). The newer client/server
products developed in Java and Microsoft .Net
are capable of offering the “best of both worlds”
as they have the speed of a local system plus
the accessibility from a remote location. |
| |
| Client
- Server Based EMR - a case study |
The
Task
To develop a truly integrated Electronic medical
records system with Practice Management and PDA
/ Tablet PC functionality. The scope of the proposed
system included |
- Manage daily schedule and view patients
waiting
- Pull forward relevant data from previous
visit
- Capture chief complaint, history of present
illness for physician’s access
- Instantly share chart information throughout
the practice
- Receive medication interaction and allergy
alerts
- Track charts and organize charts to review
- Prescription Management
|
| The
Advantages |
- The information is stored electronically
so paper work is completely made obsolete.
- The entire healthcare system within a practice
is automatized.
- A single server running on a system can
serve remote client/clients.
- Huge paper work is reduced /eliminated.
- The manual errors is reduced /eliminated.
- The manual errors is reduced /eliminated.
- Minimum effort and time required with ease
of usage.
- Appointment Scheduler: The appointment scheduler
which takes charge of your appointment tracking,
fixing and blocking.
- Insurance Eligibility Check: to take care
of the vital process of checking patient’s
insurance eligibility often results in billing
errors, insurance coverage concerns and delays.
- Specialty EMR: The Electronic Medical Record software (EMR)
aimed at automating and simplifying the patient
record documentation, storage and retrieval
process.
- Chief Complain (CC) Reason
for Consultation (RFC): for recording
a patient’s disease symptoms.
- History of Present Illness
(HPI): The HPI is the history of the
patient’s chief complaint.
- Medication Reviewer: is
a complete list of all medications that the
patient is on or had been taking at some point
- Allergy List: This
is a list of all the patient’s allergies.
- Past Medical History,
Past Surgical History, Screening (PMSS): This
is a list of all the past surgery and medical
issues that the patient has been treated for.
- Social History: This is a list of all social or habits the
patient has.
- Family History: The
complete family history is captured.
- Immunization: A
complete list of all immunizations that the
patient has had.
- Review of System (ROS): The ROS is a complete review of body
systems with the patient, usually done by
the nurse.
- Document Management: The Document Manager
allows the medical institution to store vital
patient documents such as
- X-Ray’s, Paper Reports, and Lab Reports
etc.
- Prescription Writer to streamline the entire
prescription writing process making it simple,
fast and effective.
- Lab Order Integration: the Lab Order Entry Interface synchronizes
lab results with patient records.
- Medical Transcription: A PDA-compliant medical
transcription system that manages the transcription
cycle from the beginning to end by integrating
voice recording, digital scripting, delivery
of voice files to the medical transcriptionist
and final transcript receipt.
- Patient Reminder works for the benefit of
the doctor as well as the patient as an interactive
voice technology system, which automatically
calls and gives the patient appointment specific
information.
- Medical Calculators: A
diverse range of Medical Calculators that
allows the medical practitioner to make rapid,
accurate calculations within seconds, with
the focus on “evidence based medicine”.
|
| Technologies
& Standards |
| The
proposed system was developed using: |
- Dot net framework version 2.0 for development
- SQL Server 2005 for database
- Web services for integrations
- Unparallel emphasis on Security and Confidentiality
of proprietary information
- Significant reduction in costs of Infrastructure,
recruitment and Project management.
- Hassle Free management of day-to-day operations
of the Center.
- Easy access to skilled resources with the
option of ramping up resource requirements
whenever needed.
- Functional and Design Specifications to
make sure functional and design issues are
understood before project implementation starts.
- Prototyping to get early customer feedback
and demonstrate important project features
- Regular status reports and meetings so you
always have up-to-date information on project
status
- Project change control mechanisms that allow
the project to respond to the real world without
getting out of control
- Source code and design change control systems
to ensure that project modifications, revisions
and enhancements are tracked.
- Test plans and automated test suites wherever
applicable to prove the final product deliverable
does what it was intended to do
- Superior 24/7x5 Support mechanisms to ensure
timely resolution to issues rose.
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