Is a Web-Based EMR in Your Future?

Topics: Optimizing for Electronic Medical Records Transition

A close look at Web-based EMR use reveals many advantages with few downsides for many healthcare providers, especially small and medium practices and organizations. Vendors were initially met with skepticism about security and other compliance issues, but such concerns are being dispelled as use grows and such services prove to be up to the challenge. A closer look reveals compelling motives: lower initial costs; anytime-anywhere access; built-in compliance; and easier maintenance.

FAST FACT: Web-based EMR systems are the fastest growing segment of the market for a number of good reasons. As the technology matures and security issues are quelled, small practices and others are eyeing hosted systems as a reasonable — and affordable — choice.

The appeal of Web-based (also called cloud-based) solutions has made the technology the fastest growing segment in the electronic medical records (EMR) market, according to a new report from New York-based market research publisher Kalorama Information.The 2011 sales growth rate was at 22 percent. Most of those sales went to private, office-based physicians. Even with subsidies and incentives, such practices bear the burden of EMR implementation without much in the way of benefit — besides assured payment for Medicare and Medicaid services.

Rather than requiring outright purchase, Web-based EMR licensing is usually based on rental or access fees. Initial implementation costs are significantly lower, though at current prices, some systems might be more expensive over the long haul. However, given the trend toward Web-based solutions and the highly competitive nature of all IT segments, Web-based EMR costs are likely to remain flat or decline as users increase.

The attraction of Web-based EMR systems is undeniable.

Choices, Choices

Not every Web-based EMR technology is alike, but given the high rate of physician dissatisfaction with existing EMRs, any organization — especially small and medium practices — considering a new system would be well advised to include hosted solutions in their review and selection process.

To determine if a system is right for your organization, it helps to begin with the understanding that Web-based EMRs are a category, not a product, platform or standardized technology. While offered in many versions, all share one characteristic: they are all accessed using Internet technologies. That's just the starting point, though, since too many commonly used terms are often vague and confusing.

Clouds and PaaS Appeal

Vendors muddle the picture by offering Web-based software and services under a variety of names like "cloud-based" or "hosted" applications, catch-all tags with a confusing variety of meanings and an equal number of implementations or configurations. Offerings under either heading may be also be called SaaS (Software as a Service), ASPs (Application Service Providers) or PaaS (Platform as a Service).

An SaaS or ASP vendor may offer only one component of a total system. A PaaS, on the other hand, is more likely to provide most or all required technologies, including software for deploying Web applications and an infrastructure (hardware) on which to run that software. Regardless of descriptive terminology, a Web-based EMR uses software and data hosted in an offsite (to the healthcare organization) application and data center.

Hosted software appeals to users for fundamental reasons. The Web-based EMR model costs less to implement and maintain because the service is based on multitenancy, the practice of spreading applications and data across a large number of servers shared by multiple subscribing organizations. Not only is the cost of implementation far less expensive, the vendor handles everything IT-related but the operation for you. There are no servers to buy, install and configure. Worries like connectivity, hardware, software, monitoring, maintenance, backup, restore, failover and scaling all fall under somebody else's care.

Web-based EMRs also provide anytime-anywhere access — assuming available Internet connectivity. In a mobile-device, social-media driven world, end users expect the same immediate access to the information and communications services they have outside their professional lives. Advances in mHealth using wireless diagnostic devices also increases the need for location-independent access. The complexity involved with typical on-premise EMR installations puts that kind of hardware-agnostic interoperability beyond the reach of all but the largest or well-funded organizations.

Potential considerations in selecting a Web-based EMR might include supported programming languages, integration with other applications, including third-party applications and services, database support, and customizability. New EMR users who want to use a Web-based EMR service must be certain they can integrate their new platform with their existing paper records storage and backup method, especially if it includes dual-path archiving — concurrent paper and electronic backup of identical data.

Contrary to popular opinion, cloud-based data is actually more secure than locally stored information. Fear-mongers like to warn of risks associated with confidential information in the hands of potentially inattentive vendors. No cloud-based healthcare IT vendor could survive without armor-plating patient data and its access. In fact, most current Web-based EMR vendors are HIPAA compliant and must meet other regulatory requirements. Better hosting services offer integrated data backup, essential for a complete patient records system.

A Web-based EMR system offers distinct security advantages. Remote data dramatically reduces liability for healthcare providers by removing risks intrinsic with local storage. Policies can be applied and enforced from a single location. The proliferation of intelligent mobile devices like smartphones and tablet computers makes this vital. An unsecured iPad can't access restricted data if the server doesn't recognize it.

Looking Ahead

The combination of accelerating EMR adoption and changing compliance requirements and standards suggests the potential for confusion about EMR technologies will remain constant for the foreseeable future. A Web-based EMR from a reliable vendor can help providers keep out of the fray yet in compliance. Newly minted Accountable Care Organizations (ACOs), loosely coupled providers whose compensation is based more on patient outcomes than fees for services, will increase in number. Traditional EMR systems may not provide the best fit for them.

Finally, the pressure for EMR adoption will only increase for those healthcare providers not already engaged in their use. Web-based EMR systems can be implemented in spans measured in weeks rather than months or years. Vendors will consequently feel pressures based on demand for complete, turnkey systems. Any healthcare organization considering a new electronic patient record system would be well advised to investigate Web-based EMRs in detail.

Do you have more questions about your current Health Information and Management strategy? Read additional Knowledge Center stories on this subject, or contact Iron Mountain’s consulting services team. You’ll be connected with a knowledgeable product and services specialist who can address your information management challenges.


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