Electronic health record (EHR) vendors and health IT industry pundits will tell you that there are nuanced technical distinctions among application service provider (ASP) EHR, electronic health records software (Software as a Service (SaaS) EHR), and cloud EHR systems.
Like a patient pain-management regimen that's well managed, an electronic health records software (SaaS EHR) system can save a lot of agony and discomfort -- especially for older physicians who weren't planning to stick around for much more than a few years past 2015, after which the Centers for Medicare & Medicaid Services begins to penalize health care providers who haven't installed certified EHR systems.
Dr. Yatin Shah, part of a seven-physician practice in Joliet, Ill., moved from paper to a self-hosted EHR system in 2004. That was far better than paper, but "far from complete," he said. In 2006 he changed to a SaaS system hosted by a company that has since become ClearPractice LLC. As of now, much of the practice, including EHR, messaging, billing and prescribing, is online.
"Pretty much everything in my workflow is paperless," Shah said.
What electronic health records software offers to providers
For small practices putting together a meaningful use compliance program, an electronic health records software system offers many benefits over self-hosted, out-of-the-box software, Shah said.
• Access. If physicians use an online electronic health records software system that supports smartphones, they can check updates to patients' electronic medical records or receive messages whether they are up the street at their child's soccer game or on vacation halfway around the world. This also is achievable with self-hosted EHR systems, but the latter require some support, as well as the creation of mobile VPN tunnels from properly configured PCs, a process for which physicians will likely have to hire consultants.
• Add-ons. Some vendors, ClearPractice included, offer complementary tools for such office functions as e-prescribing, practice management and billing. With these, the transition from paper to electronic workflows is simpler. Shah's implementation of EHR and billing is set up to submit claims to insurers automatically (in most cases) when physicians finish a patient chart.
• Cost. Little investment is needed for EHR support in the physician's office. The vendor takes care of such issues as integrating with the local hospital's EHR system, paper records and lab results. Shah's staff does scan some paper records from the community hospital when patients get admitted, but he said it is a daily chore with which they can keep up.
• Community. SaaS vendors create a community of users who can share best practices and specific tips and tricks for using the software. Practitioners using self-hosted, out-of-the-box software must either figure it out on their own or find a user group to join. Users also share suggestions and details with the developer, who improves the software and keeps everyone on the same page.
• Updates. The vendor is the one who deals with upgrades and releases, often installing minor releases and bug fixes every few weeks. This eliminates the cost, training and version control issues involved with typical out-of-the-box software and its major upgrades every few years. The vendor also covers the cost of upgrading, expanding and replacing the EHR system hardware, including the hardware for storing imaging data.
• Cash. Many SaaS vendors are offering meaningful use incentive guarantees, which offset their subscription fees for a few months or in some cases, many more. "It certainly lowers the cost threshold for the physician to get into the system," said Gary Ferguson, ClearPractice CEO.
While the electronic health records software model requires some IT resources at his office, overall IT costs have been minimized, Shah said. That helps stretch the incentive payments even further. "We do have a server, but we don't have a full-time IT person because we don't have the financial resources and I don't think there's a need for that," he said. "We do have a person we use whenever there's an issue. We end up calling him once every two or three months for something minor."
Nipping Internet connectivity issues in the bud
One feature that may make some providers think twice about an SaaS EHR system is that constant Internet connectivity is needed, both for entering new data into the system and for viewing previously recorded patient data.
Pretty much everything in my workflow is paperless.
Dr. Yatin Shah, internist
To overcome outage issues, Shah contracted with a service provider for a T1 line, The result has been fewer outages, most of which last minutes if not seconds, he said. Only once in the last four years has Internet connectivity been down for a few hours at a time.
"There is no guarantee that you will have service every single minute of every single day," Shah said. For that reason, he suggested that doctors not take the choice of a carrier lightly. (In his case, the provider is AT&T.) "The chances of something going wrong are small, [but] being with a name-brand company would help you get the system up and running sooner than a smaller company could."
Let us know what you think about the story; email Don Fluckinger, Features Writer.
This was first published in May 2010