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After EHR system implementation, maintenance, service questions remain

Once an EHR system is installed, attention turns to maintenance, service and support. Using an IT service provider for such tasks may be the best bet for small practices.

As health care providers adopt systems to handle electronic health records (EHR), data interchange and practice management, they need to decide who will manage and maintain those systems.

Some midsized and larger hospitals with IT staffs could decide to manage and maintain their EHR system in-house, but smaller hospitals, clinics and doctors' offices may prefer to contract with an IT services firm to do the work. Hiring a services firm -- often referred to as a value-added reseller or system integrator -- could mean the difference between the success or failure of an EHR project, especially for smaller clinics and physicians' practices without an IT staff.

For Alabama Cardiovascular Group PC in Birmingham, the choice was clear. The organization partnered with Birmingham-based IT service provider ETG Inc. when it decided to implement an EHR system. "We never considered having it in-house, due to the expense," said Doranda Coker, administrator at Alabama Cardiovascular. "The importance of ensuring that we have a system that is up and running at all times -- or at least with very minimal downtime -- and the cost related to purchasing and maintaining staff and equipment, played a role in our decision."

Alabama Cardiovascular's experience is typical among medical organizations. Once they decide to adopt EHR technology, they face questions regarding cost and post-implementation maintenance and management. Protecting patient confidentiality and complying with strict Health Insurance Portability and Accountability Act regulations for privacy and storage are other issues.

How much to maintain an EHR system?

Cost is a big issue. The annual cost of owning and managing enterprise software applications is as much as four times the price of the initial purchase, Stamford, Conn.-based market research firm Gartner Inc. estimates. As a result, companies spend more than 75% of their total IT budgets on maintaining and running their existing systems and software infrastructure.

Fortunately for small clinics and doctors, the up-front investment for automating operations need not be prohibitive -- nor does the cost of ongoing maintenance and management. With the advent of cloud computing and Software as a Service (SaaS) technology, a small practice can be up and running in short order with minimal costs if it already has a network in place and uses a browser.

"I strongly recommend [SaaS]," said Dr. Alan Gorenberg, an allergist with four offices in Southern California. "[It] has the advantage of simplicity. There's very low technology overhead and very low cost of equipment."

An increasing number of IT service providers, such as ETG, handle not only the initial technical assessments and deployments, but also the ongoing maintenance and management. In such cases, a client enters into a service-level agreement (SLA) with the provider, stipulating its responsibilities to the client.

Emergency response time, 24-hour support, management of technology updates and preventive maintenance to keep IT networks problem-free are stipulations SLAs typically cover. It is never a good idea to settle for an oral agreement; IT industry experts strongly advise having a written SLA.

ETG uses an all-or-nothing approach with its clients: If a doctor or clinic wants to hire ETG, it has to agree to let the service provider run and maintain its IT systems remotely over the Internet, in what's called a "managed services" arrangement. ETG is software-neutral, monitoring updates and troubleshooting applications regardless of their brand, CEO Mike Jones said.

AdvancedMD Software Inc., a Draper, Utah-based provider of practice management software for doctors, also uses the Internet to deliver, maintain and update software. All transmissions are encrypted for security purposes, and the doctors' data is backed up off-site in a secure facility, CEO Eric Morgan said. Doctors pay for the technology month-to-month; this eliminates high up-front costs, he said.

Using SaaS technology also eliminates a lot of hidden costs, such as the electricity to run and cool in-house servers and other IT devices, said Gorenberg, an AdvancedMD client. Another hidden cost is the productivity lost when the network goes down and data is lost.

Before switching to AdvancedMD, Gorenberg's practice management software never fully integrated with his EHR system, he said. That resulted in his spending more money for repeated on-site attempts by the software company to fix the incompatibilities.

IT service providers offer speed, stability

Cost is a major factor in implementing practice management and EHR systems, but it isn't the only one. Some very important non-monetary reasons weighed heavily in Birmingham Heart Clinic PC's decision to hire ETG as its IT service provider, Business Administrator William Sester said.

"ETG delivers speed and stability, first and foremost," Sester said. "I can reach ETG 24/7 if needed. I have direct access to many of their team members. They respond when we need help and understand the importance of our needs."

In partnering with an IT service provider, doctors, clinics and hospitals have to be very selective. It's important to find a provider that understands the special requirements of health care providers, doctors and hospital administrators said. It's critical that the provider respond quickly when there is a system problem, considering patients' well-being may be at stake.

Other special concerns have to do with all the "moving parts" of the overall health care apparatus, AdvancedMD's Morgan pointed out. For instance, insurance companies make frequent changes to their billing procedures, so software systems that handle billing and payment have to be updated accordingly, he said. (Sheridan Richey, vice president of engineering at AdvancedMD, said such updates occur overnight so they are ready for doctors and their staff in the morning.)

Having a partner that handles the ongoing maintenance of the IT environment while also providing the necessary security and data backup is invaluable, because it lets them focus more resources on patient care as opposed to running IT systems, health care providers said.

It's critical to find a partner that understands health care, Sester said. "They provide us with the equipment and services we need to be some of the best cardiologists in the Birmingham area," he said. "We need to focus on our patients. ETG allows us to not only do that, but they also assist us in utilizing technology that will make us better physicians."

Pedro Pereira is a freelance writer in Huntington, N.Y., who has covered the IT industry for almost two decades. Contact him at pedropereira@verizon.net.

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