Much of Dr. Rowley’s guest post and the comments on it were about whether a hosted one database for multiple practice system facilitates sharing of patient information better than a bunch of disparate client server installs. I’ll leave most of that discussion for the comments on the post, but I will mention that the biggest challenges with sharing information between multiple EHR systems isn’t the technology. The 2 biggest problems I see with sharing patient information between doctors are:

1. Doctors who aren’t using an EHR and won’t give up their paper charts
2. Defining the rules for sharing

Think about what it takes to share information. You have to ensure that the patient has given you permission to share that information, manage how long and which parts of the information can be shared and then go to work to make that happen without sharing more than you should share. Much more could be said about sharing patient records, but my point is that the technology of sharing information isn’t the problem with client server installs. The technology is there, but the policies aren’t.

One final note about sharing using the Practice Fusion model of SAAS EMR is that it still strongly depends on everyone using Practice Fusion. The problem is that there are at least over 400 EHR vendors selling product. This means that ever EHR system will have to learn to talk with each other and can’t just learn to share with itself. At that point, I’d argue that it’s not that much easier for a one database hosted solution to share data with a different EHR software than it is for a client server based EHR to do the same.

Wait, I told you’d I wasn’t going to talk about sharing….so back to some of Dr. Rowley’s other points.

It is true that a client server based system does require a larger up front cost in server and IT support than a hosted solution like Practice Fusion. However, it’s really quite amazing how quickly those costs have dropped. Just today I got a quote for a server for a local doctor’s office that cost under $3k. Prices on servers have become so affordable that it’s not nearly the expense that it was 5-10 years ago.

What wasn’t pointed out by Dr. Rowley is the need to invest in a more reliable and faster internet pipe when using a SAAS EHR. A client server EHR works on your local network which will always be much faster than anything an ISP can provide. Not to mention significantly more reliable. Choosing to go with a hosted EHR can work, but you’ll just have to plan well for when your internet connection goes down.

Hosted EHR companies also love to tout how the software automatically updates as new releases are made. This really can save time compared to in house EHR systems that require you to update an application on each computer (we won’t talk about the in house EHR software that is web based). What they don’t tell you is that you may not want or be ready for the new features. In the client server world, you can test the update and prepare for the changes being made on your schedule. A one database hosted option doesn’t give you that flexibility. If the update breaks something you enjoy, then you’ll have to deal with it until the company can fix it (assuming they think fixing it is a priority).

It’s getting late or I’d keep going about the pros and cons of both the SAAS versus client server models. Don’t get me wrong, I think hosted EHR are certainly a viable option for those implementing an EHR. However, even hosted EHR come with their own list of challenges. Selecting an EHR is more about choosing which challenges you are willing to work around than it is choosing the perfect EHR that does everything exactly the way YOU want it.

I also wanted to talk about Dr. Rowley’s suggestion that “NextGen is an example of one approach, and PracticeFusion is an example of a fundamentally different approach. Rather than seeing them as “a spectrum” of approaches, it might be more appropriate to consider them as different generations of product: EMR 1.0 vs. EMR 2.0″

I think it’s unfair to call NextGen or any other similar EMR as EMR 1.0. Some of the features offered by the client server model blow away PracticeFusion and other web based EHR. The web has come along way (and is continuing to improve), but still can’t compare with some of the UIs client server can offer.

I do agree that they are fundamentally different approaches to solve the same problem. They each have their own benefits and challenges. Pick your poison.

Finally, I was a little surprised that Dr. Rowley didn’t mention the most unique part of his model until the end of his guest post. PracticeFusion’s “free EMR” model that is funded by advertising is what sets it apart from even the various hosted EMR options. This description of PracticeFusion’s business model is its most defining characteristic:

Practice Fusion’s free EMR is an emerging product built on this vision, and has a business model where in-product targeted ads pay for the service. The ads can be traditional vendor ads (pharmaceuticals, devices, billing and transcription services, etc), or can be “counter-detailing” ads, where insurers or local medical groups or IPAs can display their preferred treatment methods for the condition-at-hand.

You can read some of my past thoughts on free EMR by PracticeFusion. I’m still very curious to see how PracticeFusion fairs in the marketplace. One thing is certain, they’ve got a pitch and their selling it to everyone who will listen.

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It’s hard to believe that it’s been over 3 years since I started this blog. I first started out just wanting to document my experience with EMR. I still do that to a large extent, but it’s grown to a lot of other things including some of the various EMR related technologies like the ever popular Dragon Naturally Speaking medical. Regardless of the topic, I still am passionate about EMR and the effect that it can have on healthcare. I think a ton of things need to be done to improve its implementation, but it’s needed as a platform for the future of healthcare. It will be fun to see it evolve over the years.

Also, I wanted to wish everyone a Merry Christmas and a Happy Holidays. May you enjoy the season and celebrate with those you love and care about.

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• Benefits of an EHR Consultant
• Challenges of an EHR Consultant
• Finding a good EHR Consultant
• Making the most of an EHR Consultant
• Does an unbiased EHR Consultant exist?
• etc…

Basically, I’m interested in answering the question of whether an EHR consultant has your best interest in mind and things you can do to ensure a quality experience with a consultant.

Also, you might look back at my five part series on EHR consultants to get you thinking.

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So, of course, I was interested when I got an email about the People’s Health Blogger Awards. For all of those who enjoy what I’m doing on this blog, I’d love to have your vote as a great health blogger. Just click the “Vote Now” button below:

for John Lynn http://www.emrandhipaa.com

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Start slow, don’t hesitate to ask for pointers, and get some good habits started at the outset.

And you’ll do fine.

The last part is the best part. You really will do fine. Many have implemented an EMR successfully before you and you can do it also. It will take work and effort, but it will make it that much more meaningful and fulfilling to you in the end.

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OVERVIEW:
The PowerMic II is a speech recognition microphone designed to be used with Dragon Medical 10.

However, the PowerMic II is much more than a hand held microphone. It is a powerful tool that enhances a physician’s control of dictation and navigation through documents, templates, electronic medical records and other applications. It has been designed specifically to be utilized with Dragon Medical 10, and the extraordinarily tight integration shows that to be true.

Not only does the PowerMic II have full mouse functionality, but there are 10 function keys that are programmable to provide practically any operation that a physician might want to do on his/her computer.

Yes, you can already use Dragon Medial 10 to do almost anything you want to on your computer by voice. However, using the PowerMic II and Dragon Medical, you substantially enhance your ability to do essentially anything you’d like on your computer, using the more convenient method at that moment: voice or function button.

The PowerMic II is designed to be fully functional with Dragon Medical 10 only. Dragon Preferred 10, Professional 10, and Legal 10 are not capable of using all of the programmable PowerMic II features.

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Briefly looking at the document one section in particular caught my eye that was called “Prerequisites for Achieving Interoperability.” I was excited to read what they thought was important for interoperable EMR software and the following is what I found:

The path to interoperability is fraught with challenges. Some of them are technical – determining what standards should be used to achieve interoperability and implementing those standards within HIT systems. Some are cultural – encouraging both vendors and providers to share information. And some are financial – identifying sources of funding needed to acquire the technology and to establish and sustain health information exchanges.

Nonetheless, we believe that interoperability is achievable, under certain conditions outlined in this Roadmap.

I was really disappointed in their list of prerequisites. Not one mention of the legal issues related to interoperability? That seems like one of the largest problems with interoperable medical records. It kind of falls under cultural, but it still should have at least been mentioned under cultural if that was their intention. An interoperable EMR is no use if legally you can’t exchange those records easily.

At least they did talk about the need to find a motivation mechanism for vendors and providers to share information. The honest truth is that interoperable EMR software doesn’t sell more software. Not to mention, there’s very little financial benefit for a doctor to spend time sharing information either.

The key is that interoperability is important and finding ways to meet/overcome these prerequisites is important and worthy of significant attention.

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Don’t get me wrong, there are definitely some drawbacks to an online conference. There is something nice about seeing someone face to face and experiencing a live demo of a product. Not to mention the free conference giveaways and free dinners with vendors. However, there are also some great advantages to a completely virtual conference also. Take for example, the networking with colleagues. I think almost all of us are familiar with the feeling that we should be networking with those around us. Yet, there’s kind of this uncomfortable feeling of how to start a conversation with those around you. One nice thing about the internet is that it helps to take down those barriers and allows people to feel more comfortable interacting. It’s worked really well for guys meeting girls online and so I don’t see why a virtual conference couldn’t offer the same benefits to its attendees.

I applaud HIMSS for this move into the virtual conference world. I’m excited to see how it plays out this Wednesday, November 19th and Thursday, November 20th. There are a number of HIT sessions that look interesting along with some EHR, e-prescribing and even an opening keynote about healthcare and politics. You can see the full list of sessions here. I’d like to see a broader range of sessions and a larger “vendor floor” (albeit virtual), but for a first offering I think that HIMSS has done a great job.

I have a meeting here and there throughout the virtual conference that I have to attend, but I’m sure I’ll be active in the conference chat rooms when I am attending. Also, I’ll be posting updates to my Twitter account if you want to follow me there. You can also follow HIMSS on twitter now too.

Here’s a link to register for the HIMSS virtual conference. If you’re planning on attending also, let me know. I’d love to see what other bloggers plan on attending.

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Fear
Ego
Money
War Stories
No one wants to go first
Product not perfected yet
Waiting on Govt mandates
Waiting on hospital install or Stark gift
I have people for that
Change

A really great list. Mike also discusses each of these points. As time permits I’d love to take some of his points and write some comments on each.

More important for this post, I wondered what other reasons might be missing from this list. Here’s a few others that I came up with:

I’m retiring soon
I don’t like computers (similar to “Computers Scare Me”)
Procastination/Lazy
Commitment problems (can’t decide on which EHR system)

Those last couple sound a lot like why many people don’t get married. Pretty interesting since I’ve compared implementing an EMR to marriage multiple times. Any other reasons for not implementing an EMR that we’ve missed?

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I haven’t take much time to make the list at all, but I think it’s better to start it and then as ideas come to my head I can add to it as time permits. I already have a number of other ideas (like quality of medical care), but I need some more free time to put all the details down. Now that I’m thinking about it a little bit more, maybe each benefit of an EMR should have it’s very own blog post describing the benefit that’s received by using EMR. We’ll see how that works. Seems like a worthwhile series of posts to me.

Also, in all fairness I’m certain that I’ll also soon be creating a list of problems associated with EMR. I think it’s important to keep the discussion well rounded and that people are well aware of both the benefits and challenges associated with using an EMR.

Finally, I certainly welcome comments from people on benefits or challenges associated with use of an EMR. I look forward to hearing ideas from other people’s experience to help me round out the list of benefits and challenges that many have already experienced first hand. Might as well try to pass on that knowledge to those who are still implementing or looking to implement.

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