As is often common at the end of the year, a lot of companies have started putting together their “Top 10″ (or some similar number) lists for 2011. In fact, some of them have posted these lists a little bit earlier than usual. This week as people are often off work or on vacation, I thought it might be fun to take one list each day and comment on the various items people have on their lists.

The first list comes from Booz Allen Hamilton and is Booz Allen’s Top 9 ways IT is Transforming healthcare. Here’s their list of 9 items with my own commentary after each item.

Reduces medical errors. I prefer to say that Health IT has the potential to reduce medical errors. I also think long term that health IT and EMR will reduce medical errors. However, in the interim it will depend on how people actually use these systems. Used improperly, it can actually cause more medical errors. There have been studies out that show both an improvement in medical errors and an increase in medical errors.

My take on this is that EMR and health IT improves certain areas and hurts other areas. However, as we improve these systems and use of these systems, then over all medical errors will go down. However, remember that even once these systems are perfect they’re still going to be run be imperfect humans that are just trying to do their best (at least most of them). Even so, long term health IT and EMR software will be something that will benefit healthcare as far as reducing medical errors.

Improves collaboration throughout the health care system. I’m a little torn as we consider whether health IT improves collaboration. The biggest argument you can make for this is that it’s really hard to be truly interoperable in really meaningful and quick ways without technology. Sure, we’ve been able to fax over medical records which no one would doubt has improved health care. However, those faxes often get their too late since they take time to process. Technology will be the solution to solving this problem.

The real conundrum here is the value that could be achieved by sending specific data. A fax is basically a mass of data which can’t be processed by a computer in any meaningful way. How much nicer would it be to have an allergy passed from one system to another. No request for information was made. No waiting for a response from a medical records department. Just a notification on the new doctor’s screen that the patient is allergic to something or is taking a drug that might have contraindications with the one the new doctor is trying to prescribe. This sort of seamless exchange of data is where we should and could be if it weren’t for data silos and economics.

Ensures better patient-care transition. This year there was a whole conference dedicated to this idea. No doubt there is merit in what’s possible. The problems here are similar to those mentioned above in the care collaboration section. Sadly, the technology is there and ready to be deployed. It’s connecting the bureaucratic and financial dots to make it a reality.

Enables faster, better emergency care. I’m not sure why, but the emergency room gets lots of interesting technology that no one else in healthcare gets. I imagine it’s because emergency rooms can easily argue that they’re a little bit “different” from the rest of the hospital and so they are able to often embark on neat technology projects without the weight of the whole hospital around their neck.

One of the technologies I love in emergency care is connecting the emergency rooms with the ambulances. There are so many cool options out there and with 3G finally coming into its own, connectivity isn’t nearly the problem that it use to be. Plus, there are even consumer apps like MyCrisisRecords that are trying to make an in road in emergency care. I’d like to see broader adoption of these apps in emergency rooms, but you can see the promise.

Empowers patients and their families to participate in care decisions. Many might argue that with Google Health Failing and Microsoft HealthVault not making much noise, that the idea of empowering patients might not be as strong. Turns out that the reality is quite the opposite.

Patients and families are participating more and more in care decisions. There just isn’t one dominant market leader that facilitates this interaction. Patients and families are using an amalgamation of technologies and the all powerful Google to participate in their care. This trend will continue to become more popular. We’ll see if any company can really capture the energy of this movement in a way that they become the dominant market leader or whether it will remain a really fluid environment.

Makes care more convenient for patients. I believe we’re starting to see the inklings of this happening. At the core of this for me is patient online scheduling and patient online visits. Maybe it could more simply be identified as: patient communication with providers.

I don’t think 2011 has been the watershed year for convenient access to doctors by patients. However, we’re starting to see inroads made which will open up the doors for the flood of patients that want to have these types of interactions.

Helps care for the warfighter. This is an area where I also don’t have a lot of experience. Although, I do remember one visit with someone from the Army at a conference. In that short chat we had, he talked about all the issues the Army had been dealing with for decades: patient record standards, patient identifiers, multiple locations (see Iraq and Afghanistan), multiple systems, etc. The problem he identified was that much of it was classified and so it couldn’t be shared. I hope health IT does help our warriors. It should!

Enhances ability to respond to public health emergencies and disasters. I’ve been to quite a few presentations where people have talked about the benefits and challenges associated with electronic medical records and natural disasters. They’ve always been really insightful since they almost always have 5-6 “I hadn’t thought of that” moments that make you realize that we’re not as secure and prepared for disasters as we think we are.

It is worth noting that moving 100,000 patient records electronically to an off site location is much easier in the electronic world than it is in paper. With paper charts we can’t even really discuss the idea of remote access to the record in the case of a natural disaster.

Possibly even more interesting is the idea of EMR and health IT supporting public health emergencies. We’re just beginning to aggregate health data from EMR software that could help us identify and mitigate the impact of a public health emergency. Certainly none of these systems are going to be perfect. Many of these systems are going to miss things we wish they’d seen. However, there’s real potential benefit in them helping is identify public health emergencies before they become catastrophes.

Enables discovery in new medical breakthroughs and provides a platform for innovation. Most of the medical breakthroughs we’ve experienced in the last 20 years would likely have been impossible without technology. Plus, I don’t think we’ve even started to tap the power that could be available from the mounds of healthcare data that we have available to us. This is why I’m so excited about the Health.Data.Gov health data sharing program that Priya wrote about on EMR and EHR. There’s so many more medical discoveries that will be facilitated by healthcare data.

There you have it. What do you think of these 9 items? Are there other things that you see happening that will impact the above items? Are there trends that we should be watching in health IT in 2012?

Be sure to read the rest of my Health IT Top 10 as they’re posted.

I’m always on the lookout for new online communities around Healthcare IT. I test drive them for a little while and then decide how I’m going to incorporate them into my daily routine. I evaluate what benefits I get from participating. Sometimes the benefits of participating are just helping someone out. There’s something really satisfying about doing something for someone else.

My latest test drive has been the Healthcare IT Question and Answer site on Stack Exchange. I’ve used Stack Exchange a bunch before when I needed some programming help. However, I’m guessing that most people in healthcare IT (unless you’re a programmer) probably aren’t that familiar with Stack Exchange. Well, they created such an interesting community around question and answers that they got a whole bunch of VC funding and they’ve been growing their network into all sorts of new niches. Thus, the launch of the Healthcare IT Stack Exchange community.

You can go and check out my techguy profile on the HIT Stack Exchange site if you want to see what I’ve done. I’ve already got a reputation of 46 (whatever that means). I’ve already answered 9 questions on the site and a few people have been nice enough to vote up my answers.

For example, if you are a MUMPS lover, you can see my answers on this MUMPS replacement question and this NoSQL in Healthcare IT one. I couldn’t resist answering a question about CCHIT. I also took a swing at the PHR question, but I’m sure I could have dug a little more on that one to mention some other PHR software. Instead, I opted for the two most popular ones. I even hopped in the chat room, but it wasn’t that exciting since I was the only one there. You can check out the chat room, but you won’t be able to chat until you have enough reputation. Keeps out spammers, but makes for a boring chat room until you get some critical mass.

Of course, the real challenge with any site like this is the standard chicken and egg problem. You need a large number of people to ask and answer questions. However, in order to get a large number of people asking and answering questions, you need a lot of good questions and answers. I guess we’ll see how it evolves over time. The sidebar of the site says they’ve had 113 questions, 241 answers, 319 users and 147 visitors/day. A pretty small community, but a pretty good response rate considering the number of users. I just wish there was more discussion of EMR & EHR on the site since that’s what interests me most.

Let me know what you think and if you see any good questions or answers on the site that you think I should see. I’ll be keeping an eye on it to see how the community develops. I’d hate to have my 46 reputation points go to waste.

I’ve regularly talked about my belief that there isn’t just one major EMR market. Instead, I firmly believe that there are a number of EMR markets that are divided by clinic size, medical specialty, and possibly even location. In fact, there’s likely even other factors. There are just far too many EHR companies for this to not be the case.

I think this was also well illustrated in this blog post on Kevin MD about the “Perfect EMR Traits.” Here’s the perfect EMR trait #1:

Perfect EMR Trait #1: The ideal medical record would be tailored to the specific needs of a clinician, only exposing them to portions of the record which are relevant to their work.

Knowledge within healthcare is rapidly changing. Possibly more so than another other industry. Techniques which were considered state-of-the-art, can change in a matter of weeks. The electronic medical record has the potential to be the tool which disseminates those changes down to the clinician, through point-of-care decision support. EMR software should facilitate the clinician decision making, rather than requiring clinicians to keep track of the latest and greatest. This individualistic attitude creates discrepancies in care, which inherently leads to imprecise care.

While it is certainly technically feasible for an EMR vendor to be able to create software that satisfies Perfect EMR Trait #1, it’s just not practically feasible for an EMR vendor to satisfy every clinic size, medical specialty, and in many cases locale. This means that we’re going to see a wide variety of EMR software that satisfies the various EMR market needs.

With this as a preface, consolidation of EMR companies is going to become a very very real thing. However, I’d caution EMR companies that choose to just directly sunset an EMR software acquisition. In some cases, this is a reasonable solution based upon the EMR company’s existing EMR software. Plus, in many cases EMR vendors will be acquiring the EMR market share for their existing EMR software. I’m sure we’ll see more of this.

My recommendation for EMR vendors acquiring EMR software, is to be more selective in the types of EMR software that you acquire. It’s definitely worth considering the idea of sustaining the EMR software development of multiple EMR products. Is it really that hard to see a large EMR company that has an ED EMR software, a General Medicine EMR software, an OB/GYN EMR software, a Pediatric EMR software, etc etc etc.

An EMR vendor making a decision to act in this manner will require them to change how they look at EMR acquisitions. The EMR acquisition targets will dramatically change. Instead of looking for failing EMR companies where they can cheaply buy more EMR market share, EMR companies with this approach should be focusing on a quality EMR software that hasn’t yet achieved the EMR market share that they deserve.

The cool part about the strategy of maintaining multiple EMR software instead of the strategy of sunsetting one or the other is that you purchase a bunch of happy EMR users instead of alienating a whole mass of EMR users that’s software is no longer supported. Of course, this will require proper communication of your goals and objectives so that current EMR users see the benefit of the acquisition and aren’t left wondering what the acquisition means to them. I’m not just talking about standard PR spin. I mean real tangible communication and interaction which demonstrates your plans for the acquired EMR going forward.

An EMR company with this method of EMR software acquisition, also needs a different set of skills. After sunsetting an acquired EMR, you need to have a strong set of integration and transition services to make the change to your EMR as smooth as possible. You also require a unique sales force that can sell the transition to your EMR over a transition to an altogether new EMR software. None of these services are needed if you continue to maintain the acquired EMR. Instead, your company must focus on other redundant services like marketing that could be leveraged across companies.

Of course, this isn’t an easy task to do well. Acquisitions rarely are an easy process. However, I think this is a lesson that was recently learned by Google as well. There’s value after an acquisition to keep autonomous business units. In fact, doing so opens up a whole new set of acquisition targets in a less competitive environment.

If I were a board member at an EMR company, this is the type of stuff I’d be considering. Certainly not every EMR vendor is 1. in a position to do these things and 2. has the culture to make it happen. However, I predict that the EMR company of the future will be a conglomerate of multiple specialty specific EMR software and not just a one size fits all atrocity.

A few months ago, the blogger over at Health Finch wrote blog post which analyzes 3 of the top health care IT companies and how they were started. It is very interesting to see the evolution of the large health care IT companies. Here’s the summary of the 3 companies Health Finch looked at:
Epic Systems – Started with Scheduling and Billing
Cerner – Started as a Laboratory Information System
McKesson – Started dong Rx Management

As a PS to the post, they point out Epocrates working on the same model with their Epocrates EMR. That is one of the most interesting things I’ve noted when attending the various EMR related conferences that I attend. There’s a whole variety of ways that EMR companies are approaching the market.

Another example of this trend is the Care360 EHR from Quest. Think about all the benefits that Quest has over many other providers. Sure, the most obvious one is that they have easy access to the lab data. You can be sure that an interface with Quest labs will be free (unlike most other EMR vendors). Although, certainly it also could be a challenge if you want your EMR to interface with another lab. That could be interesting.

However, Quest has a number of other advantages over a new EMR company. They have an entire sales force (which I think they prefer to call consultants) that already have existing relationships with thousands and thousands of doctors. Quest could literally only sell EMR software to their existing lab customer base and do fine. Of course, that’s probably not the best strategy, but that’s a powerful advantage over the other EMR companies.

There are a ton of other companies that we could talk about. Those entering ePrescribing first. Those transcription companies that are offering an EMR solution. I find it absolutely fascinating. So, if you know of others, I’d love to hear your EMR vendor’s story in the comments.

Suffice it to say that we’re in the middle of an all out war by EMR vendors. The good part is that it’s not likely to be a winner takes all affair, but there will be many many EMR vendors that will end up on the winning end.

John at Chilmark Research posted a note about the importance of how ONC and HHS define the terms “meaningful use” and “certified EHR.” I wanted to echo his comment so here it is:

Note: We can not emphasize enough just how important these two terms (meaningful use & certified EHRs) are to the market. These terms will literally define the HIT market for the next decade and whether you are an HIT vendor or one looking to adopt an HIT solution, having a clear understanding of what these terms mean and their implications will be critical to your success.

Basically, the $36.3 million in EHR stimulus money is dependent on “meaningful use of certified EHRs.” That’s a lot of money and influence on two terms. I hope as many people as possible will participate in today’s HIT policy committee meeting which should work to define “certified EHR.”

This is the second guest post by Bill Horvath II describing the pros and cons of thin clients with an EMR.  Also, take a look at his first entry discussing the pros and cons of laptops with an EMR.

Thin Clients

Overview

An office which chooses this approach will typically have one thin client terminal in each exam room, as well as in each physician’s office, and at stations occupied by non-mobile staff who need access to computerized records.  The terminals are typically managed or ‘driven’ by a server, which provides applications, data storage, and administrative control over the whole system.  Remote access to charts is usually provided via application server software.

Pros

• Easy To Use – Thin clients don’t have to be carried or pushed from room to room, and don’t require recharging.  Some manufacturers also use smartcards or other technologies to offer location-independent desktop sessions, whereby the desktop session virtually ‘follows’ the doctor from room to room, eliminating the hassle of logging out and logging in at each station, or of figuring out how the last person to use the computer left it.  Many thin clients can go from off to fully ready to use in 15 seconds or less, and because they have no moving parts, they are silent when operating.  And because data storage is centralized, a complete backup strategy is straightforward.
• Inexpensive – A fully-furnished thin client (with monitor, mouse, keyboard, and cabling) can be purchased at a price starting around $650, depending on the makes and models of the components.  Spare parts are inexpensive to keep in inventory, and individual parts can be replaced in the event of failure.  Because they are highly reliable (and their capabilities are usually determined by the central server which administers the network), they can remain functional for 7 years or longer.
• Reliable – Modern thin clients have no moving parts, making them exceptionally resistant to normal wear-and-tear.  Since they aren’t typically moved by the doctor, they’re less likely to be broken through an accidental drop or collision.
• Trivial to Replace – Since thin clients are usually controlled and configured by am administrative server, it’s trivially easy to replace one in the unlikely event of a failure.  In such cases, replacement of the device is simply a matter of unplugging cables from the old unit and plugging them into the new one.
• Energy Efficient – Because they have no moving parts, thin clients use very little electrical power.  Around 5-15 watts or less is common, even when operating at full capacity.
• Highly Secure – Thin clients, by definition, have no local data storage, meaning it’s impossible to lose data by way of theft or equipment failure, and a bad actor can’t use a stolen device to extort money or expose private or embarrassing information.  Some thin client manufacturers also provide two-factor authentication built into their products, which precludes access to the system entirely without an alternate means of identification, such as a smart card.  Under these circumstances, the thin client won’t even present a password request (or other user interface) without the required token.  It is also easy to physically lock a thin client in place to prevent theft.
• Unlimited Scalability and Upgrade Capabilities – The capabilities of some manufacturers’ thin clients are completely determined by the managing servers, which means the maximum number and processing power of the thin clients in any particular installation are limited only by the capabilities of the controlling server.  To allow for more simultaneous users or more complex applications, only the servers need to be upgraded or replaced; the thin clients can remain unchanged.
• Automatic Firmware Updates – Many thin client manufacturers provide software in their thin client server package which automatically keeps the firmware of the thin clients up-to-date.

Cons

• Expensive Back End - A thin client installation with an administrative server will almost always be more expensive at the point of purchase than a set of laptops, especially if the laptops are deployed without an administrative server.
• Single Point of Failure – If the server which provides administrative control to the thin clients fails, all of the thin clients may be down until the server is brought back up.  Exposure to this risk can be mitigated by using redundant servers, which themselves feature redundant systems (power supplies, memory, processors, etc.), however it can’t be entirely eliminated.
• Everyone is Subject to Each Others’ Usage Patterns – The performance of thin client’s desktop sessions can be adversely affected by what other users on the system are doing.  Someone watching online videos, for example, may occupy significant processing power and bandwidth, which can drag down the performance of other user’s sessions.  This problem can be alleviated by upgrading the administrative server, but doing so engenders additional costs.
• Limited Peripheral Support – Thin clients may have limited support for attachable peripherals, such as USB storage or printers.  (This will mostly depend on the operating system of the administrative server.)
• Geographically Grounded – Because they aren’t mobile, a thin client terminal is needed for each location in the office at which a computer is desirable.  Power and network access are needed at each such location, which may require the installation of additional wiring.
• Limited OS Options – Most thin clients come with a Linux desktop as a default option, as this doesn’t force any additional licensing costs.  Presenting a Windows-based desktop to thin client users currently requires Windows Server, Windows Client Access Licenses, and Windows Terminal Services licenses, each of which costs extra.  Furthermore, Apple does not currently offer a suitably efficient protocol for serving an OSX desktop to a thin client.
• Server Requires Physical Security – The administrative server must be physically secured from theft, accidental damage, and power loss.  In addition, such servers are typically noisy, meaning placement in a closet, mechanical room, or soundproof rack is usually highly desirable, but may require additional wiring or other expenses.

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice. Their flagship product is DoxCIS, an electronic medical records system.

In the comments of my previous post about Tablets vs. Convertibles vs. Laptop and EMR, we started an interesting discussion about “thin clients” in addition to laptops and desktops in the healthcare environment.  From that discussion I invited Bill to do a guest post about the various advantages and challenges of laptops and thin clients with an EMR.  Bill did such a detailed job I decided it was worthy of 2 posts.  The following is Bill Horvath II’s description of the pros and cons of laptops with an EMR.

Because doctors who have an EMR system need access to patient histories at the point of care, they need a computer in the exam room.  Traditional desktop computers have been used for this purpose in the past, however, more cost-effective laptops and thin clients are becoming much more common in clinical settings.  This post examines some of the pros and cons of laptops.

Laptops

Overview

An office which chooses this approach will typically have one laptop per physician, and possibly one for each of the other staff members who move between exam rooms, such as nurses.  In this scenario, traditional desktop PCs are usually used at the stations occupied by non-mobile staff, such as the receptionist.

Pros

• Mobility – The doctor can take a laptop wherever he or she goes, including out of the office.  Remote access to charts is usually accomplished via a VPN.
• Local Data Storage – The doctor can easily store files on the hard drive of the laptop, meaning those files are accessible wherever the laptop is, and regardless of whether it’s connected to a network or the Internet.
• Many OS Options – Laptops are available for virtually all of the major operating systems (Windows, Apple, Linux, Unix, Solaris, BSD, Chrome).
• Broad Peripheral Support – Laptops usually have built-in drivers for dealing with a wide variety of peripheral attachments, such as USB mass storage devices, cameras, printers, and scanners.
• Flexible Performance – With a few minor exceptions, the performance of a laptop computer is determined solely by the capabilities of the computer itself, and how it’s used by the person sitting in front of it.

Cons

• Require Recharging – When configured for mobile use, laptops run off battery power, which means they must be plugged in periodically to recharge, or the doctor must switch to a freshly charged battery when the available charge runs low.  Most laptops will provide two to four hours of continuous use on one battery charge.  Laptop battery capacity also typically declines approximately 20% per year, which adversely affects performance over time.
• Expensive – Good quality, business-class laptops start at around $1000, and can range into $3000+ for more advanced units.  Necessary accessories (docking station, supplemental monitor, extra batteries, carrying case, etc.) can add significantly to the cost.  Support contracts for the laptop can be pricey as well, as the components are tightly integrated and difficult to replace.
• Fragile – Most laptops have moving parts (typically fans, optical drives, and hard drives; also mechanisms such as the connection between the lid and the monitor) which will wear down, and which don’t respond well to being dropped.
• Difficult to Repair – It is often not possible for the doctor or her staff to repair or replace the components of a laptop (such as the screen or keyboard) if they fail. Laptops often need to be shipped to the manufacturer to be fixed.
• Hard to Replace on Short Notice – Even if a ‘hot spare’ laptop is kept in the office for emergencies, synchronizing applications, settings, and files between a (possibly broken) machine and the spare may not be trivial, nor is updating the operating system.  This effect is amplified when each doctor has their own particular configuration, and if there is no centralized management server (e.g., Apple Workgroup Manager, Windows Server Domain) in place.
• Complicated to Secure – Because they are mobile, laptops are subject to theft.  This problem can be mitigated by encrypting the hard drive, but doing so creates challenges around encryption key management, especially in multi-laptop environments, and as laptops and hard drives are replaced over time.  In addition, laptops accidentally left in exam rooms with patients are particularly subject to a variety of security risks, such as accidental damage, malicious hacking, etc., especially if the laptop lacks a two-factor authentication system.
• Limited Upgrade Potential – Most laptops are limited in how they can be upgraded over time (Typically RAM and the hard drive are the only user-upgradable components.)  This can become an issue in keeping current with software and operating systems, as new programs often have more stringent system requirements.
• Noisy – The fans, hard drive, or optical drive on a laptop can spin up at inopportune times, creating a distraction, and making soft sounds harder to detect.
• More Complicated Backups – Because a laptop’s data is stored locally on the hard drive, the laptop must be backed up on a regular basis to protect against data losses due to breakage or theft.  This typically requires action on the doctor’s part (connecting a cable, triggering the backup function, taking the backup medium off-site), though some systems come with an automated backup system which can function wirelessly.   However, changes to the laptop’s files which occur between backups may be irretrievably lost if the machine is compromised.
• Require Individual Updates – Laptops which aren’t managed by an administrative server require individual patching to stay current with operating system and application updates.  Furthermore, since laptops aren’t typically on for automatic updating late at night, the update process which takes place during the day may interrupt the doctor’s workflow by forcing reboots at inconvenient times.  Laptop firmware also usually requires manual updating, a process which may not be especially ‘user friendly.’

Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice.  Their flagship product is DoxCIS, an electronic medical records system.

I came across this article that identified the top 5 wirless challenges in healthcare. They go into more detail of the challenges, but here’s their list:

1. Physical connectivity (especially in old hospitals)
2. Technology connectivity issues
3. Meeting user demand
4. Security considerations (high risk of stolen laptops)
5. Network management issues

So these challenges are really mostly focused on hospital situations or at least larger group practices. The exception is the security considerations. However, I think most people are far past the idea of wireless being any less secure than a wired connection. In fact, one could argue that wireless is actually more secure than the wired connection if it’s set up properly.

The biggest issue on this list that I see with wireless is the first one. Some of these old buildings just kill a wireless signal. Add in asbestos and the difficulty to run wire for a wireless access point and you have a real challenge getting a good wireless signal in these old buildings.

One thing I think this list and article are missing is that I think we’re going to see an ever growing trend of people using wireless broadband cards instead of the traditional wireless. Sure, in a small fixed setting, they’ll still use the traditional wireless. However, the mobile doctors doing visits to the hospitals or other locations are going to be using the wireless broadband cards more and more.

Note: This post starts a bit technical, but even those less technical should benefit from the second half of the post.

Today I had the very exciting event of a hard drive dieing on one of my servers. Luckily, I had the drives mirrored and nobody noticed. The server just kept running off of the good drive. I’ve had this happen a couple times and it always makes me happy to say that we lost a hard drive and nobody noticed the difference. Nice to know that things work the way they should be working.

However, the thought of losing the other hard drive before I could restore the second drive is always a little bit tense. Luckily for me, I was able to just connect to the raid controller (yes I just lost half my readers) and rebuild the failed hard drive and we’re back in business (at least for now).

I admit that when this happened I went straight to my backups to make sure that they were working correctly and I immediately made a backup of all the databases on that server. Of course, the thought being that if I lose both hard drives I’d at least have my backups (which I’d saved to another machine).

Enough technical already. My point of this post was that this event really made me think about what a doctor’s office would do if they lost a hard drive. They better hope they have good IT staff to be able to fix it. It’s far from rocket science, but you do have to be careful in these situations. The other important lesson is who do you have monitoring that the drive failed? Most servers have the ability to notify you when a drive fails. However, how many doctors or IT people that support doctors have set up these notifications?

I wish I could say this was an isolated incident that’s rare. Over the past 4+ years in my current job, I’ve had 3 or 4 hard drives fail. Not a huge number, but also enough to require a good plan for when this happens. I’ve often heard that the first thing to die on a server is the hard drive. Why? Because the hard drive is a moving part (the disk spins) and moving parts break. So, you just have to expect for these things to happen and plan for it.

At the end of the day, nothing was lost and there was no down time for our EMR server. That’s the good news about a well designed EMR server. The problem comes when no one’s watching for these events or when the EMR server isn’t installed in order to plan for these types of events.

I’m pretty sure my SaaS EMR friends are going to love this post. There’s no doubt this is a huge plus for SaaS (hosted) EMR companies, but there are other challenges associated with SaaS that should be considered as well. I’ll let the SaaS enjoy this benefit for now and leave those comments for another post.

Today I came across what someone called a new Health and Human Services (HHS) health information technology (HIT) website. Unfortunately, they didn’t get the same graphic designer and web developer that have been doing such a fine job with the various websites that Obama has been putting up.

I find the first page interesting since it has HHS asserting the following:
Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will:

I wish that each of these bullet points had links to all of the research that shows these are indeed the outcomes of HIT. This should include the research that argues against HIT being able to solve these problems. That would turn the list into an invaluable resource on the benefits and challenges of HIT.

I’m going to need to take some time to look at the rest of the site. However, the link that said “Standards and Certifications” certainly caught my eye and is guaranteed to be a future blog post.