EMR ASP vs. Client/Server

Recently, I was asked by one of our clients what were some of the advantages and disadvantages of going with an EMR that is running on ASP (application service provider) model or an EMR on a Client Server setup.

Unfortunately, few online articles have labeled the ASP model as the EMR where you don't own the data, and also the Client Server model where you will suffer from terrible performance if you have multiple locations.
So, I wanted to provide some alternatives to the models listed above. When you look at the ASP model, you will find that it can be divided into two very different modes that have very different advantages and disadvantages.

Please view the following Comparative analysis: Click here

Disaster Recovery and Business Continuity Plan

There was a time in my youth I was told to be proactive in order to maintain my cars to get the most out of them. I believe that was one piece of advise my father gave which I should have listened to. Especially after going through two cars with blown engines during my college years. Today, in technology i have seen similar situations that do not get the proper attention, and assumptions are being made until the day you are faced with a true disaster then realize that you are all alone and no one to blame but yourself. The moral of this little part of my life is: "You should always monitor and perform checks on items that are important enough in your work or life".


In today's Healthcare information technology, many components go unchecked, and when disaster strikes, several organitations suffer from many directions.



So, now looking at all the complex systems that are implemented in today's health care, from a small medical office, to a large IDN the reliance on technology one must wonder, how can we better prepare for any disasters.

Working with small to mid size practices one of the key mistakes that I have seen repeatedly is the lack of awareness of what their backup consists of. There is actually a small list of things they must know but no one tells them about:


Current challenges:

• No one knows where the IT service support stops and when the PMS vendors begin.


• Are all the practices important documents stored on the server with all the other major data, or is it still lingering under the "My Documents" on the office managers desktop.


• Is the data restorable?


• Is the data being backup daily (are the backup logs monitored.) PS: "in some applications, if one file is missing the data may be unusable."


• If the practice is not using Microsoft Exchange or Lotus Notes, are their POP3 emails being backed up?

Solutions:

• Design or request a network and application layout.


• Request documentation or weekly reports on backup logs


• Implement restore drills even on a testing server. (You can actually lease servers to perform tests on.)


• Discuss disaster recovery with your staff, providers, IT support, and all your software vendors. Remember each software can have specifics when it comes to recovering from a technical disaster.


• Identify what applications are business critical and which ones are not.


• Make sure the backup rotation is appropriate. (Weekly is not acceptable, and can cause you financial and legal penalties).


• Discuss your disaster recovery process with your insurance (it can lower your premiums if you have implemented and documented best practices.)


• Invest in the right solutions up front. In many cases it might seem that you should settle for the low cost backup solution with limited storage without accounting for the growth of your storage over the next few years. Think of where your EMR plan might come in the picture, and when you might decide to scan all your paper chart. Your backup storage should be an investment that will have to be done wisely. You should not have to replace your backup solution in a year or so. So, ask if the backup you have in place is upgradable, and scalable.


• Implement server monitoring to allow for your servers to be reviewed for errors that can help in preventing disasters.

Disaster recovery for Hospitals and large organizations...to be continued..Once we move to a hospital /IDN environment, it is a different challenge. It becomes clear that it is not just a question of putting in the storage infrastructure alone, but more of having to manage the following:

• What will be covered (if there are other organizations that might not be in the same geographic area)
• Awareness and preparedness (understanding the risks to the business as well as the challenges that will need to be overcome.)
• Procedures that would need to be implemented in order to guarantee that everyone is on the same page. From an IT prospective all the way to the Disaster Management Team and staff.
• Technology infrastructure. This would include plans to either have a hot site ready with data that is replicated real time, all the way to stand by servers and solid backup or virtual platforms.

From a technology standpoint, there are many challenges that the IS department is faced with is the vast infrastructure that is in place. To point out few of them that we see in Figure 1.1.

Figure 1.1

There few more items tat might be missing from the Figure 1.1, such as the integration engine that keep all the hospital system all integrated and patient information centralized. Ranging from SUN JAVA CAPS all the way to MS BizTalk servers. In addition, there is the task to coordinate with all the different vendors. Any thing from the RAD system to the EMR servers that might be under maintenance contracts through a third party.

Reda Chouffani.. To be continued.....

who's the best candidate for the HIT job for your health organization?

Here we are in the new year 2008 with new resolutions and updated goals for all our healthcare organizations. This year we might be looking at making changes to our technology infrastructure. We also might be looking at adding new providers to the practice or even extending our hours to compete with minute clinics. Whatever we have decided to accomplish, somewhere in that list you will find something related to the healthcare technology.

In recent years many organizations are finding out that they are spending a lot on technology.
So we ask ourselves are we better off hiring our own HIT (Healthcare IT) to support all this complicated environment?
Is it worth to have someone 8:00 to 5:00 in the practice to solve our technical challenges? Some even are saying that they can afford to have an IT person on staff for the amount they spent last year on an outside IT vendor?

Many of the above questions are valid. As we look at some of the medical groups that either use an IT firm or have an internal person we notice that each has its advantages and disadvantages.


In house IT person:

Pros:

• Immediate support (no delays or phone calls needed)
• Costs are always fixed and in budget
• The person know how the practice works and the workflow
• Single point of contact for all technical needs
• Extra set of hands to use for other items if the IT queue is low
• Coordinate and manage projects that involve multiple vendors
• lower cost

Cons:

• Limited knowledge (one person can not be an expert in all IT technologies)
• Some IT personnel are very talented in technology but not knowledgeable in the healthcare domain
• Having one person responsible for all IT can be too risky.
• You get what you pay for (Being technical might not mean good project management or being on board with organizational goals)
• Noway of knowing if the work is done properly and the best practices have been used

Outsourced IT person/Group:

Pros:

• With an outside company you actually hire a whole group of talents (server support, workstations, PMS, Interfacing, Medical Imaging, Integration,..etc..)
• Having access to a group with extensive experience in the healthcare market
• Accountability tend to be greater here as it is a company not an individual
• Not one single point of support (Having a group know your infrastructure means that if one Tech is not available, then there are many others that can take over and get you up and running.)
• Provide integration ideas and solutions to improve efficiency and lower costs
• provide best processes and procedures (procedures on disaster recovery, backups, security, HIPAA, asset management, monitoring system health..)

Cons:

• Can we say $$$$$
• Response time is slower than inhouse IT staff
• you sometimes get support from someone who is not familiar with your infrastructure which drives costs up.
• Sometimes vendors are selling more than what is needed

In today's Healthcare, not one method is better than the other. Just like everything in life, it is a balance that creates the best results. The best pattern to use here if you are a large practice would be to have an inhouse IT person that can handle the day to day issues, but also hire an outside healthcare IT vendor to become your virtual CIO. This way, the HIT can be the top layer that can keep an eye on your infrastructure through continuous audits, and meetings and also provide solutions and direction when it comes to projects that will affect the practice. Some might argue "well what if I don't have enough IT work to be done for this person?" Then the other option would be to negotiate with HIT vendor to get a Hosted IT person. You can pay a set amount of dollars and they can provide you for a term of 6 months or more an IT person that can report to your practice everyday just like one of your employees. This means will also allow you to have access to the "Virtual CIO" for your practice and have an IT person that you can decide to terminate when you choose to.

Now if you are a small practice and none of the above options are valid, then you will find that the best way is to look for a local IT vendor that supports other medical offices and has a good reputation. They should be able to provide you with good support and for a fair price. But still consider paying for an outside consulting to come in once a quarter and tell you what are some of the technologies that are out there that can help you become more efficient and improve patient care.

With all these new initiatives and constant changes in Healthcare technology. From e-Perscription to RFID technology, EMR, and PHR how can anyone know for sure what would truly have the highest ROI for their practice. Most IT vendors can provide the same type of support for equipment, but the key is to have a company that can act as a virtual CIO for your group. A vendor that can work with the Office manager or the Practice Director and help them implement the right technology that goes along with their organizational goals.