Web-Based Electronic Medical Records

If your view of web-based electronic medical records was formed five years ago – or even one year ago – it’s time to look again. Web-based, or Software-as-a-Service (SaaS), applications have gained tremendous momentum thanks to Microsoft, Google and innovative technologists that have enhanced core SaaS technologies. Physician practices and their patients are a prime beneficiary of these advances. SaaS systems for electronic medical records and practice management now provide the security, interactivity and dependability that they may have lacked in the early days. However, because there are so many different options, designed for every different kind of facility, selecting a program can be tremendously confusing. This buyer’s guide is designed to assist the buyer in understanding the market and knowing where to start.

Here’s what we’ll cover:

What is Web-Based EMR Software?
Deployment Strategies
The Web-Based EMR Vendor Landscape

What Type of Buyer Are You?
Market Trends You Should Understand
Benefits & Potential Issues

What is Web-Based EMR Software?

Electronic medical records manage the clinical data within a healthcare organization. They store online patient records and charts, track demographics, print (or electronically send) prescriptions, facilitate laboratory and device integration, and include templates for SOAP notes.

What distinguishes online medical records from on-premise systems (which is locally installed and hosted by the practice) is that all the information will be accessed remotely, and sometimes the interface is even accessed through an Internet browser. This has a number of advantages, which we’ll address below.

Deployment Strategies

There are two types of web based EMR systems, with a subtle difference: application service providers (ASPs) and browser-based systems. Browser-based systems, just how they sound, use an Internet browser to access the information. The benefit of this is that the information can be accessed from anywhere, and it always looks exactly the same as you’re used to. ASP describes a client/server system, where the practice installs a very light software “client” onto their computers, but all of the data is hosted by the vendor on a remote server. Most ASPs will also be “web-enabled,” meaning that information can be accessed through a web browser if necessary, but the browser access will tend to have certain disadvantages, like slower load times and less intuitive functionality

Other than deployment type, the biggest decision you’ll face is whether to implement a standalone electronic medical records system or a single, integrated system that comes along with billing and scheduling modules. Standalone web EMR applications are generally better for buyers with unique needs that full-suite systems can’t address, buyers who outsource their billing, and those who have already invested in a billing and scheduling system they do not wish to replace. Many popular vendors sell their systems in modules, meaning that the buyer can decide whether they want just the web based EHR or the medical billing and scheduling systems as well.

What Type of Web-Based EMR Buyer Are You?

EMR vendors have customized systems for just about every medical specialty and clinic size: outpatient or inpatient, solo practice or hospital, primary care or specialist, the choices number in the hundreds. In general, these programs can be grouped according to certain criteria:

• Size. Managing the medical records at a small practice with one or two physicians is much simpler than at a large facility with 100+ providers. Though both are looking to eliminate paperwork and improve efficiency, the ability to transfer information and store tens of thousands of patient records is an expense small practices don’t need to incur.
• Medical specialty. Most EMR vendors customize their templates to every different kind of medical specialist – internal medicine, pediatrics, OB/GYN, cardiology, and so on – as well as to specialists with other designations like chiropractors, psychologists, therapists, counselors, and optometrists. These systems facilitate a doctor’s workflow much better than a generic system that just stores basic information.
• Facility type. Buyers at inpatient facilities like hospitals and acute care centers need to manage additional details like patient beds, shifts, and physician rounds, which ambulatory care facilities don’t need to consider. Although these types of facilities tend to lend themselves better to an enterprise system than to a web-based model, there are a few SaaS solutions for inpatient facilities.

The Web-Based EMR Vendor Landscape

Based on your buyer type, the following chart should give you a general indication of some of the top contenders in the EMR vendor landscape.

Market Trends You Should Understand

These electronic medical record market trends should be considered as you select a product and vendor:

• Health Information Technology for Economic and Clinical Health (HITECH). The American Recovery and Reinvestment Act, signed into law in 2009, included $19 billion in funding for the adoption of electronic health records. Providers are eligible for up to $44,000 in reimbursements for the installation of medical records online, which can cover most or all of your expenses in your adoption process.
• Patient portals. Support of smartphone and tablet devices is one of the most rapidly growing segments of technology adoption. EMR vendors have caught on to this demand, so if you use mobile devices in or outside of your practice, ensure that mobile functionality is a primary consideration. For more information, visit our buyer’s guide on tablet PC EMRs.
• SaaS for larger practices. Once upon a time, a web-based deployment was the exclusive domain of small practices who couldn’t afford the up-front costs associated with a locally installed system. That is no longer necessarily the case. More and more vendors are targeting larger practices, offering solutions that compete in functionality with the enterprise systems, offering the best of both worlds.
• More customization. Traditionally browser-based systems have lacked the ability to customize the program to the practice. This is beginning to change, as web EMR technology is advancing and the vendor market becomes more competitive.

Benefits & Potential Issues

Web-based EMRs have a number of key benefits over locally-installed systems:

• Limited IT burden. With a web based EMR, data is kept at a remote centralized location and monitored by IT staff that handles all of the routine back-ups, upgrades, and maintenance. The resulting security and maintenance support is typically far superior to anything a practice – particularly a small practice – could implement on its own, particularly if it doesn’t already have a server.
• Ease-of-use. Since the user interface is essentially a web page, it tends to be highly intuitive and easy to learn. This, in turn, reduces training time and expenses.
• Remote access. Many physicians – particularly those who spend a lot of time on call – appreciate the ability to access their EMR from outside the office. This feature comes standard with any browser-based system and most ASPs, but not necessarily with an enterprise solution.
• Lower up-front costs. Rather than paying a large installation fee, web-based systems come on more of a subscription basis – by paying a monthly fee, the costs are relatively low, but ongoing, becoming an operational expense rather than a capital expenditure.

One of the biggest drawbacks to an online EMR system is that it is dependent entirely on Internet accessibility. If the connection goes down, the ability to access web-based patient records goes down with it. This will be a huge problem if your Internet connection has any history of unreliability. (Note: (ASPs may cache some data, allowing you to locally store information for a few days at a time.) They’re also traditionally harder to customize to the practice, although this is a trend that is beginning to change.

One concern that medical practices often express is regarding data security, since HIPAA compliance such an important consideration. But it should be a given that program marketing itself as an EMR should be HIPAA compliant. Different programs do have different levels of security, however (for example: some programs will have different levels of data accessibility for administrative staff than for doctors), so it’s still a good question to ask when reviewing a system.

The final issue to consider when buying any kind of program is user buy-in and training. Sometimes people become attached to the old way of doing things, and don’t like being told now that they have to do something different. The best way to overcome this is to have all users involved in the decision-making process. By feeling some ownership over selection of the EMR, adoption of the system will be a much smoother process.

Conversations in the Web-Based EMR Market

The following topics have been hot-button discussion points within the EMR industry:

• Meaningful Use and online medical record technology. It's been three years since the inception of the American Recovery and Reinvestment Act, and providers--and patients--are continuing to reap the benefits of the Medicare and Medicaid EHR Incentive Programs by using web-based EHR software. Benefits include financial incentives, better record availability, and electronic prescriptions.
• Wider adoption. In January 2012, HealthFusion, an industry leader in web-based EMR solutions and web EHR, partnered with the American Podiatric Medical Association to help increase adoption within the podiatric healthcare sector, thereby advancing patient care quality. This will help more physicians comply with Meaningful Use regulations to qualify for cash bonuses under the 2009 Health Information Technology for Economic and Clinical Health Act, which is part of the American Recovery and Reinvestment Act.
• The vision for unified reporting. The Centers for Medicare & Medicaid Services (CMS) is offering another incentive to physicians for providing top-notch health care to Medicare patients. Using reporting models within web-based medical software, healthcare providers can participate in the Physician Quality Reporting System (PQRS) and Meaningful Use programs to ensure their practices are compliant with the program. Vendors for web-based medical records are working to build a unified reporting structure by 2014 so systems will be able to measure reporting requirements for both incentive programs.
• Beyond paper charts. As more practices transition from using paper charts to online electronic medical records, providers struggle with how to preserve or dispose of decades of patient information, which is just one of the cons of web-based EHR.

Have an opinion on this guide? Email the authors. We appreciate the feedback.

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