Monday, May 2, 2011

What are the Critical EHR Technology Infrastructure Issues?

The loss of access to you PMS may be disruptive, but your will still be able to practice medicine.  However, the loss of your EHR will stymie you clinical operation and pose serious challenges to continue serving patients.  Preventing the loss of your EHR requires appropriate hardware design and management commitment to invest monies to mitigate the chance of an EHR failure.

The problem is illustrated with two EHR proposals: one proposal offers hardware that is twice as expensive as the other proposal but includes built in redundancies to prevent the loss of the EHR.  All things being equal, which vendor is offering the better product?  Unfortunately, a large number of physician practices are facing this dilemma, and are not considering the implications and risks of basing an EHR on an inexpensive, but undersized or unprotected hardware infrastructure.

Even if your vendor recommends an inexpensive hardware setup, you may end up with false savings.  For example, some practices purchase hardware that is maxed out and cannot be expanded.  In the event of any growth, you may have to replace key system components.  A number of vendors do not even offer high availability options for their proposed EHR hardware.  Would you be willing to spend $5 or $10 per day per provider for additional protection against the loss of your EHR in the event of a hardware failure?  What would it cost your practice to lose access to you patient records and operational patient service information for two or three days?  How much would it cost you to restore your backed up patient information and bring the EHR records up to date?

Even if you get a great EHR product that has all of the features that you want, that EHR must be installed on a technology base that can support your practice and protect your patient records.  In too many cases, practices are purchasing systems that are based on inadequate hardware or software bases driven by cost issues.  Indeed, it is not unusual to discover that cost cutting affected computer hardware costs rather than EHR licenses or EHR services.  In a number of situations, practices discovered too late that the hardware they purchased could not meet full production or use of the EHR.  For example, practices have discovered serious communication deficiencies as they expanded the use of the EHR in their offices.  Similarly, practices have discovered unacceptable performance problems when they extended use of the EHR to all doctors or even after they installed an updated version of their EHR software.

Interestingly, many vendors offer Application Service Provider (ASP), Software as a Service (SaaS) or “cloud” based EHR products.  All three strategies offer an EHR based on hardware in a service center accessible over the Internet.  However, not all ASP/SaaS/Cloud products are backed by the same level of service, or redundancy.  Some practices have experienced debilitating drops in system response due to the lack of vendor capacity to meet the addition workload of new practices.  In other situations, practices have discovered disruptions due to hardware failures at the ASP/SaaS/Cloud computer systems when they expected redundancies and backup facilities.  For example, a hardware problem at one ASP prevented all customers from accessing their patient information.  Unfortunately, a surprising number of ASP/SaaS/Cloud contracts are not forthcoming on the level of service or availability strategies that your practice can expect.  In the absence of specific ASP/Saas/Cloud assurances, your practice may be better off implementing your own hardware base to support the selected EHR product.

In order to avoid problems and protect your access and use of the EHR, you need to insure that you invest in the hardware base that can handle the volume of work that your practice will generate and cost effectively protects you from hardware failures.  Note the following key issues:

Availability – Most practices are not researching the costs and benefits of buying systems with built in tolerances for component failures.  For example, you can buy redundant EHR database servers that will continue to work even if your main EHR server fails.  Hardware prices and new technologies have made system redundancy options and better system protection available at attractive prices.  For example, Storage Area Networks (large storage devices with a variety of redundancy options) start at $10,000.  Such options cost $100,000 or more just a few years ago.  Virtual machines allow you to establish redundant servers with only a few physical computers whereas you would have had to purchaser separate computer hardware a few years ago.  In some cases, practices will purchase extra tablets or workstations to cover any problems with access due to a failure. At the end of the day, you have to look at the costs of purchasing such redundancies against the cost of losing the EHR and the recovery period you will have to deal with.

Capacity – Of particular note is your strategy for dealing with you paper records and diagnostic images.  If you are scanning some of your old charts as part of your transition strategy, your practice will require a larger storage device.  For example, intensive scanning at the initial stages of your medical record transition has been known to exceed the storage and processing capacity of hardware infrastructure that was not designed to support initial scanning.  You need to also make sure that you leave options and capacity to accommodate growth.  For example, if you will have 50 EHR users, you do not want to buy a system that can only expand to handle 55 users.  Similarly, if you buy a fully maxed out storage device, what will happen when you need more storage in a year or two.

Communication – EHRs require more communication capacity since you are dealing with more and constant access to patient records as well as more users.  Indeed, every clinical staff member and doctor will need access to the EHR.  A surprising number of EHR installations have experienced problems due to undersized communication facilities based on the incorrect number of users or wrong communication capacity needed for each user.  Indeed, your implementation strategy could affect your communication needs.  For example, setting up a centralized scanning location for portions of old patient records will create a different communication requirement that scanning records in all practice locations.

Configuring hardware infrastructure to support an EHR involves a variety of acronyms, terms and strategies that many practices may find confusing and complex.  However, all practices need to take an active role in defining the computer infrastructure risks you are willing to deal with as well as the money that you are willing to invest in technological solutions to risks you find unacceptable.  Unfortunately, too many vendors are proposing minimal computer system solutions to minimize costs without offering alternative structures that enable your practice to make your own risk and cost analysis.

© Sterling Solutions, Ltd., 2011 

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