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To Host or Not to Host? That Is the EMR Question
By Keith Slater

Implementation of the HITECH Act has generated a great deal of excitement, not only because of the potential for improved patient care but for increased efficiencies as well. As payments from the Centers for Medicare & Medicaid Services and other providers continue to decrease and revenues become more reliant on technologies that help practices demonstrate meaningful use, practice management and EMR solutions are becoming required tools of the trade.

However, understandable apprehension still exists among many providers. The price tag stigma attached to EMR systems as well as the functionality needed to achieve interoperability raise questions about whether practices can truly enjoy any measurable return on investment.

To address these concerns, practices increasingly are turning to a new delivery model: Web-accessible “hosted” practice management and EMR solutions.

Tradition Just May Not Be Worth the Effort
Expenses add up quickly in the traditional ownership model. There’s the obvious cost associated with initially acquiring the software and associated hardware, but that’s just the beginning. New technologies typically should be reevaluated three to five years after an initial installation. Providers must think about their tolerance for ongoing and long-term resource investment in order to maintain, expand, and upgrade a solution and possibly replace equipment as disk space fills and software feature sets grow.

There are other expenses related to the traditional model, including system support and training for new employees. In addition, providers must find the right blend of IT infrastructure and staffing levels to sufficiently manage and optimize the addition of these and other new technologies.

This is not to say that the traditional ownership model isn’t the best solution for some practices, but luckily there are attractive options for alternative solutions. 

Lower Your Cost—and Stress Level
Growing demand from the provider community has prompted vendors to rethink the way they offer their solutions. The result is a variety of alternatives that are more cost-effective and cash flow friendly for practices with tighter budgets and limited resources.

Today’s providers have the ability to “rent” vendor software and may opt to have the software hosted through a hosting service, or an application service provider, model, whereby software is supplied in a secure data center environment. Off-site hosting typically enables customers to securely access the software over a high-speed Internet connection from any office PC yet eliminates the responsibility for backups and in-house server maintenance. Likewise, it reduces the skill set required for appropriate on-site IT support staff.

The hosted model enables practices to budget for a per-provider or per-user monthly fee for core functionality, virtually eliminating unexpected IT-related expenses. It also provides peace of mind for practices that no longer need to worry about the possibility of a catastrophic system failure. Often, business continuity and disaster recovery planning are services and processes the hosting facility will manage.
In addition to reducing up-front and long-term cash and resource outlays, providers can choose software brands and solutions that may not normally fall within their budgets under a traditional purchase model.

But the benefits achieved through implementing a hosted model are more far reaching than just financial. The aggravation of dealing with system problems may disappear, nightly backups become a task of the past, and software upgrades are integrated and scheduled by the vendor. Hosted solutions allow practice staff to concentrate on maximizing their use of the new software and clinicians to focus on learning how to integrate the software into daily use as efficiently as possible.

Even in the face of all the positives, there are drawbacks. In the hosted model, EMR software and all patient data are stored off site on a secure server. While the likelihood of an off-site hosting failure is remote, there can be technical issues related to local Internet connections. No Internet connection means no access to the EMR. And if an office operates on a Wi-Fi network, it’s imperative that it be secure to prevent unauthorized access to patient data.

When evaluating vendors with hosted solutions, practices must consider a number of factors, including the following:

• Does the vendor offer training and support for practices that become clients?

• Does the vendor offer easily accessible, ongoing training and support for issues related to use and software upgrades?

• How does the vendor protect the data stored on its servers?

• What kinds of firewalls are in place to prevent hacking and/or data loss?

• What happens if there is a catastrophic failure on the hosting side?

• How will a failure affect a practice’s ability to provide effective practice management and excellent care delivery?

• How long will it take for a practice to regain access to its data?

• Since the software is the same whether traditionally purchased or accessed via the hosted model, what practice sizes are in the vendor’s “sweet spot”?

Given the high degree of security inherent to online transactions, this broader range of EMR acquisition options represents a natural progression for the industry. By taking the onus off providers for maintenance, upgrades, and aggravation, we enable them to stay focused on what matters most: effective practice management and excellent care delivery.

— Keith Slater is general manager and vice president of Henry Schein Medical Systems in Boardman, Ohio, which provides MicroMD EMR and practice management solutions to medical practices of all sizes and specialties.