Major advantages include interoperability and flexibility.
John Haughton, M.D.
Buying an electronic health record (EHR) system now has potential risks and rewards. If providers adopt EHRs and are certified for meaningful use for at least 90 days in 2011, they will likely receive an $18,000 bonus from Medicare. On the downside, choosing the wrong system can cost tens of thousands of dollars in license fees and lost productivity.
Providers must consider technology at large, including the advent of secure cloud computing, as well as the specific capabilities of EHRs in such areas as health information exchange (HIE), collaborative care, quality reporting, registries and analytics.
Levels of interoperability
Physician practices should have EHRs that can communicate patient and population care needs and trends with other systems and other care team members. But, except for a limited bolt-on ability to exchange continuity of care documents (CCDs), most stand-alone EHRs were never designed to share and communicate patient information with other systems and full-blown HIEs.
Certain cloud-based solutions provide secure, auditable and reliable interoperability on all of these levels. A connectivity vendor that offers full interoperability can assemble the requisite data from multiple systems in a clinically useful single view, so that physicians don't have to buy and maintain point-to-point interfaces for many different systems. When evaluating cloud EHR solutions, it is important to ensure that the selected vendor has a secure network that links to all of the data sources the practice requires.
The full-service connectivity vendor may offer a variety of cloud-based EHRs and other useful applications, but it should be neutral with respect to the marketplace. By limiting ties to any particular EHR company, the connectivity firm can serve as a trusted, vendor-neutral conduit for information exchange.
A cloud-based EHR vendor should allow application sharing and acquisition to occur in a simple, low-risk fashion — more akin to an “app store” on a mobile phone than a multi-year acquisition process that can be part of some current stand-alone solutions. The physician may be served better if he or she can identify a technology partner that supplies a range of applications from different vendors meeting the needs of a specific practice better than the modules of an integrated EHR.
Other planning considerations
As health reform and a move to value-based payment evolve, doctors will need access to functions that are not commonly found in traditional, stand-alone EHRs. For example, registry functions in most EHRs are fairly minimal. But registries are important for quality improvement, quality reporting, and population health management and pay-for-performance reporting. So a physician can pick a connectivity vendor that is also an approved registry or incorporate a stand-alone registry program in a connectivity vendor's “app store” to generate actionable reports on care gaps for individual patients. Registries provide snapshots of patient subpopulations by condition and other filters. Some registries can automatically report quality data to Medicare and other payers to fulfill PQRI, pay for performance and other program requirements.
Many physicians are concerned about the security aspects of cloud-based EHRs and online data exchange. But encrypted communications, well-protected Web portals, proper authentication techniques and audit trails can ensure that patient data remains secure. In fact, sourcing an EHR from a reputable cloud solution minimizes the effort to remain compliant with complex and evolving security rules, as the cloud vendor carries that responsibility. With a locally hosted system, the physician office or practice must implement the security protocols directly on their own equipment.
To create a virtual health record whenever it's needed, the cloud aggregates data from multiple systems, without allowing access to the office or practice-specific database segments directly by an outside user.
John Haughton, M.D., is chief medical information officer for Covisint, a Compuware company.
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