EHRs: A way around start-up costs

If you're thinking about getting an electronic health record system, you must first decide whether you want the software and the patient data to be stored in your office or on a remote computer server. The advantage of having the EHR on your office network is that you have complete control over the data. The disadvantage is that you have to buy the server and a license for the software, which can involve hefty up-front costs. You'll also have to maintain the server and the associated database.

So some physicians have chosen to have a vendor store the EHR program on a remote server and, in effect, rent it to them. Using a secure broadband Internet connection, this "application service provider" (ASP) shares the program with computers in your practice and stores changes in the electronic record as physicians and office personnel enter new data. With today's high-speed connections, the data interchange between the ASP and a practice's computer network is nearly as fast as it would be if the EHR were sitting on a server in your office. And the ASP does all of your server maintenance and program updates.

You can also rent practice management software from the ASP. Or, if you already have a billing/scheduling system on your office network, it can be interfaced with the electronic health record delivered by the ASP.

Keeping records safe is easier Many physicians wonder whether their data will be secure and accessible if they go with the ASP option. This is a legitimate concern, but many doctors have had good experience with ASPs.

Brett M. Law and Matthew W. Marchal, a pair of family physicians in Richmond, VA, have had their Physician Micro Systems EHR for nearly a year. While PMSI sells its electronic records for use on office-based networks that include servers, it also provides an ASP version, which Law and Marchal chose. Their patient data is stored on PMSI's "triple backed up" servers in Seattle. Since last February, the family doctors have lost access to their records for just one two-hour stretch, and that was because their Internet connection went down.

This example illustrates two things to look for in an ASP setup: First, the ASP must have redundant servers-ideally, in more than one location-and backup generators in case of power failures. Second, notes Mark Johnson, an ASP vendor in Dallas, it's helpful to have more than one way of connecting with the Internet, so if your DSL or cable connection goes down, you can still access your data.

You should also make sure that your ASP contract gives you the right to get your data back if you switch vendors, warns Ron Sterling, a healthcare consultant in Silver Spring, MD. And watch for buried language that gives the ASP the right to switch off service and terminate your license if you miss a payment. "That's pretty dangerous, because they have your medical records," he says.

An ASP contract should specify that patient data are confidential and shouldn't be shared with third parties. An ASP's encryption of data and use of "virtual private networks" provide a high level of security, but you should ask the vendor about that, too.

ASPs come in many flavors Most established electronic health records companies offer their software for use in both conventional office-based networks and over the Internet. Some vendors, such as Alteer, and MedPlexus, supply their own products on an ASP basis only.