Providers that do not currently have an EHR face a difficult challenge. They must decide between the 400 + certified EHR systems. Performance should be the deciding factor when it comes to purchasing an EHR. After all, you may have an inexpensive or even free system, but if it does not perform well, you did not get a good deal.

Availability is the foundation of performance. An unavailable system performs poorly by definition. Complexity is a key factor in availability. The more complex a system is, the more potential points of failure it has. The more points of failure, the more likely your system will fail.

We designed XLEMR to be as simple as possible. XLEMR requires three things in order to see patients: a Windows computer with Microsoft Office 2002 or later, access to patient records, and power. Patient records is a system of folders under Windows Explorer that contains patient data in MS Word, Excel, and XML format. In an office, this is typically shared from a server. In our “stand alone” architecture, this is stored on the local machine.

The “stand alone” architecture runs XLEMR from a single computer. We do not need an internet connection to see patients. We also do not need any database software or LAN infrastructure. In a disaster recovery situation, we simply copy patient data from the server, on-site backup, or remote backup to any working computer. We usually accomplish this by USB flash drive or external hard drive.

Compare this to the infrastructure and long list of technologies needed for a SaaS solution. Even a relatively simple solution like an air card depends on infrastructure like cell towers, routers, switches, cables, data centers and servers. Recently, we played around with an EMR solution for the iPad called Dr. Chrono.

We received several errors from Dr. Chrono stating that the server was not available. Once we verified our own internet connection, we had no idea what point in the long chain of infrastructure caused our error. Furthermore, we have no access or authority to address any connection issues once the signal leaves our building. Limiting our critical infrastructure helps avoid connection-related issues over which we ultimately have no control.

Many SaaS vendors will advertise 99.999% uptime. What they mean is that their resources, such as their data centers and servers will be available. Just like our experiments with Dr. Chrono, once the signal leaves their building, they really have no control over the infrastructure needed to provide you service. If an issue occurs in between your office and their data center, it is up to your ISP or some third party to fix. We all know how frustrating dealing with ISPs can be.

If you have not yet purchased an EHR, narrow your search down to simple solutions. Ask prospective vendors what infrastructure they require. If you are considering a SaaS EHR, pay close attention to the availability guaranteed both by your vendor and your ISP.

We would like to thank everyone who participated in our stimulus webinar yesterday. Dr. James Jewell of Rock Hill, South Carolina practices geriatric medicine in and around Charlotte, North Carolina. Dr. Jewell shared his personal experiences attesting for meaningful use.

Dr. Jewell works with three nurse practitioners. A long time user of XLEMR, Dr. Jewell began working towards meaningful use earlier this year. Once he upgraded to the meaningful use certified version of XLEMR, the Regional Extension Center (REC) for the Carolinas worked closely with him to begin attestation.

The REC approved Dr. Jewell for the Medicaid stimulus track. The Medicaid track pays providers up to $64,000 to implement and use a certified EHR system. In order to qualify, a practice must have at least 30% Medicaid patients for a period of 90 days. Rules for Medicaid vary from state to state, so anyone who is interested should check with their respective REC for details.

Unlike Medicare, Medicaid only requires that eligible providers (EPs) purchase and install a certified system. They do not have to begin meeting the meaningful use measures until stage two. Stage one offers approximately $20,000 per provider. Dr. Jewell has already collected the stage one payments for himself and his providers.

You can download Dr. Jewell’s presentation on our website at http://www.xlemr.com/webinar.html. You can also go here for a direct download: http://www.xlemr.com/videos/110713_Stimulus_Webinar.wmv. The presentation runs approximately one hour. For best results, download the file to your computer before attempting to play. If you would like to speak with Dr. Jewell privately, please call us at 678-908-3543 or write to info@xlemr.com.

The iPad has generated a lot of buzz in the health IT scene lately. Physicians seem to naturally gravitate towards iPhones and other smart phones, so it seems natural that they would also enjoy using the iPad. Despite the buzz, it is not clear just how useful an iPads or similar devices would be within a medical context.

The iPad is a neat device, although most of us at XLEMR do not own one, we can appreciate its sleek design and easy portability. Many people love the easy touch screen interface the iPad offers. We look forward to where the technology will evolve in the near future.

That being said, we are dubious about the value the iPad offers the healthcare market. Most health IT experts like the iPad for consuming data. Looking up data, reviewing medical images with patients, or otherwise passively accessing information seems to be the iPad’s best use-case.

Data entry is where the iPad becomes less useful. Typing anything more involved than a quick tweet becomes cumbersome and frustrating. Using an iPad for the amount of data entry required by EMR could really slow down physicians.

Speed is the critical factor in judging EMR systems. The main complaint physicians have against EMR is that it slows them down. Slowing down a physician’s workflow results in lower patient volumes, and in turn, less revenue for the practice.

Navigation, training, and cost are other factors physicians should consider if they want to use an iPad-based EMR. Navigation closely relates to the speed issue. Users become easily frustrated if they can not access parts of the record in an efficient manner.

Training will still be necessary, whether a physician selects a native iPad EMR or purchases an interface to his existing system. Many people believe that Apple’s graphic user interfaces are easier to learn than Windows interfaces. That may or may not be true, but staff will still need training.

Finally, cost will be something physicians should consider. Apple hardware tends to be a good bit more expensive than equivalent Windows machines. As for the EMR application itself, pricing will likely depend upon whether the EMR is designed for use on the iPad from the ground up, or whether it is an interface to a standard system.

In short, the jury is still out on the iPad. Although many experts suggest the iPad may be of limited use with EMR, we are considering developing an interface. Please stay tuned to our blog for more information. In the meantime, you may want to check out Jonathan Wofford’s blog about the iPad.