If your EHR Web host locks you out

March 21, 2008

Take these precautions with Web-based EHRs.

Key Points

Doctors who once worried about losing a paper chart now worry about losing all of them in the world of Web-based software.

That's a risk-small, but real-when an "application service provider," or ASP, hosts an EHR program on its computer and charges you a monthly fee to access it via the Web. On the plus side, such software is initially more affordable than a program that you buy outright and install on your own computer in a traditional "client-server" network. But when patient records reside in somebody else's computer hundreds or thousands of miles away, it's easy to fear losing control of them. What if your ASP goes belly-up?

The number of possible players in ASP arrangements heightens this insecurity. The ASP can be the company that makes the software, a billing company, or an IT services firm. A hospital wanting to subsidize an EHR for its medical staff could either host the program on its own computer or farm out the job. Confused? We interviewed several healthcare IT experts to learn how to retain your records in five different ASP scenarios.

You part ways with the software vendor. Thinking of ditching your EHR program for a new one? "It's easier to divorce a spouse than divorce EHR software," warns Drury.

The hard part isn't retaining your patient records. Vendors of ASP programs proclaim that you own the data and they'll turn it over to you at any time. What makes the divorce so difficult is transferring that data into your new system.

Chalk up that problem to the lack of interoperability between competing EHR programs. You can't pour the contents of one program-diagnoses, medications, lab results, etc.-into another program and expect data to automatically fall into the right database fields. You can hire someone to write a special program to transfer the data, but that's not practical, given the high cost involved, says healthcare IT consultant Mark Anderson in Montgomery, TX. Some programs are able to exchange a so-called Continuity of Care Record, but it's only a chart summary, and even then, data conversion may not be glitch-free. The most feasible solution is converting patient records in the old system to PDF files and importing them into the new one, says Jeffrey Daigrepont, a principal at The Coker Group, a practice management consulting firm in Alpharetta, GA. EHR vendors advertise that they'll indeed export your records as PDFs.

Another way that divorced vendors surrender data is by installing a copy of their software on a computer in your office, but only allowing you to read your patient records with it. While you can't enter new information, you still can look up the note from Mrs. Smith's last visit and print it out, if necessary.