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often unavailable outside the hospital. Smaller commu- nity hospitals, in particular, are unable to provide such access to physicians. An IHR, in contrast, utilizes integra- tion techniques to enable physicians to view encounter- based patient charts for their patients from any location at any time. Moreover, a truly patient-centric IHR uses a master patient index with a record locator to collect all

Ravi Sharma is president and CEO of 4medica. For more information on 4medica:

of the regional data on a patient from multiple providers if the proper authorizations are obtained. What this means to the practicing physician is that it is now possible to assem- ble the actionable data needed to make more informed medical deci- sions more quickly – and to do it without purchas- ing a conventional EMR system. While there are SaaS (aka “ASP-model” or “cloud-sourced”) EMR systems, they are just as cumbersome to use as client-server EMR sys- tems – and, in fact, many of them are just client- server applications hosted by the vendor. Despite being hosted remotely and delivered over the In- ternet, such EMR systems do not necessarily have any better connectivity than those that reside on an in-practice server. In contrast, an IHR offers

a patient-centric chart that incorporates data across multiple organizations to provide physicians with a more complete view of the patient health record. That is why the IHR model is superior to, and will eventually replace, the EHR approach.

Meaningful use The American Recovery and Reinvestment Act

(ARRA) specifi es that providers must show “meaningful use” of qualifi ed EHRs to receive government incentives. But the interim fi nal rule on EHR certifi cation addresses only EHR components that are related to meaningful use. Moreover, the government defi nes any combination of certifi ed EHR components that is used to show meaning- ful use as a qualifi ed EHR technology, which is not the same as the conventional EHR systems that have been

marketed by different vendors for years. Can the components of an IHR, as described above, satisfy the meaningful-use criteria? Let’s start with the fact that a key goal of the meaningful-use criteria is to increase interoperability and connectivity. Almost half of the 25 Stage 1 (2011) meaningful-use criteria require interoperability or connectivity. That will require archi- tectural changes for most of the existing EMR systems. Moreover, the visit-note documentation that most EMR systems have is not required for Stage 1 certifi cation. While several major EMR vendors have pledged that they will meet the challenge, it will not be easy for most. Physician groups that have an IHR, on the other hand, are more likely to demonstrate meaningful use more easily by working with Web-based certifi ed modular products – and at a much lower cost. An IHR would already include the desired connectivity for items like electronic prescribing, exchanging data with other physi- cians, providing CCDs to patients and the ability to accept lab results in discrete format. Quality reporting, too, can be ac- complished fairly easily, as the IHR’s SaaS model leverages relational data- base like Oracle.

If practices wish to qualify for the full amount of government incentives, they will have to dem- onstrate meaningful use

sometime in 2011. Since it takes 12 to 18 months to choose and implement a typical EMR system and even longer to show meaningful use with connectivity and integration with other systems such as labs and elec- tronic medications, groups that are just getting into the market now are likely to miss such deadlines. When one considers the poor adoption rates amongst existing EMR systems, these physician groups are likely to ex- perience the inherent diffi culties with work fl ows that make most of the existing EMR systems more diffi cult for them to use.

An IHR can be implemented in a much shorter time frame, cost less and provide a quicker return on invest- ment. If a group with an IHR can also show meaningful use and win government incentives, it will come out a winner, and so will its patients.


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