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Thought Leaders: EHRs

Look up: The right EHR may be in the cloud

Major advantages include interoperability and fl exibility. By John Haughton, M.D. B

uying an electronic health record (EHR) system now has potential risks and rewards. If providers adopt EHRs and are certifi ed for meaningful use for at least 90 days in 2011, they will likely receive an $18,000 bonus from Medicare. On the down- side, choosing the wrong system can cost tens of thou- sands of dollars in license fees and lost productivity. Providers must consider technology at large, includ- ing the advent of secure cloud computing, as well as the specifi c 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 com- municate 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 continu- ity 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 solu- tions provide secure, audit- able and reliable interoper- ability on all of these levels. A connectivity vendor that offers full interoperability can assemble the requisite data from multiple systems

John Haughton, M.D., is chief medical information offi cer for Covisint, a Compuware company.

For more information on Covisint solutions:

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 vari- ety 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 fi rm can serve as a trusted, vendor-neutral conduit for information exchange.

52 February 2011

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 dif- ferent vendors meeting the needs of a specifi c 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 mini- mal. 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 in- corporate 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 fi lters. Some registries can automatically report quality data to Medicare and other payers to fulfi ll PQRI, pay for per- formance 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 offi ce 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 offi ce or practice-specifi c database segments directly by an outside user.


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