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The Downside of EMR as a Service

Software as a service has firmly planted itself into the very fabric of the internet and daily computing.  EMRs are beginning to venture into this new territory.  At first glance it makes logical sense. It is cheaper and easier to access in many ways. It sometimes comes free. It doesn’t take up valuable hard drive space and can be accessed from anywhere. What is there not to like about it?

 

Well for starters, beauty is only skin deep. When it comes to EMRs, there are some special considerations. Doctors are very busy people and speed and efficiency count. Using an internet based program presents some speed and reliability concerns. For now and into the foreseeable future, most practices will have a certain amount of paper to deal with. Scanning documents over the internet is a very slow process. Scanning documents directly into a server, bypassing the internet, is lightning fast. So if the EMR is an internet “service,” physician practices will likely be forced to keep a paper file due to the prohibitively slow upload ability of scanning documents in. This negates some of the appeal of EMR—going totally paperless. In my group of 12 psychiatrists who are using the paperless EMR ChartShare, it would take a fulltime scanner 2 ½ months (24/7) to scan all the paper documents currently in our system to an internet service program.  This is even if the documents were stacked in one continuous pile going in consecutively without concern for where they were stored. The speed of direct scanning into a local server is dependent mainly on the speed and capacity of the scanner.  Scanning across the internet is contingent on the capability of the internet connection speed, which is very finite. This may someday improve if everyone is on fiber optics, but that is a ways off.

There are some philosophical concerns as well. Physicians have typically always “owned” their records and have been their long term stewards. The idea of floating records out in cyberspace seems very foreign. There will be a greater need for trusting outside corporations to very private information.  I’m still not convinced that that is completely secure.  I still like owning my records, even if they are in digital form. I know where they are and how they are secured.

 

Having a local server is just plain faster. There is no internet lag. With multiple users, the servers can be scaled up to accommodate the load requirements. Comprehensive programs like ChartShare that do everything a clinical practice can throw at it, do better on a local server. On the business side, a good EMR tends to crunch a lot of data and perform extensive searches. This excels on well scaled local servers.

 

Until service software can match the speed and efficiency of local server based programs, I’m sticking with the ownership model, even if the initial cost is higher. In the long run, time is money and having a faster system will pay for itself.