The Office 365 products and services go well beyond the simple creation of presentations, web pages and spreadsheets via web tools.  They contain a valuable set of features and functionalities that end users are dependent on for day-to-day work.  And as we look at health care and its own line of applications that enable better, more connected patient care, one must wonder if there will be a time where electronic health records (EHRs) will learn from the lessons that companies such as Microsoft and SalesForce have identified as critical for success in the software industry.

The following is a list of eight takeaways from cloud-based applications that EHR vendors should consider as part of their long term software development strategy:

Make it cloud or browser-based: Given the pace at which technology change is moving today, IT is more focused on aligning organizational objectives and ensuring compliance rather than managing physical servers and the downtime associated with them.  For that reason alone, many organizations are now looking to leverage cloud-based or browser-based products that require low up-front costs and offer higher up time, availability and redundancy.  Vendors such as Cerner, AthenaHealth and others provide a full hosted application model where there is very little need for a full infrastructure in-house to maintain the application.  In addition, with this model, a cloud-based application requires very little maintenance and experiences very little downtime that could be associated with upgrades, conversions or system updates.

Low up-front cost: In every EHR implementation, there are several items that contribute to the high costs.  From workflow redesign, training and hardware procurement, to software licensing, maintenance and product support, many see the future in solutions that are provided at a monthly fee per user or business unit.  This reduces the up-front costs and allows for the organizations to appropriately budget and justify the use of the new products and solutions.

Scalability: For products that are offered through SalesForce, Google, or Microsoft office 365, it takes the same effort to sign up 5 users as it does to sign up 5000 users; the system is designed to easily scale out.  This is all done behind the scenes, where the client is ready to start using the application right away.  This capability would benefit EHR vendors greatly as their products continuously need to have the ability to scale out, especially when there are clear indicators of health systems mergers, acquisitions and growth.

Easy to use UI: One of the critical success factors for any user-facing product in the market, including EHR packages, is an easy to use, functional and feature rich user interface (UI).  Many EHR systems fail to impress clinicians simply due to the busy and cumbersome UI.  These products must be  easy to use and allow health professionals to attend to their patients without feeling lost in the software.

Integration: As we move toward a health care model that rewards for outcome measures, complete patient care and care team collaboration, many applications are starting to look for ways to allow for protected health information (PHI) to be exchanged, safely and securely.  For Google docs and Office 365, having the ability to connect to other systems, as well as the collaboration platforms, was a useful function in the products.  This would also be a significant feature for EHR packages.  While some do provide the ability to receive and submit health information across a given HIE, there is still a significant lack of adoption from physicians.

Collaboration: Microsoft and Google chose their own collaboration platform as part of their products.  Within Office 365 and Google Docs, there are capabilities for end users to use video conferencing and chatting capabilities.  This provides a useful method for users to communicate beyond the simple email messages.  As accountable care organizations (ACOs) begin to implement their collaboration platforms, there will be a clear demand for chat, audio and video conferencing capability.

Platform agnostic: For software vendors in today’s market, the big question from the majority of prospects and potential buyers is: “Do you have an app for that?”.  That said, for many of these products, having the mobility capability as part of their offerings is now a must-have for clinicians.  Whether it is a hospital system or a small independent physician practice with two physicians, a medical application should have some sort of mobile application that will allow its user access to the information from smartphones, tablets and many other mobile devices.

Power is in the numbers: There are clearly some very powerful players in the EHR marketplace.  These are the groups of vendors that are well established and have had incredible success with high number of users.  However, this does not always mean that there would not be a place for a disruptor.  And in the world of technology, especially the world of software products, it is all about the new, functional differentiators that a product brings to the table and the perceived the value that the software has from users in the market.  Similar to SaleForce, AthenaHealth, Facebook, Chatter, LinkedIn and the other very successful sites, there will continue to be room for new innovators that can disrupt the marketplace and continue to push the technology buck forward, especially in health care.

But as we continue to see EHR flyers and marketing brochures outline the benefits of not using paper charts, we can pause and recognize that there are factors other than the typical benefit that will eventually drive physicians to seriously consider adopting EHR. There are several reasons that can put a medical organization who still relies on paper chart at risk. Especially when we are seeing the transformation that is currently happening the US healthcare system.

Following is a list of 6 items that can put the paper based practice at risk in the near future if they don’t adopt an EHR?

More patients will be asking for it: As more patients get exposed to the benefits of their physicians using EHR and see how a healthcare providers who uses EHR can communicate as well as share medical information with them electronically (such as: X-Rays Lab results, treatment plans, e-prescriptions, and PHR), many of these health service consumers will begin to ask and look for physicians who are using these technologies. This would provide many organizations with a competitive edge and enable them to differentiate themselves from others. This could potentially penalize physicians who are not using electronic health records by losing new patients to their competitor.

Telemedicine and servicing a broader geographic area: Several large health systems are beginning to provide basic health services and specialists consults over video conferencing and for a reduce rate. Many of these services are provided via secure communication channel and do not require for the organization to have a physical office near the patient they are servicing. But many of these physicians that will provide telehealth services will be in need for an EHR to be able to share information quickly. This provides them with a competitive advantage as they can efficiently service a broader patient base outside of their immediate community.

Everyone will be collaborating but you: Some states have already implemented an HIE and as more adopt the health information exchange and some of the care delivery models, many physicians are starting to exchange and collaborate on care. These physicians are able to receive complete patient summary of record electronically and share their information about a patient with others as well. This is also the vehicle that will used by physicians to communicate and collaborate on care as well. But for physicians who are still paper based, they may encounter more challenges when attempting to collaborate and be a member of the care team for certain patient population.

Using remote health monitoring to manage chronic conditions: With the increase in patients with Chronic disease and the current competitive market, many health organizations are looking to adopt technologies to assist with remote patient monitoring services. These would be ways to capture health information and monitor patient’s vitals real time. These technologies would require physicians to have some sort of EHR in place to be able to transmit the information to.

Recruiting new physicians: As part of the medical school curriculum, many new graduating physicians have had exposure to electronic medical records. This would most likely suggest that many of them would favor practices and health organizations utilizing EHR for their future employment opportunities. This would make it difficult for paper-based practices to recruit talent.

Penalties, employers and payers will demand it: Some of the current incentives through MU may not fully cover the costs associated with software and hardware for a new EHR, however some predict that penalties and lower reimbursements may cause more heartburn for physicians who elect to stay with paper charts.These pressures will continue to mount, as there is an increasing push for modernizing the US healthcare.

This is where a hosted model, or infrastructure as a service (IaaS), becomes a more attractive alternative for hospital and health systems currently taking the steps toward EHR implementation. However, this framework will change the role of the IT department in-house, and this is an important distinction to make. With this model, the IT department will no longer be in the business of IT, but will instead be tasked with supporting the organization’s enterprise IT goals and objectives and ensuring that technology is there to improve efficiency within the IaaS model.

Top 7 reasons why hospitals why would consider IaaS for EHR implementation:

Faster resolution and support:

For many of the larger hospitals and health care systems, when implementing an EHR system across the different departments, the IT team spends a tremendous amount of time upgrading, troubleshooting and communicating with the EHR vendor to support the product and resolve technical issues. This creates a tremendous amount of additional work for the IT department. With a hosted or IaaS model, the vendor is fully responsible for maintaining the system, supporting it and ensuring uptime. This means that the hospital IT team spends less time troubleshooting and more time with end-users.

Less upfront capital:

Imagine you are a 500 bed hospital getting ready to implement a system like EPIC or Cerner. There are significant amount of capital investments that need to be made up-front, not only during the upgrade of the infrastructure that will support the system, but also with the additional resources needed to support it. Essentially, when a hospital decides to implement the IaaS model, they are changing the cost from a capital expense to an operational expense, where they are paying the vendors a monthly fee for the services and access to the system and support, which becomes a much more attractive option for many institutions.

Redundancy:

As the natural disasters that we have experienced in the recent months help to illustrate (i.e. tornados, hurricanes, earthquakes), it is critical to have system redundancy and continuous availability in case of system failure. This would mean that a hospital system will have to invest in a data center located in a different geographic area, which will allow them to switch systems quickly in the event they need to protect the hospital records and electronic patient data.

Focus on healthcare informatics:

Getting away from the business of learning and troubleshooting issues with a new EHR system and moving to providing business value through technology is what healthcare IT should be all about. With the quick availability of IaaS services, infrastructure delivered as a service, it enables IT to leverage and focus their time and resources in bringing innovations, solutions and improvements to the healthcare system.

Scalability:

IaaS providers offer a service model where you pay as you go, or as you grow. You can easily scale out the system as needed without any hardware upgrades, which can sometimes be as simple as submitting a request online for additional computing power or storage. And voila! The system can now accommodate additional users from a new hospital acquisition or outpatient practice.

Security:

Security is in the mind of every cloud computing adopter. Whether it is protecting sensitive intellectual property or patient medical information, many IaaS providers have implemented strong security practices and have been granted certifications such as ISO/..IEC 27001 and PCI. These have helped their customers meet the different regulatory and compliance requirements from HIPAA.

Less downtime during major upgrades:

Major upgrades have caused of a lot of headaches for IT folks. Requiring downtime during back-ups, coordinating with the vendors, scheduling onsite visits from vendors — these are all things that can easily be handled, more efficiently, by an EHR vendor in an offsite data center. The hosted model eliminates many of the challenges experienced during a local upgrade and shifts the responsibility and work from the organization and back to the EHR vendor.

Many health care executives and decision makers are beginning to see the benefits of the IaaS model and are starting to carefully evaluate what their IT departments could look like in the future. Employing the technologies and solutions that can help improve efficiency and cut operational costs, while transitioning IT from reactive support to a more proactive business/vendor partnership model.

For many products in the EHR market today, there are actually only subtle differences in terms of their capabilities and functionality. But at times, these are the exact features that can be the key to a successful implementation of the EHR, or not. One could almost apply the Pareto principle here, or the 80-20 rule, where approximately 20% of the features possess the key differentiators and and critical success functions, while the remaining 80% comprise the common features found in most EHR systems.

Some areas of consideration that have spurred conversations among decision makers regarding EHR package evaluation are:

• How effective would some of the products be when interacting with HIEs?
• How are the different EHR solutions going to take ACO models?
• What are some of the different mobile capabilities would be available?

As we’ve been privy to watching unfold, technology has been playing an increasingly important role in the effective, efficient delivery of health care, and continues to present opportunities for innovation and offer a measurable value to both physicians and patients. From utilizing an HIE for better coordinated care to adopting mobile technology and integrating mHealth devices for the viewing of radiology images, lab results or e-prescribing, we are going to continue to see adoption of tools that will not only prove to drive down costs, but also improve the overall quality of care.

For organizations that have selected an electronic method to capture patient information and clinical data, there are several options from which to choose:

Web-based forms: These forms are browsers based (such as html forms) and offer the flexibility of being available and accessible without the need to pre-install anything. They also can be viewed using almost all current platforms and provide the ability to store all data captured from the users as discrete. However, the organization would still rely on web developers to make changes to these forms.

Thick forms: These are the forms that run within specific applications. They are similar to the forms that are available in most EHR packages that are used to capture clinical data as well as registration data. Unfortunately, these forms often are fixed and not easily changeable. They are also only available in the package of which they are a part. We can classify some of the forms available through mobile devices, such as the iPad and Android tablets, under this category as well. MHealth tablets have already seen several apps in their repositories that enable end users and/or patients to enter the data directly into the devices. These forms are, in most cases, written specifically for that platform (iOS or Android).

PDF forms: PDF forms have been one of the most commonly used forms in the industry. These forms can be generated from MS Word documents, or simply by using many of the available off the shelve form builders. They also offer the flexibility to store the data in XML and/or directly to a database. They provide the ability to perform front-end data validation and can run on almost any platform.

Digital Pen: These not so ordinary ballpoint pens can capture handwriting and drawings from special digital paper forms. The information is captured in the device and then uploaded to a central server, where it is then processed and automatically converted into text. While this concept simplifies the capture of data, unfortunately there is still the dependency on the accuracy of the handwriting recognition software and quality of the symbols, which may cause some concerns if the information is not readable.

OCR-based forms: Optical Character Recognition, or OCO, has been around for a while and utilized in many markets, from banking, to the justice system having the ability to scan through a document and recognize the handwriting. An organization can use any form, which provide tremendous flexibility, but unfortunately you are still dealing with a paper document that requires scanning and then disposal as part of the workflow.

The reality is that we are simply finding hospitals using a combination of the above solutions to resolve their data capture challenges. The market had some promising technologies out there, and at one point, xforms showed some promising results, but lacked wide adoption. I was very disappointed to see that xforms did not gain popularity, as it made a lot of sense from a conceptual design standpoint. Similar to XML (XML is a widely adopted method to exchange data across systems in a standardize format), xforms relied on a standard “xml” like method to describe the fields, data types. That meant that many applications had the ability to easily display the forms included mobile devices, as part of an application or simply viewed via browser.

But luckily the dream of having standardized coding for form building has been reborn again through HTML5. Not only can HMTL5 be viewed from any browser or device, but it also means that the forms can easily be modified using web based tools and some of the advanced web authoring applications.

I am most definitely not asserting that HTML5 is the only way to go. There have been many more successful technologies available that enabled efficient data capture across applications and platforms. But we simply need to have some standardization and interoperability in these forms.

Healthcare will always require some data input from patients, family members, clinicians and other staff members. Different devices will be made available for this purpose from tablets, kiosks, mobile devices and desktops. And to ensure ease of use and improved workflow, the technology has to be there to support the overall mission, and so far it’s still too early to tell which technologies will be best suited for the age of electronic data exchange.

Original Article

We also continue to see growth in the hospital market. With more physicians aligning with hospitals systems and IDNs, executives and health IT leaders are looking for new ways to scale out their infrastructures while providing a measurable ROI for the organization.

Currently the market offers several models from which to pick, the selection needing to be based on organizational needs and future goals.

PaaS (Platform-as-a-service): In this model, a hospital would either have access to a private or public platform as a service. It will enable the organization to deploy a set of solutions (EHR, RIS, billing) without having to bear the burden of the hardware and software costs associated with those applications.

SaaS (Software-as-a-service): For this model, we actually see some hospitals providing this service to practices and physician affiliates. This model provides access to a software product (a web based EHR, for example) as a service without any hardware requirements. Some hospitals may decide to work with EHR vendors to gain access to their solutions via this model as well.

IaaS (Infrastructure-as-a-service): With some of the hospitals expanding their reach into smaller communities and rural areas, it becomes challenging to have to try and deploy new IT infrastructure from servers, software, VoIP, networking and technicians. This IaaS model eliminates the complexity, long deployment cycles and costs associated with the equipment.

Many organizations have adopted a variety of these service models and have been able to capture a realized ROI. The bottom line is that these models allow providers and IT leaders with the ability to provision and utilize servers, take advantage networking capabilities, and access storage on demand. These offerings will ensure that health IT leaders can continue to focus their efforts on other projects, from meaningful use and HIPAA 5010 compliance, to ICD10 implementation and more.

Original Article

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

In previous articles, I have discussed the impact mobile health’s rise in the industry and the EHR vendors’ reactions toward the plethora of new mHealth products entering the market every day. Wireless capability and remote data exchange is becoming of vital importance to physicians, as it allows clinicians the ability to expand the continuum of care and push forward telehealth and remote patient monitoring capabilities in their every day practice.

But in a product evaluation session I recently attended, one of the software vendors described their product as being one of the few solutions that offered a truly mobile app for its physicians. Unfortunately, after careful review, what was meant by a “mobile app” was nothing more than the browser based view of the chart that was available to any device, specifically an iPad, Android tablet or a Blackberry.

So, the question I was asked was: What is the difference between a native iPad iOS/Android app and a web based app accessible from iOS/Android platforms? Keep in mind that it is important to recognize the difference between the two, as there are some key functionalities that are lost with the web based app.

There are two common types of apps available in the healthcare market place, the first being web based apps:

Pros:

• A web based app relies on server side processing for rendering content – and while there are some web sites that use local resources on the device itself, simply put, it is a web page that had some additional scripting done to it to ensure the look and feel is somewhat similar to the look of the native apps.
• Easy to deploy and won’t require marketplace approval or Apple Store review.
• Healthcare providers can have access to most of the features and functionality currently offered via web portals from the software vendors on almost any platform.
• Server side processing means better performance in most cases, since the end user does not have to wait for the information to transferred and manipulated on the device itself.
• From a development standpoint, web solutions tend to be easier to develop than native mobile device apps. In fact, there seems to be a shortage in mHealth developers vs. web developers.

• Web based apps are also cross platform compatible, where they can run on any browser regardless of the device you are using.

Cons:

• Loss of hardware integration: In a web based model you are most likely not going to have the ability to use the cam or capture data from an external device ,such as location from GPS, or download data from a heart monitor, read vitals and other data from medical devices.
• Loss of some features, such as multi-touch, gesture recognition. There are web sites that have created controls similar to iOS controls, but they still lack the typical experience that accompanies the native ones.
• Lack of strong support for offline functionality when physicians don’t have access to WiFi or internet access.

Native apps are the products or apps developed using the device’s own development kit or (SDK):

Pros:

• With the ability to be completely offline and the availability of local databases, native apps can easily and securely make charts and other health information available offline for review. This would allow end user to capture data and then synchronize it with the main data store once the connection is made back.
• A native app has the ability to interact with all the available devices through the SDK (software development Kit).Whether the app needs to transmit instructions to an external device, or simply capturing the image of a skin condition, the native app has many options from which to choose.
• In most cases, there are specific guidelines and rules that are required from app developers prior to getting their app published in the online app catalog.

Cons:

• Native apps are move difficult to develop and require specific platform knowledge and programming language.For the iPad/iPhone Objective-C is the common route taken to develop, although other programs, such as MonoTouch, allows software developers who are used to Microsoft c# or .net to write for iOS.
• Costly and longer development cycle comes with this type of product creation.
• Lack of cross platform compatibility, which requires the software vendors to choose a preferred platform or have multiple teams developing for multiple platforms.

Whether evaluating web based or native apps, the most important step during the selection process is ensuring that it meets your minimum set requirements and resolves a workflow challenge. At this point, there are four major players: RIM, Apple, Microsoft and Google. Each vendor has a different programming language and different functionalities. It’s hard to determine who will lead the market down the road, but it is important to focus on what the app can do for you now, as a first step, so that you have a tangible ROI to take back to the table.

Original Article

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

The recent CMS press release states that “providers will fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use. A complete EHR system will provide a report of the numerators, denominators and other information. Then you will need to enter that data into our online Attestation System. Providers will qualify for a Medicare EHR incentive payment upon completing a successful online submission through the Attestation System-immediately after you submit your results you will see a summary of your attestation, and whether or not it was successful.”

The current site is for only the Medicare incentive program, so EPs who will engage in the Medicaid program will need to attest directly on their state’s individual Medicaid websites. The good news is that once providers have completed the online attestation process, they should receive incentive payments within approximately four to six weeks.

While this is only for meaningful use Stage 1, based on the comments made on the proposed Stages 2-3, it is clear that physicians, vendors and other key industry stakeholder groups are requesting pushing back the deadlines for the remaining stages. However, it will be up to the newly appointed ONC director, as well as the secretary of the DHHS, to decide what is the most viable option.

Original Article

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

For the healthcare software market there are several strong giants that provide robust products with every feature known to man. And we continue to see the blurring line between the differentiators of these products. It is common to hear the same sales pitch from each and everyone and not be able to really see why product XYZ is better than product ABC.

So the question to be asked is should healthcare organizations be concerned and careful to whether the product they are purchasing is going to last? Should there be concerns around the acquisitions that are happening? Well the good news is that EHR vendors are not going anywhere. Many of which that were considered too small to get certification and be on the certified EHR list made the mark and are worker even harder to maintain their market share.This is due to the fact that most of the requirements from the certification bodies for meaningful use are functionalities that good healthcare software firms should have in their products to start with. And thanks to faster development life cycle many application developers have been able to meet almost all requirements from the certification bodies.

The one thing that continues to be a critical aspect to whether a software solution will survive the ever-changing market is simply put how the actual EHR product is designed. Is it an open architecture? Can it easily adapt to changes without major redesigns? Examples are the ability of the product to support web services, cross platform, web capable, strong database engine as well as written using OOP (Object Oriented Programming).

But of course there are still top performing EHR vendors that have products that were built using old development platforms and non-SQL based databases. Some of these products have been very successful and in high demands in hospitals.

We have seen many software vendors today in a race to provide mobile apps for their products in order to ensure that the you are not the odd one out. But it remains to be seen weather the “App” is worthy of its title. These mHealth apps must provide first and for most VALUE to the end user (in this case care givers) and not be another marketing bullet in the products brochure or another costly feature on the price schedule.

Original Article

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.

Currently, almost every medical organization gathers vitals at almost every date of service. And now with meaningful use requiring clinical staff to track patient vitals electronically, some  are considering ways of how to use digital vitals capture systems, and do away with a nurse having to manually enter the data into the chart or on paper.  Even though it may not be lots of data to enter, it is easy to see how such devices can speed up the data capturing process.  Several products are available in the market place from vendors like MidMark and Welch Allyn that provide wireless/wired medical devices that can interface with some of the commonly used EHR products in the market.  This simple integration can reduce the time to capture vitals that is commonly associated with the need for clinical staff to read thermometers, blood pressure gauges and other commonly used equipment. Read More

Reda Chouffani is the Co-Founder of Biz Technology Solutions, Inc and an active Healthcare Information Technology writer for Healthcare IT Insider and TechTarget’s Health IT Exchange.