The Challenge Of Electronic Health Records
The challenges faced by Medical Associates are familiar to anyone with a stake in the health-care vertical: the move to electronic health records (EHR) that are both secure and portable, which means saying goodbye to paper charts and handwritten notes and welcoming tablet PCs, electronic prescriptions sent directly to pharmacies, and digital billing codes that physicians generate themselves. It also means deciding what backlog data to digitize, and to whom to provide access, and at what level—all compliant with HIPAA.
Advanced Micro Computer Specialists, Horsham, Pa.—Medical Associates' solution provider—steered the organization toward AEP Networks' Netilla Security Platform (NSP). Medical Associates opted for an SSL VPN, which, Bowman said, was crucial to allowing physicians secure, realtime access to electronic medical records.
The specialized security features of the NSP solution, Bowman notes, include thin-client access to client/server applications, Internet access via HTTP reverse proxy, and network-layer access to enable PCs to exchange data through an SSL tunnel. Bowman also employed AEP's Netilla Security Platform Load Balancer, and has more recently begun integrating NSP's other network access control features.
"Every scenario is different," said Bill Murray, vice president of Advanced Micro Computer Specialists. "The Medical Associates model was a combination of an ASP with a health-care flavor, so to speak."
Although if you asked him today, he might suggest a solution with more virtualization aspects. "Bryce's situation is a unique one where the ASP model—which I thought from day one was a good model—made the doctors' lives easier, because everything was bundled," Murray said.
"People get nervous when you say access from anywhere at any time. We needed to make it secure and functional, but there's nothing worse than a system so secure that no one can use it," Bowman added. "We brought Bill in to see different ways of modeling things, and we were looking at an SSL VPN type connection for all of our offices. AEP ... was very advanced ... and the support was extremely good."
"It can be very overwhelming for a physician's office to go from a paper environment to an EHR environment," Bowman said. "You've got to look at processes. One of the misnomers is that EHR is going to fix workflow problems."
"There are always process changes that need to take place, or at least should, or you're just automating errors faster," said Gerry Bartley, executive vice president and managing director of health-care consulting at InfoLogix, Hatboro, Pa.
Previously president and CEO of Healthcare Informatics Associates, Bainbridge Island, Wash., which was acquired by InfoLogix in October, Bartley's consultations usually concern hospitals, but in any type of health-care setting, he said that problems arise when a client fails to set the right expectations with their employees.
"One of our main challenges is to get a hospital to agree to do workflow analysis. They often see that as delaying what they want to get done, or the vendor is pushing them on a schedule to get things implemented as quick and vanilla as possible," Bartley said. "It is to both sides' advantage to make sure you're answering the right questions. Too often we see a vendor head in a direction they think the client wants."