Providers that do not currently have an EHR face a difficult challenge.  They must decide between the 400 + certified EHR systems.  Performance should be the deciding factor when it comes to purchasing an EHR.  After all, you may have an inexpensive or even free system, but if it does not perform well, you did not get a good deal.

Availability is the foundation of performance.  An unavailable system performs poorly by definition.  Complexity is a key factor in availability.  The more complex a system is, the more potential points of failure it has.  The more points of failure, the more likely your system will fail.

We designed XLEMR to be as simple as possible.  XLEMR requires three things in order to see patients:  a Windows computer with Microsoft Office 2002 or later, access to patient records, and power.  Patient records is a system of folders under Windows Explorer that contains patient data in MS Word, Excel, and XML format.  In an office, this is typically shared from a server.  In our “stand alone” architecture, this is stored on the local machine.

The “stand alone” architecture runs XLEMR from a single computer.  We do not need an internet connection to see patients.  We also do not need any database software or LAN infrastructure.  In a disaster recovery situation, we simply copy patient data from the server, on-site backup, or remote backup to any working computer.  We usually accomplish this by USB flash drive or external hard drive.

Compare this to the infrastructure and long list of technologies needed for a SaaS solution.  Even a relatively simple solution like an air card depends on infrastructure like cell towers, routers, switches, cables, data centers and servers.  Recently, we played around with an EMR solution for the iPad called Dr. Chrono.

We received several errors from Dr. Chrono stating that the server was not available.  Once we verified our own internet connection, we had no idea what point in the long chain of infrastructure caused our error.  Furthermore, we have no access or authority to address any connection issues once the signal leaves our building.  Limiting our critical infrastructure helps avoid connection-related issues over which we ultimately have no control.

Many SaaS vendors will advertise 99.999% uptime.  What they mean is that their resources, such as their data centers and servers will be available.  Just like our experiments with Dr. Chrono, once the signal leaves their building, they really have no control over the infrastructure needed to provide you service.  If an issue occurs in between your office and their data center, it is up to your ISP or some third party to fix.  We all know how frustrating dealing with ISPs can be.

If you have not yet purchased an EHR, narrow your search down to simple solutions.  Ask prospective vendors what infrastructure they require.  If you are considering a SaaS EHR, pay close attention to the availability guaranteed both by your vendor and your ISP.

Ryan Ricks
Security Officer