Thinking about a Web Based EMR?

Several Ophthalmic EMR's are now web based. With all the recent hype of "the cloud", fancy lingo like "its the future", and claims of lower upfront costs and less IT concerns, why not go web based?

Web based software has been around for ages. Early on it was largely unpopular due to lack of technology, poor internet connectivity and geeky names such as SaaS (Software as a Service) and ASP. The recent widespread availability of broadband internet, the success of smart phones, tablets, and services like Salesforce.com, and the Google inspired buzzword "Cloud Computing" have launched the once laughed at concept into a fad bandwagon that every vendor seems to want to jump on these days. With the significant profits waiting to be made in "the cloud", why wouldn't they?

Although you probably think we are Cloud haters by now, we'll start by saying web based software is a great option to have for lightly used software and services. There is also no doubt the tech industry is rapidly embracing the concept. Google, Amazon, Apple, Microsoft, and countless other companies and investors are investing billions of dollars to build the infrastructure to serve the anticipated exponential growth of data "the cloud" will generate. Programs like Microsoft Office, and even your entire personal computer are already offered via seemingly low cost monthly subscriptions over the internet.  Although the concept can be mutually beneficial, and works great for your lightly used disposable computers, iPhones, and   on the go sales agents... a web based EMR is not for everyone, and before you dive head first in that world, consider a few of its drawbacks.

Lack of Ownership & Control

With web based EMR's, data is not yours. Your EMR is not your EMR. It is their EMR, and they are letting you use it. You are not free to use your data however you wish, you are at their mercy and their control. They can lock you out of their system at any moment for any reason they see fit. If you become tired of the all the issues web based software creates, and you decide to change, you may have to pay the web based provider chart access fee's indefinitely in order to access charts entered into their system. If they provide you the raw data, it will likely not be in a usable format. You will never lose your dependency on them.

Your data is located on the same database server hundreds if not thousands of other users are using. Make no mistake they will data mine your blinded clinical data, and make huge profits selling it to other companies. Will they share the profits with you? HIPAA does not protect you from blinded clinical data collection. The government wants your data, and so does everyone else. You will have no control over what is done with your data, no matter how much encryption they claim, or how many promises the sales person makes. They have the data and the keys, and it is valuable.

Furthermore, they can update their system at any moment, instantaneously affecting hundreds if not thousands of users. Will they always do it right? How many times will they adversely effect their entire user base? With Client/Server you will receive updates as you are ready for them. Updates will be forced on you if you are web based whether you are ready for it or not.

Individual responsibility or big brother? You decide.

Outages & Reliability

Don't let them distract you from reality by telling you their system has 99.99% uptime and reliability, and their "economies of scale" make it more reliable and secure than Client/Server. Although their servers may not go down because of the redundancies they can afford from their end, on your end that is just NOT TRUE! There are other contributors to downtime swept under the rug such as your internet service going out much more frequently, large scale internet problems not affecting them locally, problems they cause "tripping over the wrong wire" on their end, forced updates gone wrong, oversubscription, problems caused by other users that affect you, performance issues during peak times of the day, issues related to internet browser compatibility, toolbars, widgets, add-ons, spyware, adware, the list goes on and on. With Client/Server you can limit your surface area, and will experience far better reliability as long as you choose the right equipment (which we will help you with). You can even achieve datacenter uptime using our server failover and/or our low cost real-time server synchronization features. Click here for more information about server synchronization.

Lack of Performance

Connecting to the Cloud . . .    Loading Patient . . .   Uploading Images . . .    Loading Images . . .

When they demo their software to you, it will be demonstrated in a clean and ideal artificial demo environment, where there is no such thing as latency, outages, oversubscription, and lack of bandwidth. They all "do it better than the next guy", and all have "worked the kinks out". Only when you go live will you realize the realities of web based software, and you will be dramatically slowed down by it. Furthermore, Ophthalmology as you know is very image intensive, and your hopes are high if you think that 12 four megabyte Fundus Photos will display in real time over the web. Server side image processing helps, but it is still much slower, especially during peak times when there are large demands on their servers caused by all their users. Not to mention the agonizing amount of time spent waiting for uploads to complete. Don't let them tell you files are compressed so they upload/download faster. Most images are already compressed and will usually not compress much further. If you go web based, have your patience handy, and reduce the amount of patients you see, because you will be slowed down. Some Cloud Based software vendors can move the server/data to your site, but you will still be limited with decreased performance, ergonomics, and features.

Lack of Features & Cumbersome Internet Browser Interface

Web based user interfaces are dramatically different than client/server. Although on the surface they are attractive, the devil is in the details. There are many things not possible or practical in web based software, and make no mistake you will be limited in more ways than one. As the program is based on a web page type interface, is not as fluid as Client/Server and it will annoy you, even if they move the server to your site. Because it is used within an internet browser, toolbars, widgets, add-ons, etc will effect the presentation, ergonomics, & reliability of the EMR. You may not realize this during demos because they are at the wheel, and they clean up and full screen the internet browser during presentations.

Reduced Integration Flexibility to Practice Management Systems and Diagnostic Test Machines

Because your clinical system is "on the cloud", interfacing your Practice Management System and your Diagnostic Test Machines will either be complicated, unreliable, costly, and/or impractical. If the Cloud Based provider supports these integrations, all sorts of workarounds and 3rd party tools will have to be implemented to accommodate technology that was not designed to be used in this environment. Costly VPN's may have to be setup, and complicated/delicate 3rd party software tools will have to be installed and configured on your unreliable workstations. If you don't have a server, the interfaces will go down every time you have a problem with the workstation hosting the software as they do not offer the reliability found on a server. Once setup, the interfaces may not be real-time, creating delays that will force you to hit refresh buttons, or force you to wait for polling and/or data transfer to occur over the internet. As the cloud based provider grows, the complexities and wide array of patches and workarounds the provider has done in an attempt to accommodate these integrations may become difficult to manage, leaving your practice exposed to reliability issues. If you outgrow or lose your desire to stay on the PM system offered by your clinical system provider, your Practice Management options will shrink considerably as many of them do not fully support this type of environment.

Cost

Over the long haul, you will pay much more for EMR going web based than you will immediately realize. It is long been said that the key to long term success is recurring revenues. A web based EMR takes this concept to levels that will drain your bank accounts for the rest of your practice's life. Rather making an investment that will only affect you for a short period of time, you will be bound to a significant recurring monthly expense that will never go away. To add insult to injury, you will still need computers, and you will have to pay much more for a reliable internet connection that has both fast download & upload speeds every month. If upfront cost is a barrier for you, we can lease our software and hardware to you with 36 or 60 month terms and a $1 buy out, usually for less or near the monthly cost of ASP. You will physically own the software and data from day 1, and be able to pay it off. Also, because of performance issues and lack of features of ASP, you will be slowed down and not able to see as many patients. How much will that cost you? Can you afford to go down every time your internet goes down? Don't save a penny to end up losing a dollar!

Web based software is a great thing for the right kind of user, and there is no doubt web based software will change things for many people. In the distant future, web based EMR's will be successfully used in greater numbers once gigabit internet speeds are commonplace, fiber is available to all, and the platforms are improved to match Client/Server user experiences. But the reality is the future is not here yet, and right now the web based EMR vendor has more to gain than you do.

Don't let their talented marketing staff steer you down the wrong road!

Still not convinced? Click here and take a free trial of the cloud based Microsoft's Office 365, and try to create a word document with columns, right click to copy and paste images, and insert large images. This way you can experience the cumbersome interface, the lack of functionality, and the lack of advanced features "the cloud" has to offer for yourself.