A certain doctor’s practice had been using EHR software for many years; they had been paying a pretty penny too. For their own reasons they wanted to change their software. They were going to brave the uncertain and scary world of transitioning their current EHR to another one.
A round of applause for that decision alone, for many practices tolerates their EHR system only because they have paid a lot of money for it and have spent a lot of time training on it. They just don’t want to go through the pain all over again. This works out in favor of most EHR system vendors, doesn’t it? Make the process so painful that the physicians would not want to go through it again and thereby locking the caregivers into an eternal commitment. This is a version of Stockholm syndrome where the hostages become accustomed to the demands of their kidnappers. And this is very profitable for the EHR companies, as they charge anywhere from 20% to 60% of the original cost of implementation every year as licensing and “upgrade” fees for no additional benefit.
The next step for the practice was to retrieve their patient records from their existing EHR so that they could port it over to the new EHR system they were considering. This process drove the head of the practice into one of the most anxious days of her professional life. No, they wouldn’t give her the data without her paying them $15,000. No, they wouldn’t give her structured data but only PDF documents of her patient records. No, she cannot access the data herself. Even if she did access the data, the data was stored in a proprietary database. Even if it was accessible via ODBC, the database structure was so convoluted that it would take weeks for someone to analyze and extract the data.
Fortunately for her, we at ZH Healthcare, have made an art of extracting data from such type of databases, and we did the entire transition for her in about four weeks. The process cost the doctor a mere $2500.
This is not an isolated incident, but a pervasive business model in the EHR industry that Congress is trying to solve, as detailed in this article in Politico. Another article, titled “Why do EHR firms own patient data when other software vendors don’t?” also points out to the absurdity of the current situation with lock-in EHRs.
[Read More: Who Owns the Data in Your EHR?]
This episode and many more like hers have driven me to issue the following advisory to the rest of the folks who are thinking of putting their data on cloud based EHR systems or any other cloud based applications that store data that is critical to you and your customers.
Before I list down the list of items to check off before you sign off on that cloud agreement make sure you:
Understand the following two important points
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You have the power.
Do your homework. You are not the poor sheep who are being herded for slaughter. There is so much competition in the market today for EHR systems: over 1000 and counting in the US alone. There are more and more companies out there who are willing to grab on to any edge they can get to serve the customer. Go around and find one that will meet your demands.
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Why sign a fixed contract?
In previous years and decades we needed to lock in prices because prices generally went up. That is changing in the SaaS market place. Prices are generally going down. Also, if you are not happy with a service you should be able to leave. You should stay with your provider only if you get great service and not because he has locked you in. You don’t want to help build more monopolies, do you? You should strive to find a company that is independent and strives to retain you every single day and whose policy reflects that.
After interacting with hundreds of clients over two decades, we have come up with the following six features that every cloud provider must offer their clients to make them secure in trusting you and also to have some control over their data.
Six key features every cloud EHR provider must offer you.
Your EHR provider accommodates interoperable formats like CCDA.
Most MU 2 certified EHR systems are mandated to have the CCDA export and import feature. This format will not give physician practices the appointments or billing data but it will definitely give them all clinical data related to the patient. If you are worried mostly about the clinical data alone, download and store your patients’ records in the CCDA format.
You must be allowed to download your database whenever you want.
We allow all our subscribers to download a copy of their database using SFTP to their local repository. Most EHR companies have secure ways of storing your data, but what if this security is compromised? Your data could be lost forever! By allowing subscribers to download their own data, the company creates another bulwark to guard the data. Even if all the secure, cloud based architecture with disaster recovery and business continuity fail to impress you, you should be able to have a copy of the database in your own secure environment.
Do they give you API access?
This is one of the standard methods most cloud providers give access to the database. Learn more about Cloud APIs here.
The best way is real-time replication of the database.
This is really important. Clients should have access to real time replication or mirroring of their database to their local servers or private clouds. This gives the clients the latest changes in the database as it is made on the cloud as well. Clients can then integrate their other applications and systems to this local replica.
Do they give you structured data?
Most EHR companies provide you data in PDF documents or unstructured formats. This means that you cannot import them into other databases. What is the use of having an entire list of patients and their demographics in a PDF document? The most popular open source database, MySQL database, is preferable. Let me distinguish this from point one above: CCDA formats allow you to get data of clinical documents. Most practices use their EHR systems combined with scheduling, billing, pharmacy and other data. Therefore a transition is easier if these data are provided in a structured format.
Is the DB schema published?
What’s the point of getting a huge database with numerous tables if you do not know how they link to one another? An EHR provider should provide their database schema so that you do not have to run a puzzle contest to decipher it. You should be able to easily identify relations and then manage and analyze the data for any purpose that you want.