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Practice Vine Enables API for Any EHR

Posted on October 1, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently introduced to a new company that is working to take traditional client server based EMR software and connecting them to the cloud. The company is called PracticeVine. I think they have an interesting approach to consider.

While many people love to proclaim the future of cloud based EHR, they underestimate the install base of client server based EMR and some of the advantages of a locally hosted EHR. PracticeVine provides a way for client server based EMR to have some cloud based functionality. Their first implementation is a Patient Forms tool for MacPractice EHR.

When you dig into a PracticeVine implementation, you see that if they’re successful, they’re essentially building a powerful API to an EHR software. With MacPractice they started with forms, but over time I could see PracticeVine building out other features which continue to expand the API like functionality that they need to provide cloud based functionality to client server based EHR software. Could PracticeVine become the ultimate EHR API provider?

Obviously, that’s an ambitious goal and far more than what they’re trying to chew off now. However, it’s really interesting to think about what the ultimate EHR API provider would look like. It’s even more exciting to think about what could be possible if we had deep EHR APIs for all the EHR vendors.

The real challenge that PracticeVine faces is resistance from EHR vendors to let them build this out. It’s not like most EHR vendors are even thinking about an API for their EHR. In fact, most of them can’t see past meaningful use stage 2. I’ll be interested to see where PracticeVine takes this. I really hope they’re successful at getting EHR vendors to interface with them.

SaaS EHR Down Time vs. In House EHR Down Time

Posted on August 9, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As part of my continuing series of posts about EHR Down time (see my previous Cost of EHR Down Time and Reasons Your EHR Will Go Down posts), I thought it would be interesting to look at how a SaaS EHR down time is different from an in house EHR down time.

I’ll use the list of reasons your EHR go down as my discussion points for how it’s different with a SaaS EHR versus an in house EHR. On each point, I’ll see if either approach has an advantage over the other.

Power Outage – Certainly a power outage will impact both types of EHR implementations. If your computer or router doesn’t have power, then it doesn’t matter where your EHR is hosted. However, many clinics use laptops which can run for quite a while without being plugged in. Plus, a small UPS for your network equipment is pretty cheap and easy to implement.

However, a good UPS for your own server will cost a bit more to implement. Plus, the UPS won’t likely last very long. Most UPS are there to give you enough time to power down your system properly or to handle a short power outage. Of course, in this case we’re talking about a small clinic implementation. I have done an EMR implementation where we had some nice UPS and even a backup generator. However, this is the exception.

Conclusion: Slight Advantage for the SaaS EHR

Hard Drive Failure – Certainly the failure of a hard drive in your desktop machine will affect both types of EHR install equally. So, that part is a wash. However, the hard drive failure on your local server is much more of an issue than a SaaS EHR vendor. At least, I’ve never heard of a hard drive failure causing an issue for any SaaS software vendor of any type. Both in house and SaaS EHR implementations can implement redundant hard drives, but SaaS EHR vendors have to implement redundant servers.

Conclusion: Advantage SaaS EHR

Power Supply Failure – This one is similar to the Hard Drive failure. I know a lot of EHR vendors that have their clinics buy an in house server that doesn’t have redundant power supplies. I can’t imagine a SaaS EHR vendor buying a server without redundant power supplies even if the redundancy is across servers.

Conclusion: Advantage SaaS EHR

Network Cable – Cables can get pulled out of switches just as easily as servers. So, I conclude that it will affect SaaS EHR and in house EHR the same.

Conclusion: Tie

Switch/Router – Loss of a switch/router will cause either a SaaS EHR or in house EHR to go down.

Conclusion: Tie

Motherboard Failure – An in house server only has one motherboard. If that motherboard fails, you better hope you have a great tech support contract to get a motherboard to you quickly (For example, Dell has a 4 hour support contract which is amazing, but pricey). Certainly a motherboard can fail for a SaaS EHR as well, but since they likely have multiple servers, they can just roll the users over to another server while they replace the motherboard.

Conclusion: Advantage SaaS EHR

EHR Software Issue – This is a hard one to analyze since a software issue like this could happen on either type of EHR install. It really has more to do with the EHR vendor’s development and testing process than it has to do with the way the EHR software is delivered.

You could argue that because the SaaS EHR is all hosted by he company, they will be able to see the issues you’re having first hand and will have tested on the hardware they have in place. A client server/in house EHR install could be on a variety of EHR systems that the EHR vendor didn’t know about and couldn’t test as they developed and deployed the system. So, I could see a slight benefit for the SaaS EHR system.

However, one disadvantage to the SaaS EHR system is that they are hosting it across dozens of servers and so when something goes wrong on a server it’s sometimes hard to figure out what’s going wrong since all the servers are the same. Maybe that’s a bit of a stretch, but we’ve all seen times when certain users of a service are down, but not others.

Conclusion: Maybe a slight advantage to SaaS EHR

Internet Outage – This one is the most clear cut benefit to an in house server. When your internet connection goes down, the in house server keeps plugging along no problem. Loss of your internet connection with a SaaS EHR is terrible. No doubt that’s often the greatest weakness of a SaaS EHR. Although, it can be partially mitigated with multiple internet connections (ie. wired internet and wireless broadband internet).

Conclusion: Advantage In House EHR

I have to admit that I didn’t realize going into this analysis that it was going to be a landslide for the SaaS EHR. Although, that’s quite clear from this analysis. When it comes to EHR down time, the SaaS EHR is much better. Unless, you live in an area where the internet connection is unreliable and slow. Then, you don’t really have much choice since SaaS EHR needs a reliable internet connection.

It’s also worth noting that this article only talks about how EHR down time relates to SaaS EHR versus in house EHR. There are certainly plenty of other arguments that could be made for and against either implementation method such as: speed, privacy, security, cost, etc.

Information Week Cover Story on Selecting an EHR

Posted on February 3, 2011 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across a link to this cover story for Information Week about selecting the right EHR. Unfortunately, the site requires registration to access the article, but you can also get a login for the site without registering on this great website called BugMeNot. Now to the content of the article.

The article starts off properly in describing that selecting the right EHR is a tough and challenging task. The biggest challenge is of course the 300+ EMR and EHR vendors out there. Sadly the advice they give in the article doesn’t do much to actually help individuals that are trying to select an EHR. Here’s the list of steps they offer (and my commentary):
The state of your infrastructure – No doubt this is an important part of an EHR implementation, but why they list it as a first step is a bit beyond me. The fact is that you really can’t properly assess the state of your infrastructure until you know which EMR software you want to use. Do you need a server room? Do you need a faster internet connection (ie. SaaS EHR)? Do you need tablets, ipads, desktops, etc? These answers aren’t known until you know which EHR vendor you select. So, this is an important step, but it’s done mostly during implementation instead of selection.

Features, functions and usability – The problem with this item is the order. Most doctors who are selecting an EHR don’t really know what features and functions are available in an EHR system. Sure, they have some idea of some of the features, but it is amazing how many new features they come across once they start demoing EHR systems. Remember, they’ve been focusing on patient care and not the latest EHR features and functions.

The other challenge for this area is that at a base level (which the article above mentions as well), the features and functions of most EHR software is pretty close. It is the more nuanced functions that differentiate one EHR software from another. So, this isn’t a first step in the EHR selection process. It’s a later step after doing the EHR demos. Instead of starting with features and functions, doctors should focus on the benefits they want to receive from an EMR as I describe in my EMR selection e-Book. These benefits will help to provide a guide for narrowing down your EMR options.

As far as usability, this is incredibly important. Just this is assessed at demo time as well. Although, I find this even better assessed when you either 1. do a test run of the software yourself and/or 2. talk to existing users of that software. That’s how you evaluate an EHR’s usability.

Networking and interoperability capabilities – Certainly you want to make sure it interfaces with your existing systems. This is barely worth mentioning since this is top of mind for most people selecting an EHR.

Technology knowledge – Another important aspect of an EHR implementation. Although, this isn’t very important in the EHR selection stage. I’ve never known someone to switch which EMR software they like best because they think their staff isn’t technical enough for one software but would be fine with another software. Technical skill can be overcome through training. It shouldn’t influence which EMR software you select.

Partner systems – This is the same as the interoperability capabilities mentioned above.

Deployment options – Finally something that’s a real differentiator. Knowing the pros and cons of an in house EMR and a SaaS (hosted) EHR software is very valuable and a great way to start narrowing down the field of possible EMR vendors.

Maintenance and support – Your ability to support the selected EMR matters and should be part of the selection process. Just most of the time this will really influence your decision to go with an EMR hosted on site or a SaaS based EMR mentioned above.

Now you can see why I wasn’t all that impressed with their list of EMR first steps. I won’t rehash my list of first steps. You can find them in my EMR selection e-Book. It’s free so go check it out.

The article does provide a list of best practices which is more valuable (with my commentary as usual):
1. Look for vendors that know your practice – Of course they won’t really KNOW your practice. However, there’s some real benefit in going with an EMR software that has 100 clients that are from your specialty. Don’t underestimate the value of them knowing your type of practice’s needs.

2. Evaluate the costs to acquire, deploy, maintain and support the hardware and software – Including all of the costs in your comparison of EHR vendors is really important. Don’t forget the hidden costs of training, interfaces, ongoing support, extra hardware, etc.

3. Consider a cloud-based or hosted EHR setup – Definitely worth considering. Just be aware of the benefits and challenges with going “to the cloud.”

4. Get the right training for your staff – Probably as important as getting the right training is choosing to make the time for that training. You can pay all you want for the right training, but if your doctor says he’s too busy to attend, then it won’t do much good.

This reminds me of a comment Dr. West made on a recent post:
“I know an orthopedic surgeon who bought an EMR for $25,000 but then didn’t have the time to waste in learning it, so they just use it for the scheduling calendar now. A $25,000 calendar!?”

5. Use a certified EHR – If you’re a new reader, you missed out on some of my amazing rants about certification. I’ll keep it short for this post. Basically, EHR certification provides no value to the doctor. The only exception is that it now is necessary if you want EHR incentive money. Other than that, it provides no assurance of anything of value to a doctor. Don’t focus on it. Don’t give yourself the false impression that it’s better because it’s certified. Evaluate the benefits of the various EMR software based on your needs and requirements.

6. Invest for the future – This isn’t meant to be interpreted “spend more money on an EHR system cause then you’ll be getting a better product.” In fact, the opposite case could be made that the more you spend on your EHR the more likely it’s a legacy system which is hard to upgrade and improve and won’t be great for your future needs.

The real message of this point is described pretty well in the article:
1. Assess the future viability (financial and directional) of the EHR company
2. Assess the scalability of the EHR software (do you plan to expand your practice? Can it support that?)
3. Will the EHR software be able to support meaningful use stage 2 and 3 (especially if you want to get the EHR incentive money)?
4. How much is the company investing in new features and releases? Will they be able to quickly adapt to your changing needs (ie. new interoperability requirements and needs)?

Obviously I think the article left a lot to be desired. It’s nice to see EMR selection as a cover story. I also think it’s hard in an article to try and cover everything that’s needed to be able to select an EMR properly. I also think it is really funny that for the article they sent out 20 RFP’s for a fictional company. Then, they compiled and analyzed information from the seven vendors that responded. Where are the other 13? Or maybe I should ask, where are the other 293 EHR vendors?