EHR Implementation - Server vs SaaS
Is a SaaS solution the only way to meet meaningful use in time?
There has been a great deal published in blogs and on vendor websites concerning the assertion that with the short time frames proposed for meaningful use determination, a SaaS EHR is the only option able to meet the meaningful use requirements in a timely manner. A SaaS (software as a service) EMR is also often referred to as a "web-based" EMR - the EMR software, server hardware and data is hosted by the vendor and does not reside on a computer in your practice. We would like to provide some clarification on this assumption, which we have found is not always the case.
According to John Lynn, author of the popular blog, EMR and HIPAA, "There is still plenty of time for a clinic to implement an EMR of any type and get EMR stimulus money." He acknowledges that at some time in the future this will change, but at this point we are still far enough out that time is not an issue. To begin with, it would be incredibly helpful if CMS and HHS would actually get some EMR software certified and provide some practical meaningful use details. However, lacking these details should not prohibit doctors from evaluating and planning for their EMR implementation.
It is true that a clinical practice can typically implement an EMR faster if it is a SaaS EMR and not a client-server EMR (hardware, software and data housed on-site). The time for the server to be shipped to you practice alone just takes time, not to mention scheduling an IT company such as LAN Systems to install the server in your office. However, if you need laptops, additional computers and/or a wireless installation to effectively use your SaaS EMR, you are going to be waiting for computers to arrive and installation to take place anyway. Generally though, SaaS EMR is faster to implement than a client-server solution.
Of course, this doesn't mean that you can't quickly implement a client-server based EMR. For example, Mr. Lynn reports that he implemented a doctor's office in a week from when the server arrived. This is an incredibly fast implementation. Other than ordering time (for server, software and workstations) it was as fast as any SaaS EMR implementation. So, it is certainly possible. Mr. Lynn warns however, "You just better make sure you have the right IT people supporting your implementation."
Our point is, that it is incorrect to state that SaaS EMR is the only option that is fast enough to implement in time to qualify for meaningful use. Many of the client-server EMR vendors have really streamlined the process for installing a server in a clinic. However, this is not true for all of EMR companies, so it is a question worthy of asking any EMR company if you are faced with compacted time lines. You would also want to get the proposed implementation time line guaranteed in writing from your selected vendor.
We would be remise to not point out that there are other factors which influence whether a practice would choose a web-based solution vs. a in-house client server solution. A SaaS solution is typically less expensive, especially in initial costs. It does not require the purchase of a server and practices usually pay a monthly software fee rather than purchasing the software "up front." However, some practices prefer to "own" their software. Also, many physicians do not want their patient data off-site, or in the hands of a SaaS third party. When data resides "off site," information is typically downloaded on an as needed basis. Some physicians believe that they will not have access to their EMR via the web if they do not have a Saas solution. This is typically not true, as most client-server EMRs offer access via the internet, for access from home, the hospital and in a mobile environment. Both solutions will require wireless access for office portability.
While the speed of accessing general patient information from a SaaS solution is usually acceptable, this is not always true for downloading images such as x-rays and MRIs. These larger files may require may not download in an acceptable time limit. In addition, it should be noted, that an effective EMR needs to integrate with the Practice Management System. In the past, web-based PMS solutions have not been popular in the practice environment.
In summary, at least for now, it is a mistake to rule out a great client-server EMR just based on the meaningful use time line. Your practice needs to determine the best solution to meet your clinical needs and manage the implementation project in a way that works best for your organization and your staff.
