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To host or not to host? Developing a decision-making matrix for your organization
By Nancy Stafford
Ok, you are ready to think about your electronic health record (EHR) commitment. This is not like a marriage; it is more like choosing a car. In a marriage, both sides change often. With a car, you get what you get. There can be modifications, like a new paint job, louder horn or a more powerful engine, but mostly, once you have made the decision which to buy, that is what you get.
For this article, let's think of a matrix as a starting point, a list of logical order to help clarify the end decision. This is the stage to list all the advantages and disadvantages of a solution. As the title suggests, this focus will be on the option of hosting or not hosting an EHR server. The server is an actual piece of information technology (IT) equipment. It usually does not take up much space, maybe as large as a roll-around office chair, but often much, much smaller.
Host your own server
One of the advantages of hosting your own server is that you have control over it. No strangers will have access. Once all your records are stored electronically, you can use your record room for some other purpose.
Technologically, the reason to host your own server does not make much sense. Who on your current staff would be able to maintain it? Would you be able to send someone to training – pay for the training and spare them from your staff while they are in training? Maybe you do have an IT professional. Are they familiar with this technology, or will they need training too? Then there is the issue of the physical maintenance. Would you have a generator to maintain power in case your power company has an outage? Would your current heating and cooling unit be left on over night and on weekends to preserve a specific temperature and humidity to protect your server?
How about security? Two kinds of security come to mind: information on the server and the server itself. If you do not send you EHR anywhere and your staff is unable to touch the server, the information is fairly safe. But, wait, doesn't that defeat some of the reasons to have EHR?
Servers are expensive pieces of equipment. However, since they have serial numbers and have a very specialized use, they probably do not attract much attention except that they contain exploitable information, such as name, birthday, social security number, address and all kinds of information for someone to open loan accounts.
How about contracted servers?
Contracting with a server company has many advantages.
These companies are server professionals. They know their systems and take care of the maintenance and upgrades. They do all the checks regularly. It is their business to make sure their server is up and running.
They have continuous security in place – both technical and human. They protect your files with physical controls such as climate controlled facilities, remote storage facilities for backup files and constant upgrades and compliance schedules. Professionals make sure your data is backed up professionally. They have a generator on site to provide continuous power to the data center.
They may also offer upgrades as part of their contract. That means that you will have the very latest technology. You won't have to worry about your system going obsolete.
How about community servers?
Some practices are partnering with hospitals or other practices and sharing servers. For instance, Alliance Community Hospital, Ohio, has a server that allows it to become a reseller of connections to EHRs and practice management services. The hospital provides hosting through a subscription-based service to local physicians. The physicians provide their own hardware (computers) while the hospital supplies the software.
This service usually costs the hospital between $15,000 per physician and another $6,000 per year, per physician to maintain. The hospitals usually provide the EHR capability and the doctors pay a monthly fee to use the service.
This arrangement helps the physicians realize EHR connectivity without the huge upfront investment. It also supports the effort to combine inpatient and outpatient records. Usually, the hospital record is a small part of a patient's data. Therefore, the aim should be to combine both records with the outpatient data driving the assembly of the information.
Small rural practices
What about rural clinics and practices? Some jump right in with partners who are long distance from each other. These practices seldom have any EHR hosting experience, but spend millions to get EHR capability. Often, their planning is less than adequate and they do not ask the right questions of the vendors. They turn around with their money spent and their EHR systems won't do what they had hoped it would.
One vendor notes that their sales people can tell how successful a clinic will be with their EHR systems by the number of health IT professionals on the clinic's staff. Many rural and single
practices do not have any IT on staff. In this vendor's opinion, these clinics would not be satisfied with EHR.
Rural practices have different issues than do urban clinics with EHR adoption. For instance, a rural practice may not have adequate broadband reception; their cell phones don't have any signal. These independent clinics also seem to want to hold their data tightly. So they are not the easiest sale for centralized hosting as in a hospital or from a service.
Overall, where is the value?
The overriding theme of all hosting decisions is return on investment (ROI). There is no point in spending so much that your practice cannot sustain the server. But, there are so many regulations and rules with which to comply. Some practices may be temped to economize and do as little as possible. This may result in patching a system together with tape and hope, but a system like this will not deliver a reliable EHR system. Can your practice afford to pay fines for compromised records?
While this is not a permanent commitment, it is important. You can add bells and whistles later, but start with a hosting plan that suits your practice's needs, then add the wire rims and the fancy horn.
What can I do?