The computer world changes very fast; in fact, so fast that it's getting harder and harder to keep pace. For this reason we are always in a learning mode and it is very exciting to find out what is coming next.
Some of the big questions chiropractors now have to answer when going paperless are: Should I use a system that saves and stores the software and all my data on the Internet? Should I use a system that has the program in my office, but my data is stored on the Internet (technical term: cloud computing)? Or should I keep my program and my data local (in my own clinic)?
As a chiropractor, do you really care about where your program and data are stored? My answer to you is yes, please care. This is an important decision you will have to make when converting your paper office to EHR. The choice you make will be the foundation for your system, and as you know, you build a much better house on a good foundation. Let's take a look at some of the pros and cons of Internet, cloud computing and local storage.
1. Access to Your Files
In my experience, chiropractors' biggest fear (by far) for going paperless is not being able to access their patient files. With paper files, the worst that can happen (short of a fire or flood) is that the file will be somewhere else in the clinic and the staff will have to search for it. But with an EHR system, if your computer system does not work, you will have no access to your patient files. And with no patient file access, you simply cannot do your job.
For any EHR developer, this "all-the-time access" should be priority one. A good EHR system has to provide you peace of mind that you will always have access to your patient files. With Internet-based programs, you can access all your files from any computer in the world; this is a nice feature for doctors who travel. Unfortunately, you do not have any control over your Internet provider or the company that stores the data. This mean if one of them fails, you fail, too.
This is the same problem with cloud computing; you may have the EHR program software in your office, but your data is somewhere else. If the Internet fails for one hour, you will not have any access to patient files during that time. This can be very annoying when patients are sitting in your waiting room, ready to be treated. Local storage of data and programs eliminates this potential inconvenience. Your system will work with or without the Internet.
With new advances in technology like remote access or other Web-based programs, you can access your computers from anywhere in the world as well. But what happens if your office computer crashes or gets a virus? If this happens with Internet or cloud computing, your system will still be down on that computer, but you can access your data from another working computer. With local storage, a good EHR provider should set you up with one of the regular working computer to act as an emergency file server, which is continuously backing up the data on other computers in the office. This way, if your main server fails, you will be up and running in less then five minutes. I have never seen a doctor without access to patient files for more than 10 minutes. This is less time than it often takes to search for a lost paper file.
2. Data Privacy
One thing is for sure: If you store your data locally, you have all the freedom to apply the appropriate HIPAA level of privacy. You know exactly where your data is stored and who has access to it. If you have any technical challenges or need service involving your data, you have control over giving access to your provider and will be able to look at everything it does when manipulating data.
This benefit isn't as clear when you save your data over the Internet. Who has access to it and when do they have access? Could your data get mixed together with other clinics' data, as they are all on the same server? What if you need a special report; who will do this for you? What is the guarantee that you are the only one with access to your data?
3. A Question of Time
Unfortunately for all of us, the Internet is the slowest network on the planet. The Internet is slow to begin with, and sometimes, it's even slower. Doctors and staff cannot waste their time waiting for the Internet to respond to what they need. A local network operates much (I mean much) faster, meaning just about every operation you need will happen instantly. This speed helps doctors to keep focus on patient care, not on the computer system itself.
4. System Protection
In this world where companies come and go, doctors also need to ask: "What happens if my EHR provider goes out of business?" With local data storage, this will never be an issue; other system providers will always be able to take your data and convert it for you. In a worst-case scenario, a new system can be loaded with data from the old system. By comparison, having your data stored on the Internet could be a problem if the company ceases to exist; if your program is Internet-based as well, you may not even have a program to run anymore, which would mean you could lose everything.
It's Your Decision
Software developers and software providers love to get the public in a frenzy over the latest technology, but history has shown us repeatedly that "new" does not always mean "better." Sometimes, it actually means worse, and sometimes it is totally useless. This is as true with EHR as with any other technology. My suggestion is that you take a deep breath, relax and thoroughly investigate all of the pros and cons of every system before you make a purchasing decision. In the end, you deserve to have the final word on which technology makes the most sense. Peace of mind should be a key factor when going paperless.
Claude Cote is an expert in electronic health records, insurance billing and chiropractic clinic management with more than 22 years of experience, installing EHR systems in 17 countries worldwide and 47 U.S. states. He is the founder and president of Platinum System C.R. Corp (www.platinumsystem.com). Contact him with questions and comments regarding this article at
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