December 2000 Bulletin

Weigh pros, cons of ASPs, in-house EMRs

HIPAA, industry pushing practices to computerized medical records

By Ronald Sterling

Like it or not, the health care industry will drive your practice into using some form of computerized medical records over the next three to four years. From the implementation of HIPAA electronic standards and the demand for more efficient health care, your orthopaedic practices will be faced with the decision to "do the keypunching" for the organizations you work with, or use an electronic medical record (EMR) to process the electronic information that will become the lifeblood of your practice.

Electronic medical records require software, hardware and a lot of commitment. Your choices are many. There are approximately 200 different companies that offer electronic medical record solutions as well as EMR Application Service Providers (ASP).

ASP is a term used to describe the latest version of time-sharing computer vendors. Basically, ASPs allow multiple organizations to share the same computer software and hardware facilities. ASPs use the Internet to service and communicate with your practice. Thereby, the communication costs are a fraction of what a direct connection would cost. A multioffice practice can save money on communication expenses by using an Internet connection to an ASP rather than direct connections to an in-house system.

In deciding on whether to use an ASP, or acquire your own in-house medical record system, you should consider the following issues.

Software. ASPs offer existing products over the Internet as well as new products that are being developed exclusively for the Internet. EMR products that have been developed for the Internet are in their introductory phase. Many ASP vendors have limited numbers of users and lack a comprehensive medical record for orthopaedic practices. Advantage: Traditional EMR Vendors.

Hardware. Many practices do not buy appropriate hardware to mitigate the loss of their EMR. Fault tolerant or high availability systems can cost two or more times as much as standard computer systems. By spreading these costs over a larger number of practices, as well as centralized buying power, ASPs imputed hardware costs are less per practice. Advantage: ASP Vendors.

Communications. For practices with several offices, the communications costs to connect all of the offices with the central computer system can be prohibitive. However, an Internet connection to an ASP is very cost effective. Advantage: ASP Vendors.

Support. ASPs offer more specialized expertise than a practice could afford. Additionally, the ASP staff has immediate access to the hardware and your data. Your practice still has to maintain the various master files and information you need to use the medical record. Traditional EMR vendors rely on dial-up lines to your system and an onsite staff person to work on hardware problems. Advantage: ASP Vendors.

Business relationship. In theory, ASPs can cost much less than owning a medical record system. For example, some ASPs offer medical record services for less than $100 per month per provider. By contrast, an in-house medical record system can easily exceed $1,000 per month per provider. However, there is a catch. Most ASPs not only earn money on services, but derive revenue from advertising, additional services and selling analyses of your data. For example, you may be subjected to advertisements. Most ASP contracts allow the vendor to distill information from your clinical data and sell the summary information. In other words, the ASP gets to earn money from analyzing your patient data. This is a major weakness in the ASP models since your data effectively becomes their data. Advantage: Traditional EMR Vendors.

A variety of events that are outside of your control will increase the significance and importance of EMRs to your practice. As you examine your options, be careful to consider the technical and business aspects to insure that your make the right strategic decision for you practice.

Ronald Sterling, head of Sterling Solutions, Ltd., Silver Spring, Md., is a nationally recognized expert in computers for the health care industry.

New standards

New electronic transmission standards, required by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, are discussed in HHS tells electronic transaction formats.

Computer Link welcomes suggestions about future topics for the column and questions about the use of computers in orthopaedic practice. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.

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