What is Web Based EMR?

Web based EMR's or Web based Electronic Medical Records systems, are quite the rage these days. But there seems to be a good amount of confusion as to what exactly constitutes a web based EMR and what exactly it should do and not do. Let us start with a basic definition of a web based electronic medical records system and then look at the various flavors available.

Definition :

• Should be accessible from any computer connected to the web.
• Should provide native web functionality, meaning connection through Internet Explorer without having to install remote access software such as PCAnywhere etc.
• Should be a secure connection to meet HIPAA requirements.
• Should be designed for use on the web, so the full functionality is available on the web.
• Should be reliably available during your workday.

That sounds simple enough, but not so fast! There are actually 3 flavors that you will see vendors claiming are "web based" - but is it really? Let's look at them one by one.

Web Access through remote connection software

This seems simple enough. If you have software similar to Citrix or PCAnywhere installed on your office computer, and your office computer is running, and if you have the same software installed on your local machine, THEN, you can connect to your office computer to run the EMR. By this method pretty much ANY software can claim to be web based. But the problems with this method are numerous. For a successful session to occur, many things have to go just right:

• Violates rules 1, 2 & 4 as defined above.
• Your office computer must have the required software (PCAnywhere for example).
• Your local computer must ALSO have the same software installed. This is NOT so easy if you are trying to access your office computer from, say, the computer in the hospital's doctors lounge. You most certainly won't have admin privileges to install any software on that machine, so tough luck, you can't connect from there.
• You are connecting from the local computer to your office desktop, which in turn may be connecting to the server. You are looking at a lot of moving parts here to work together. Any of these not working just right = no access to your data.
• You will need to pay additional licensing costs for this to work.
• You may need to open multiple ports on your firewall as each computer in your office can most likely handle only one connection, so you are looking at one to one connections. This is a security concern.
• In almost all cases, you are buying the software outright, paying everything upfront. This translates to a pretty expensive option.

This solution is most often proposed by vendors with Client-Server model software. But you must be aware of the numerous pitfalls you are likely to encounter in this approach. This is a sham and should not even be really classified as web based EMR. This is the approach with the highest risk of failure.