Web-based Patient Records Management

Overview

Elder Medical Services P.C., the largest geriatric medical group in Western New York, wanted to transition the organization to an electronic medical records system. With many EMR systems on the market, Elder Medical Services could not find a good fit for one simple reason: unlike traditional practices, all Elder Medical providers are mobile, working in locations that do not have computer workstations. The solution: create a web-native EMR system that would require only a browser to use and develop a robust offline synchronization process to ensure all patient encounters are properly documented.

Situation

Elder Medical Services P.C., the largest geriatric medical group in Western New York, decided to transition to an electronic medical records system to better comply with regulations and derive workflow efficiencies primarily by allowing its mobile providers to access patient data on-demand and furthermore, allowing office staff to easily locate records when responding to external requests for documentation such as claims evaluation by insurers.

With many EMR systems on the market, Elder Medical Services could not find a good fit for one simple reason: unlike traditional practices, all Elder Medical providers are mobile - delivering care to long-term care and assisted-living facilities across Western and Central New York. To exacerbate issues, when on-site, providers do not have easy access to workstations connected to the internet. As an additional complication, many providers wanted to use external transcription personnel so that they could be maximally productive when visiting patients at a facility.

These constraints required the adoption of an EMR system that could meet the following requirements:

1. Be accessible on-demand via any computer, anywhere, and at any time.
2. Be highly secure when performing in such a decentralized way.
3. Require minimal client-side software and infrastructure.
4. Have a highly usable user interface and minimal learning curve
5. Provide offline synchronization so that appropriate patient notes can be carried into a facility on a laptop and new notes can be synchronized with the EMR system when online.
6. Provide a high-level of access granularity to allow people in different roles to access the EMR appropriately. For instance, a transcriptionist would be able to enter patient encounter information but never see other notes, lists of patients, or facilities.
7. Have consistent up-time and an effective technical disaster recovery plan.

Solution

After an audit of Elder Medical Services' business processes, existing infrastructure, and project constraints, Lance Technologies proposed the development of a web-based system that would be built in an iterative fashion with intensive customer involvement. Margaret Sayers, NP, was selected to be on the development team due to her experience in driving IT initiatives at the organization as well as her business process expertise. Margaret became heavily involved in seeing the development of the system through its iterative development stages and providing valuable feedback.

The end-result was a web-based EMR system that could be accessed with any computer using a standard browser. Based on HIPAA guidelines, the system included a robust user management system that provided fine-grained access permissions. As such, users were placed in groups and thus had access only to information they needed based on their roles. Lance Technologies, in its role as business process advisor, developed human resource protocols that strictly dictated how access to the system was granted and how access accounts were audited and terminated.

Within the EMR system, patient notes were organized into individual files and the system acted as a document repository that tracked when files were uploaded and by whom. Version control mechanisms ensured not only the ability to see case history but also that a patient note could never be altered without the change being automatically recorded in a built-in access audit system.

The EMR system also allowed for patient notes to be downloaded, individually and in batch based on selected criteria, to a provider's laptop or tablet PC so that they had the latest patient records when they visited a facility. Any changes to the notes made by providers while offline could then be synchronized the next time they connected to the EMR system.

The system was deployed on a virtual private server setting at a HIPAA-compliant web application host. A mirror image of the system was also deployed at another geographically-distant data center managed by a second web application web host. Based on that infrastructure, Lance Technologies developed appropriate auto-synchronization software to mirror data between these two servers to ensure that in the event one site should go down due to major service outage, the other site could pick up almost immediately. Such a backup system provided Elder Medical Services with reliability very close to global load balanced clustering without the capital investment of over $25,000.