Electronic Medical Records


The dangers of a web-based system.

By Adam R. Aitken*

When it comes to electronic medical record (EMR) systems, there are two types: web and app. Before we get into the dangers of the web-based system, let’s discuss, at a high level, how these two technologies function.

In a web-based system, the creator designs a website that functions as an EMR. The website runs only on the servers utilized by the company that creates it. These systems are accessed solely through a web browser, giving them the inherent advantage of being able to be used on nearly any device that can surf the web.

In an app-based system, the user installs an application on their device, and the device communicates with a server. In most app-based systems the server could be owned and operated by the creator, or it could reside on site at the end user’s location. The disadvantage to the app-based approach is that the app will only run on systems for which it was designed. The distinct advantages of an app-based approach include low bandwidth and having the ability to utilize the full power of the system on which it is running. A good example of an app-based program is Apple’s iTunes. iTunes is an app that is installed on a computer and communicates with Apple’s server for music and games and other applications.

Volumes could be written on the merits of app versus web. What I want to focus on is why web could be dangerous to you and your company. With the recent closure of one of the oldest physical therapy EMR systems on the market, we were handed a nice case study. In its later stages their system became a hybrid system that was both web- and app-based. The app-based system was utilized for front and back office work while the web portion was utilized for therapist documentation. This was seen as a great solution. Office staff got the luxury of speed and multitasking capabilities, while the therapists got the freedom to use the system on any device.

When the company closed its doors early this year, we saw a stark difference in what happened with the data between the two different platforms. On the app side everything continued to function. While the users were lacking support and updates from the company, they were still able to use their system. As users transitioned to new systems, their old system still continued to function, allowing them to report on old data and finish collecting past balances.

On the web side we saw a stark contrast. When the company closed down, the web servers were powered down and went dark. Users were given their data, as promised, but the site that utilized the data was gone. The data consisted of a series of folders, each named after the patient. In each folder was a series of PDF files of all the patient’s documentation. While the company did live up to its promise of providing the data back to the end user, it was in a format that was marginally useful. All reporting and statistical data were gone.

While having all of your patient charts in folders in PDF format is not the worst possible scenario, imagine what would have happened had this company been 100 percent web based when they turned off the servers. At this point all of the patients’ ledgers would be converted to spreadsheets and dropped into patient folders on a disk. Now the missing reporting becomes a much bigger issue. Being able to query what is still outstanding becomes impossible and being able to pull past financial records for audits becomes a nightmare. The app-based system solves this issue since the application will continue to run even if the EMR company closes its doors.

Take Away

There are roughly 20 companies serving the physical therapy EMR market. With this oversaturation, competition is fierce and companies will start to close their doors or be acquired by other companies. In the last 12 months we have seen one company close its doors and two others acquired. Many people I talk to don’t ask about the system the company uses to access that data. Make sure you have a system in place that can access your data, allowing you to survive a financial or professional audit.

Adam Aitken

Adam R. Aitken is founder and partner of A2C Medical. He can be reached at Adam@A2CMedical.com.

*The author has a vested interest in the subject of this article.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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