A Look at Cloud-Based EHR Technology

Should you consider purchasing this technology?

KIM CASTLEBERRY, O.D., PLANO, TEXAS LORIE LIPPIATT, O.D., SALEM, OHIO

The “push to the cloud” is a hot topic these days, and rightly so. Until recently, we’ve had very little choice other than deploying land-based practice management and EHR solutions.

Today, there is a choice.

Here, we discuss the pros and cons of cloud-based solutions, so you can decide whether they are right for you.

Physician/practice benefits

When considering adoption of these technologies, consider the following potential benefits:

► Automated claims submissions with coding edits. This lessens staff intervention and significantly increases timely reimbursements by third-party carriers.

► Real-time clinical decision support (CDS). This reinforces best practices standard-of-care for gold star patient management, which affects patient care by enabling the physician, with the touch of a button, access to images based on diagnosis, treatment care plans and follow-up recommendations.

► Integrated coding edits. This eliminates billing errors associated with ICD-to-CPT matches, procedures incorrectly performed together on the same day and outdated procedure codes.

► Reduced hardware costs and setup time. This decreases IT maintenance costs.

► The ability to connect from any device from any location. This facilitates timely patient care and improves convenience.

► Simplified documentation processes. Documentation is more in line with how a doctor thinks. Specifically, these systems are customizable, intuitive and, through the incorporation of clinical-decision support, reduce the work effort for the user by reducing “clicks.”

► Seamless software updates. The updates require no extra effort, regardless of the number of workstations in your practice, and allow new technologies to be added to your existing system without complicated integrations.

► Enhanced connectivity. Because data is collected and stored “in the cloud,” it is easy to transmit electronic documents, images and prescriptions to other doctors and facilities with the push of a button.

► Smart phone and tablet friendly. This provides 24/7 anywhere access to EHR. So even if you are enjoying a vacation at the beach, you can access a patient record from your phone or tablet, view an image, if necessary, and electronically prescribe a prescription.

► Secure storage. When making purchasing decisions, it is critical to determine how data will be stored, protected and retrieved, should disaster strike. In a cloud environment, the data management occurs automatically in a secure environment. Consolidating ground costs in the cloud provides roughly 50% cost savings while increasing security and providing backup protection.

Patient benefits

Solutions that enhance patients’ lives, through connected information systems, should be our goal when purchasing any technology. Here are the critical components:

► Secure 24/7 communication. Patients love communicating with their doctors and making or registering for their appointments after office hours. Even if patients are traveling out of the country and have lost their glasses, they can log in to their secure portal, obtain their prescription and get a replacement prescription or even purchase new pairs from your online optical.

► Online registration and questionnaire completion. Patients appreciate the ability to complete demographic and insurance information online prior to their exam. In addition, communications based on their lifestyle questionnaires can be directed to the patient portal prior to arriving at the office. Questionnaires that are completed prior to the patient encounter and directly integrate with the EHR save the patient time prior to their visit, while also providing the physician advance knowledge of concerns or patient needs. This integrates directly into the patient record, which also reduces staff effort.

► Online real time scheduling. Often, even if a patient schedules an appointment online, the appointment still has to be manually added by staff, which is essentially double the effort or requires a response to the patient.

► Product ordering and notifications. Real-time patient notifications not only eliminate costly direct patient communications with the practice, but they also improve patient satisfaction. Patients know where their glasses are at all stages of the delivery process.

► CDS at the point of care. Patients often present with uncommon or even rare clinical conditions. In the old days, we would review textbooks to research and ultimately reach our diagnosis. Now, we have all that information available with the touch of a button, leading to quick decision making and diagnosis. For example some cloud EHRs have adopted “info buttons” to quickly access up-to-date images, product or clinical information during the exam to assist in making the diagnosis and plan.

► Smartphone application connectivity. Patients have direct access to our practices through apps that connect them to our practices 24/7. This connectivity provides them critical pieces of information and the ability to schedule an appointment or make requests.

► Online medical records and prescription availability. Access to statements, patient records, spectacle and contact lens prescriptions eliminates time-consuming calls to your office. Since these processes are automated, no staff time is required.

Nothing is perfect

You would need to make some changes in your practice to prepare for the cloud-based systems, which involve some initial costs in the short term. For example, you may need to evaluate your Internet connection speed and change your contract, if you desire a high-performance connection speed. In addition, you may need to add a secondary (back-up) method of connecting to the Internet, such as a"hot spot.” Other costs include a monthly software licensing fee.

Also, consider the potential change in cost structure. most legacy systems have a large initial cost associated with ownership of the actual software, and a yearly maintenance type fee. Cloud-based solutions may have a monthly fee, which includes all or some of the Internet services we are used to paying for separately.

In addition, some practices simply don’t adjust well with change. If you are happy with your legacy system, and it meets all of your current needs, you may not see any advantages with learning a new EHR system.

Your decision

It’s not easy to change software solutions, but take a look at all the options a cloud-based solution is beneficial, but there may not be a sense of urgency for you to change. If you have decided to invest in a cloud-based system, then weigh the costs and features that these solutions have to offer prior to purchasing. OM

	Dr. Lippiatt is CEO of Salem Eyecare Center, Inc., in Salem, Ohio. She is a technology consultant for Vision Web and a pioneer in EHR and healthcare information technology. E-mail her at LLLEYEDOC@aol.com.
	Dr. Castleberry is CEO of Plano Eye Associates, a group single-location private practice in Plano, Texas. He is a technology consultant for Vision Web and a pioneer in EHR. E-mail him at KimCastleberry@PlanoEye.com, or send comments to optometricmanagement@gmail.com. Both authors are technology consultants for VisionWeb but have no financial interest in the company.