Coming months will likely bring a number of changes in the realm of Health Information Technology. More than $30 billion from the Federal stimulus bill was budgeted to HIT, $18 billion of which was allocated for direct physician incentives for adoption and use of electronic medical records (EMR). Physicians surely know by now that many of the details regarding these incentives remain undefined. Despite the lack of clarification on what constitutes “meaningful use” of EMR, incentive structures that will determine physician reimbursement have been laid out and are still being tweaked.

Given the uncertain state regarding HIT, clinicians may be understandably concerned about investing in technology during the national push to digitize health records. But as more EMR companies emerge on the market, physicians should first consider how they would like their EMR system to function in practice. For those who are concerned about the current state of affairs, the Application Service Provider (ASP) model represents a sensible, cost-efficient way to integrate EMR into practice.

The ASP
Unlike the traditional server model, in which a physical server is added to the practice, an ASP allows you to run your EMR via the Internet. There is no server in the office, and all that is required to run it is a broadband Internet connection through which all computers can access records and other vital information. The immediate drawback of having an in-house server is that you will need an Information Technology expert to manage and update your server. Apart from the added costs of hiring an IT professional to handle your server, there are also a number of time-related measures that will likely weigh on productivity and finances. These include moments when the server is down (during which your employee is addressing the problem). Another is the cumbersome practice of backing up the records in the event of a crash. These examples may not show up “on paper” but they must be considered as part of the server package.

With an ASP, these are issues with which you will never need to concern yourself. The practicing physician or practice manager would need to find an Internet provider to install broadband Internet service, an appropriate router, and establish a secure network. Once this is done and the practice data has been entered into an ASP, all physicians and staff members should be able to access practice or patient information from any computer in the practice, or from any location with broadband Internet access. The main concern with this setup is that if your internet goes “down,” you will have no way to access your records—or add to them. One excellent suggestion would be to have a redun-dant Internet line in the office (e.g. one DSL line, as well as a cable modem).

Inevitably, some clinicians may not feel that the information and records on an ASP are as “safe” as they may be on a server. Given the importance of medical records and the information they contain, it's understandable for physicians to have concerns about the security of records that exist in digital space. But it's important to note that all data that is entered into an ASP is owned by the practice itself and can be withdrawn at any time, regardless of the provider.

For those concerned about managing and maintaining medical records on the Web, hybrid models are available that incorporate elements of the server and the ASP model. In this case, all records are still accessed from an online source, but there is also a “headless” server for back-up. One cannot add information via the server, but anything entered online will be on the server as well. The advantage with such a hybrid model is that it is much easier to manage than an in-house server and it requires much less maintenance and management.

A Great Incentive
While the loudest voices in the discussion about HIT and EMR tend to belong to those who fully embrace technology and those who abhor it, a substantial portion of physicians are interested in EMR and its potential benefit but prefer to gradually learn and familiarize themselves with it. For these individuals, an ASP is a great beginning point. It keeps costs to a minimum, requires little with regards to hardware, and has very few technological constraints.

Finally, ASPs are also fully eligible for meeting the government incentives for EMR implementation and use. Of course, this depends on how “meaningful use” is eventually defined; some have speculated that we will not learn the criteria of meaningful use until the spring. But as stimulus funds are currently being dolled for the implementation and support of EMR, it's important to note that ASPs also represent a sensible investment from the standpoint of cost effectiveness, practicality, and financial incentives.


Dr. Kaufmann has no relevant disclosures.