Intelligent Healthcare Information Integration 3/16/10

“HOST YOUR EMR LOCALLY!” the Web Yelled Today

Here I sit, typing away between patients, grateful that we haven’t had to yank the old pens and papers from their dusty shelves. We’re still seeing patients, still point-and-clicking away, capturing data and making appointments with ease, but not because we’re just so darned connected. Actually, we’re not.

I just got off the phone with our high speed DSL provider, a company with whom I’ve been well-pleased these past four years. After the expected interminable on-hold time, I was told by the very first rep with whom I was connected that she had just received word of a large area problem affecting our service. We had been issued a “Level 4” status (as if I’m supposed to know what that signifies) and the repair worker bees were busy getting to the problem. “They have three days to correct the problem,” she told me.

Not knowing just exactly who had granted them those three days and uncertain as to what little old me could do if the problem persisted beyond the allotted period, I gratefully thanked this pleasant rep, realizing she was just another worker bee who had no more she could offer. (She was likely on her way to many more calls about the very same issue and I didn’t envy her at all.)

Four more patients seen and digitally scribed since that last paragraph, four more who won’t need to have their info re-entered at a later time nor scanned in and, thus, essentially worthless, digitally speaking. Seven patients scheduled for follow-up or for a new appointment, work which won’t need duplicated once we rejoin the Web. In the meantime, the ISP home page which I had opened twenty minutes ago is about two-thirds loaded. (Dialup was never so slow.)

My EHR is Web-based. We could have gone the ASP route. Personally, I love the “cloud” concept and see real value for many “softwares” as a service. But, perhaps it is the geek in me who wanted his own servers, perhaps I’m more of a control freak than I care to admit, or perhaps I just knew I’d be happier with locally hosted speed and reliability. Any which way, I chose to host at home and, especially right now, I’m really happy with that decision.

Full disclosure here: Yes, we’ve had problems with our servers. Yes, we’ve had down time from RAID failure. The difference, and why I’m still a fan of local hosting for our purposes, is that when those occurred, I had some control. I could call for help, boots on the ground, and see what needed to be done, swapped, or replaced. Today, I just sit and wait while the worker bees are hopefully buzzing their way to the honeycomb cell which is the source of our hive’s disruption. I have no clue if three days will pass without being hotwired to the Web. Hector’s pup, I can’t even get my daily news jolt! That’s almost as bad as a lack of coffee. (Maybe I want to restart my daily newspaper subscription?)

Interestingly, Google searches still work like a charm, fast as ever. Score one for the cloud. Still, I’m listening to the Web yell, “Keep your hosting local!” while I handwrite another prescription that I am unable, today, to e-prescribe.

From the trenches (wondering when, or if, this will get through to the Web)…

Who cares about the clouds when we’re together? Just sing a song and bring the sunny weather. – Dale Evans Rogers

Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from doc@madisonpediatric.com.