Admittedly, bandwidth can be a challenge, but Scheper was surprised to learn that satellite connectivity made the Internet more reliable than the water supply or the electricity grid. (In similar scenarios, where rural healthcare providers may be unable to secure a redundant Internet connection, paper-based backup options may be a disaster recovery necessity, he says.)
Once the cloud EHR was online, the next step was training the physicians running the spinal cord injury program. Here, end users' "clean slate" and their distinct goal-to document the progress of a single hospital program-made engagement easy, Valette says. So, too, did a schedule that gave physicians time to balance patient care with learning how to use the system, he adds. Once physicians were trained, the rest of the caregivers received their introduction to the system.
Absent Frustrations, Cloud EHR Easier to Accept
One key advantage to the St. Boniface scenario, Scheper says, was that it didn't come with as much of the "psychological change management" that tends to accompany the workflow change management so prevalent in EHR implementation. (This is irrespective of a client-server or cloud-based EHR model, he adds.)
Physicians were willing to start with the end in mind, Scheper says, rather than insist that they continue the same inefficient, paper-based processes. Nor did athenahealth insist that physicians recreate processes that did work in order to conform to electronic workflows.
It helped, too, that the Haitian physicians didn't have the same preconceived notions of, or bad experiences with, EHR systems and cloud computing that many U.S. physicians have. Many suggest that the cloud isn't secure enough for protected health information-the loss of which constitutes a costly data breach under the HIPAA Privacy Rule-but Scheper says vendors such as athenahealth, by developing a single set of security protocols for their customers, can better protect information than an individual healthcare organization can.
As for EHR systems, Scheper suggests that the marketplace is filled with "a bunch of bad options." That, coupled with the $21 billion meaningful use incentive program, which rewards those using EHR technology but will penalize those who aren't using EHRs by 2015, actually makes transforming the marketplace harder.
"Established players don't really have an incentive to fundamentally change their platform, because the government is creating massive artificial demand," Scheper says.
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