Series 2: Project Management Advanced Project Management for Behavioral Health Electronic Health Records (EHRs) 9/2013 From the CIHS Video Series “Ten Minutes at a Time”
Transcript
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Series 2: Project Management Advanced Project Management for
Behavioral Health Electronic Health Records (EHRs) 9/2013 From the
CIHS Video Series Ten Minutes at a Time
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Module 8: Three Basic Types of Information Technology Networks
for EHRs. Overview Five key terms -Two related to EHR
implementation -Three related to information technology Three basic
models of IT architecture for implementing Electronic Health
Records (EHRs) Software-as-a-Service (SaaS), Client-Server,
Web-based (Active Server Pages (ASP) in the MS.NET Framework) Pros
and cons associated with each type No model is superior to another
Must assess requirements and resources to identify the solution
that best fits your needs
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Introduction Using an Electronic Health Record requires an
electronic network Will determine the bulk of start-up costs and
long-term costs Electronic networks need four basic parts:
1)Computers that people can use to enter and to access stored
information and to access services for example, using a printer.
These are called personal computers or terminals. 2)Computer
servers that manage access 3)Computers that store information in a
format that makes it retrievable 4)Software applications that allow
the various devices to interact, ensuring access by authorized
users and protection from unauthorized users. How these parts are
set up to work together is the Information Technology Architecture
EHRs are usually designed to work exclusively in one of three types
of IT architectures
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Two Key Terms - EHRs Configurable Software can be modified to a
degree, as long as the modifications do not affect core
functionality. For example, fields can be added to an existing
screen, field labels may be changed, new screens can be added
Customizable Software can be modified to a greater extent,
including those parts of the software that are related to core
functionality.
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Three Key Terms - IT Information Technology Architecture - How
the gap is bridged between the person who needs to use the software
and access the patient data, and the patient data and
software/hardware itself. Server A powerful computer or device that
manages network resources. Different types of servers include
database servers (respond to database queries), file servers (place
to store and access files), print servers (manage the traffic among
the different computers accessing the office printers) and Web
servers. Client Computer workstation or personal computer (PC),
initiates contact with the server(s)
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Model 1 Pure Client-Server: Customer buys connectivity,
hardware, IT staff to manage it and space for housing (hosting) it;
pays licensing and maintenance fees for software application; can
set up remote access using special types of connections; EHR
business or developer support is an important component. Sometimes
called 2-Tiered Architecture. No access to the Internet.
Organization A uses dumb terminals that are only good for
communicating with the computer Provides licensed copy of
application, maintenance of software and ongoing customer service
Remote access requires special technology like Citrix, MS Terminal
Services EHR Business Examples -Systems with mainframe computers
(instead of PCs) -Often found in hospitals Network servers do all
of the computing work
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Client-Server - Some Pros /Cons PROs Much greater flexibility
for customization core software can be developed or existing
software can be modified (at a cost) to the customers
specifications Fast access to the data - vitally important in some
health care settings Better control over the data CONs Significant
upfront costs for hardware and software; also requires IT staff
with skill sets that may be expensive and/or hard to find Many
costs and risks devolve to the customer. Developer is only
responsible for the software application, assistance with initial
installation and configuration per the agreement / contract
Requires top-notch products and customer support - may be expensive
and/or of low quality Changes / updates can be surprisingly
expensive
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Model 2 Pure Software as a Service (SaaS, sometimesCloud
computing) All hardware and software is housed (hosted) and managed
by the EHR company; developed specifically for access via the
Internet using any kind of browser; usually subscription-service
model (i.e., number of users = cost); core application is shared,
the organizations configuration and data are not; EHR business is
100% responsible for system (includes data, connectivity, hardware,
software, staffing, etc.) Organization B Database Server Software
Server Examples Salesforce, (customer relationship management)
Sharepoint (document sharing and management) GoToWebinar
(thin-client for video and teleconferencing) EHR Business
Subscription allows access to software and data over the Internet
from any location Organization A B dataA data Uses a PC and
Internet in the office Uses PC and Internet from a remote area
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PROs Minimal start up costs and lower, predictable ongoing
costs, scalable to number of users; can change to a different
system quickly and easily Lower level of all types of risk,
including for project implementation; faster start-up, guaranteed
functionality, more likely to Go Live as scheduled Customer
interface supports fast adoption; relatively easy to master
learning curve; software updates transparent to customer CONs
Customizations are not feasible and additional functionality
requires a pool of customers who share the costs of development
among themselves (new functionality is available to all of the EHR
customers) Slower, since data storage and retrieval rely on the Web
For a large organization with many end-users, costs may actually be
higher over a period of time than some alternatives Software as a
Service Some Pros/Cons
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Model 3 Web-based (Active Server Pages (ASP).NET): Developed by
Microsoft. Adds flexibility to the client-server model for dynamic
Internet access that resembles the Software as a Service model;
usually the customer (but sometimes the EHR business) hosts the
hardware and software necessary to use the EHR. Sometimes called 3
or multi-tiered architecture. Presentation Tier User Interface User
Interface Logic Translates tasks and results to something the user
can understand Logic Tier Coordinates application Processes
commands Makes logical decisions Moves and processes data Data Tier
Information is stored and retrieved from database or file system
Passed to Logic Tier for processing
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Web-based Some Pros/Cons PROs Better flexibility on
configuration and customization than SaaS software can be
configured using Web-based services; customizations are at least
possible May support better access to patient data for reporting
and research Supports unified information technology approach
within the organization Allows easy access using the Internet CONs
Model still carries a significant upfront cost and long-term
commitment; requires an IT staff with the appropriate skill sets
and very good customer service Slower than pure client-server due
to interaction with the Web (although Web- services and improved,
dedicated broadband access can make this less apparent to the
end-user) May require additional subscription fees if EHR business
provides hosting services for the customers servers and
database.
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Summary There may be some variation in how products are
configured and sold, but three types of models dominate the market
itself Software-as-a-Service (SaaS) Client-server Active Server
Pages (ASP) in the.NET Framework Each model has advantages and
disadvantages. Initial determinants are What best matches your
business requirements? How much can your organization afford? How
much flexibility does your business really need?
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We Have Solutions for Integrating Primary and Behavioral
Healthcare Contact CIHS for all types of primary and behavioral
health care integration technical assistance and training needs
1701 K Street NW, Ste 400 Washington DC 20006 Web:
www.integration.samhsa.govwww.integration.samhsa.gov
Email:[email protected]@thenationalcouncil.org
Phone:202-684-7457 Prepared and presented by Colleen ODonnell, MSW,
PMP, CHTS-IM for the Center for Integrated Health Solutions