Disaster-proofing your electronic health record

The calamity on January 20 could have literally doused the digital dreams of Toledo, Kansas, family physician Ken Bertka.

When he arrived at his office that morning, water was raining down from the ceiling from a broken pipe. Desktop computers were wet and unsafe to use. So what would happen to the patient charts in his new electronic health record (EHR) system?

Nothing. Dr. Bertka has a Web-based EHR program, meaning that the charts reside in an offsite computer maintained by the software vendor, known as an application service provider (ASP). He accesses the charts over the Internet. And that's exactly what Dr. Bertka did on January 20. True, the desktop units were temporarily out of commission, but the practice's wireless tablet computers were sitting safe and dry in a cabinet. So, while the office was being cleaned up, Dr. Bertka was able to see a few emergency patients that day as well as handle others over the telephone, charts at his fingertips.

Virtual efficiencies. The physicians in the pilot project used an ASP version of an EHR from a company called MedPlexus in Santa Clara, Calif. Because data files were stored on a remote server, the physicians didn't need an expensive dedicated server of their own. Plus, they were spared the task of backing up data and working out interfaces with labs and pharmacies. "That reduced the burden on my staff," says family physician John Sattenspiel of Salem, Ore., a participant in the pilot and a member of the AAFP's board of directors.

The physicians had to install special software on their desktop and portable computers so that their machines could talk to the remote server, but they were able to download it via the Internet without a visit from MedPlexus technicians. And the software is automatically updated on their computers as it undergoes refinement, saving them from additional tinkering.

The AAFP found that the ASP model also did wonders for training. Instead of coming to each doctor's office for several days, MedPlexus employees held online classes every week or so through a service called WebEx ( http://www.webex.com/) coupled with a telephone conference. "If we had brought someone onsite, I would have had to close my practice for several days, or at least dramatically reduce the number of appointments," says Dr. Bertka. "One of my guiding principles was to implement an EHR without any drop in productivity. We couldn't afford to see one less patient."

Dr. Bertka's practice scheduled WebEx training during the lunch hour. Stretching out the sessions over several weeks made it easier for physicians and staffers to master the material. "We had a week to apply what we learned after each WebEx," he says. "You absorb more that way than if you sit through several days of nonstop training."

Avoiding downtime. While the ASP approach receives applause, it also has an Achilles' heel-getting disconnected from the Internet. Dr. Bertka found that out on the first day of training when a ditchdigger accidentally severed the cable line that provided his office's broadband connection. "I thought to myself, 'Is this an omen of things to come?'" His next response epitomized the can-do spirit that's essential in licking high-tech problems. He and his office manager temporarily spliced the two ends of the cable back together. Total downtime: 10 minutes.