Design Decision: ‘Web-based’ EMR

One of the lessons my client (Carolina Oncology Specialists… COS) learned with their previous foray into the EMR market was that it is important to have all records available at all locations. In some cases, patients went between locations on the same day, or even different days and the EMR product they had was not efficient at handling multiple sites.

So, in order to accomplish the goal of immediate clinic-wide access to up-to-date patient information we decided to implement our EMR system as a centralized ‘web’ server. I put web in quotation marks because, although it is serving data via http(s) requests, it is not on the public Internet. There are very large security concerns when operating outside of a more secure intranet.

This allows us not only to meet the requirements of the practice, but it also allows us many technical flexibilities because web servers are:

1. OS-independent
2. programming language-independent
3. easily replicable
4. able to benefit from Model, View, Controller (MVC) framework, providing even more flexibility

This decision also frees many restrictions on the client computers within the office. The client application is abstracted to a web browser, which is also platform-independent.

This could mean that you could implement your desktop and server architecture without paying a dime in Microsoft licensing! Go Linux! (You could even run this application on a Mac if you are an enthusiastic devotee.)

4 Responses to “Design Decision: ‘Web-based’ EMR”

  1. emr and hipaa Says:

    Web based is great. I read an interesting article today about Joost's failure as they tried to create a client based application to watch TV online. I remember when Joost was the media darling. However, the lesson learned from Joost's failure was that the web based application won out.I'm a little more cautious in this prediction when it comes to EMR. Mostly because EMR is more like an enterprise application than it is a consumer application. However, even there we're seeing movement to the web. It's just a matter of time.John Lynn

  2. Nick Orlowski Says:

    John,Thanks for the comments. I agree that many enterprise 'solutions' these days are implemented as client applications, but one telling example of a movement to web-based enterprise applications is the rise of Microsoft Outlook Express. Many of my friends' companies (and my old client) use the web-based addition to MS Outlook. Say what you will about MS products, their mixed client/web-based model works very well. I don't forsee a client-based application for this project, but I am not a guy who says "never".

  3. John Lynn Says:

    I think one of the challenges you’ll face with the web based model will come with document management. You can do a lot of it web based, but if you get into big installs of document management stuff, then a client is just better. Another one is if you have to integrate with some sort of image software (radiology or the likes). The images are so large that a web based model runs into trouble (at least for now). Of course, it’s all possible, but there’s tradeoffs when you choose to go completely web based.

    Maybe you’ll be the first to create one that can run on the new Google Chrome OS if it’s completely web based. Could be cool to see.

  4. orlowski Says:

    Thanks for the input! I agree that document management will be a large hurdle to clear with a web-only interface. And although this is a phased development and the first phase is workflow management, we do have pie-in-the-sky goals such as document management.

    I am unclear as to the specifics of the limitations. I don’t have intimate experience with these images, but I do understand that they are huge. Is the limitation you speak of the memory capacity of a web browser?

    Also, with a client installation, would the benefit be that serving the file is only realistically speedy enough from a hard drive? Maybe one solution could be some sort of google maps interface where only sections of the images are requested as they are needed? Lofty goals, but certainly awesome if done well.

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