I’ve been writing for a number of years on the challenge that EMR downtime causes a clinic. In case you missed them, check out some of the following posts:
My EMR is DOWN!!!
Working Offline When Your EHR Isn’t Available
Cost of EHR Down Time
Reasons Your EHR Will Go Down
SaaS EHR Down Time vs. In House EHR Down Time
Not to mention Katherine Rourke’s recent post titled, “When The EMR Goes Down, Doctors Freak Out.” Obviously, downtime is a big problem as doctors become more reliant on their EHR software. Plus, as I state in some of the article, downtime is inevitable.
One of the most common comments I got on those posts was doctors asking why they couldn’t work in the EHR software even when it was down. My answer was usually that the EHR vendor could do that, but that it would require them to architect the EHR to be able to support offline use of the EHR and that wasn’t a simple task.
Turns out that Aprima has built this functionality into their EHR called Aprima Replication. Here’s their description of the replication feature:
Every installation of Aprima EHR includes the Replication functionality. This allows physicians to continue working within patient charts when they are not able to be connected to their server (whether it is hosted locally in their office or in the cloud). They have identical functionality as if they were fully connected with the ability to look up or enter data, perform everyday tasks such as messaging and tasking, create orders, review results, etc. Everything is stored locally on their hard drive in a secure and encrypted environment and automatically syncs information the next time they are online whether that be over a mobile wireless connection, wifi + VPN over a public network, back in their office over a wired or wifi network, at home, or wherever and however they are able to connect. Additionally, all of the synchronization is done behind the scenes allowing the provider to continue working live without having to wait for the replication to complete.
Aprima Replication goes beyond other mobile technologies because this does not require connectivity, and even more importantly it is not simply a copy of the server that is “read only,” or a partial export of charts that leaves the server side locked until the provider “checks the chart back in.” This is fully functional on the provider side while disconnected AND allows others to also continue to make updates and changes to the chart, patient scheduling, handle all the needs surrounding coordination of care, billing and collections, etc. This can also be used as a great “downtime” alternative to paper in the event of an internet outage for those using the cloud or a server failure when running it locally.
I asked a couple follow up questions to clarify exactly how the offline EMR functionality worked. Here are my questions and their answers (originally an email exchange):
The challenge I have is understanding how the patient records are available without an internet connection. You can’t be downloading every single patient record locally are you?
In our unique, patent pending Replication process, every provider has a profile unique to their needs and preferences. This includes a subset of patients based on their previous schedule, future schedule, open orders and tasks, a specific facility they may be servicing such as a nursing home, their messages, attachments, (they can set size limits to address minimal bandwidth environments such as wireless air cards) etc. Based on these parameters the appropriate patient charts are “replicated” to their tablet/laptop computer. This is an ongoing, real-time process while they are connected to the network that keeps the data current. Any time they disconnect, or even lose connectivity if there is an outage, they continue to have full chart access for reviewing, adding, and editing as if they were still connected. As soon as connectivity is restored the synchronization starts up again and continues until all of their work, plus all of the work done simultaneously on the server side, is merged back together.
Does it just download some “active patient” list or the records for the patients on your schedule for some certain time period? It’s a really beautiful thing that you’re program can work without the internet. I assume all of the drug databases, etc are downloaded and available locally as well?
Yes, they are, including all drug interaction checking which remains fully functional while off line. Any orders for scripts, labs, diagnostics, or anything else, can be created offline and then processed when the computer is back in network range. So the script or order will be ‘staged’ and ready to go. It’s just like when you write an email when your offline, then when you get in range, the emails in your outbox just go.
The other question I have is how the records deal with multiple people modifying the record in a disconnected mode. What if the nurse accesses the record and documents something and then the doctor gets in and document something. Does the record get reconciled once it’s reconnected?
Yes indeed it does.
Are there every any issues that have to be reconciled manually?
There is a “collision” report. These “collisions” are rare but we do accommodate them very well. If a Replication “save” conflict occurs, a message will be sent to the user group that is defined to be notified. Replication conflict messages contain details of the conflict and the name of the associated patient if applicable.
The next time I see Aprima at a conference, I plan to check out this feature first hand. Reconciling a patient record that two people are editing can get pretty complex. I’d like to see how it handles it. Plus, I’d love to see how well it does at resyncing the data after being offline for a while. Not to mention how well it does at identifying the patient info it should have stored locally.
This is a really challenging feature to implement. I think it says something about Aprima that they took it on. If it works well, I know there are a lot of doctors that would love this feature in their EHR.