Lessons learned

Slow Internet connection dead-ends Web-based EHR for rural DO

After months of searching for an EHR, Oklahoma practice pulls plug after two months.

Topics

Layne E. Subera, DO, knew that moving from paper charts to electronic health records (EHRs) would briefly curtail his productivity until he got up to speed with the new system. But when he and partner Rudolph J. Wolf, DO, installed a Web-based EHR in their rural Skiatook, Okla., family practice last November, the slowdown they encountered had nothing to do with a learning curve.

“The EHR system required communicating with a remote server over the Internet for each data item I entered,” Dr. Subera says. “Because the Internet connection line coming into town was too slow, there would be a one- to two-second delay between the time I entered something and it would appear on the screen. That could happen 30 times during a single note—an extra two minutes of documentation—and that was frustrating.”

When Dr. Subera began looking for an EHR system in May 2010, he wanted an affordable technology that would boost office efficiency and provide offsite data storage.

A Web-based EHR seemed to fit the bill. Paying only a monthly subscription fee, Drs. Subera and Wolf could avoid the hefty up-front cost for an in-house system. In addition, its touch-screen, tablet-based interface promised quick charting and mobility. The system also automated data backups.

“We didn’t want to keep data on site because we were concerned about security issues and the hassles of doing daily backups, along with keeping a copy of all documentation offsite,” Dr. Subera says. Although the EHR could not interact with the practice’s billing system, Dr. Subera didn’t see that as a problem. Staff simply would need to devote extra time loading patient information into the EHR, he figured.

Mounting frustrations

Problems, led by the slow Internet connection in the rural town, began on day one and never let up. “We had our Internet speed tested and provided that information to the vendor, who assured us that everything would work,” Dr. Subera says. “Technically it did work, but not well. While our office is located just a block from the Internet service provider’s hub, the connection speed of 1 MB per second is just too slow.”

The start-and-stop charting bogged down patient visits and forced Dr. Subera to complete his notes at home. “I would work on data entry from 6 p.m. to 9 p.m. and again the next morning from 4 to 7,” he says. “Then I’d go to work to collect more data to input that evening. I think my partner saw three patients before he quit using it.” The vendor’s software upgrades did nothing to solve the problem.

Also, inputting patient billing information proved to be more of a time drain than Dr. Subera had hoped. “Staff had to manually rebuild each patient’s record, and that was an added headache.”

Though he had little cause for optimism, Dr. Subera remained hopeful the system would work out. “I cowboyed up for the first two months, and then in January the process was becoming disheartening,” he says. “So we decided to pull the plug on Jan. 31. We went back to paper charts the following Monday, which was a great day in my life. And we started looking for another product.”

Back to square one

During his second search for an EHR, Dr. Subera revised the list of needed features. While a reasonable price remained a priority, he also wanted a fast system that could connect with his billing program.

“We knew that the Web-based EHR wasn’t going to work for us and that we needed something we could install onsite,” he says. He checked out several EHRs before finding one that met his needs, SpringCharts. “The system’s low cost was key. And it has very low server and workstation requirements, so we don’t need high-end hardware to run it,” Dr. Subera says.

The office went live with the system in late April. Dr. Subera reports that the transition so far has been much smoother. “I started work at 7 a.m. today, worked until noon, and I’m done with all my charting. With our old system, I’d still have three or four hours of charting to do. And my partner is slowly working into it.”

Dr. Subera’s staff welcomed the opportunity to return to the older billing system. “We were accustomed to it because we had used it for three years, and it was easier,” says Nancy Orjala, the office manager. She adds that the older system involved just two steps to gain entry to a patient’s ledger versus the seven steps required with the Web-based EHR.

“If I were to give advice to anyone considering an EHR,” says Dr. Subera, “it would be to pick a system that interfaces with your billing software. And if you’re in a rural area with slow Internet connection speeds, definitely go for a traditional, on-site-server-based system rather than a Web-based EHR.”

Correction: In an earlier version of this article, Rudolph J. Wolf, DO, was misidentified in the accompanying photo. The DO regrets the error.

One comment

  1. rudolph j wolf, D.O.

    Hey, the guy on the left is better looking than me, so keep that pix. BUT….he looks a bit heavier and older than me.
    RJWolf, DO, FACOFP dist

Leave a comment Please see our comment policy