This is one of the nastier issues that are almost never discussed in the EMR community. The patient is supposed to own the data and the doctor is supposed to own the record – but what happens to that rule when the vendor ‘locks’ the data in the EMR and does not allow the clinic to have full access to it. How can any physician claim to own a record that they cannot access, except at the behest of the vendor? After all – in an ‘electronic’ medical record system, the database record is the ‘record’! How can the physician claim to be the custodian and responsible to the patient when they do not have access to the original record? How might this affect the patient care by that doctor in the long term?
There are various ways that this might occur, but the most common are when a vendor encrypts or password protects the database. In these cases the physician cannot access the database except through the use of the EMR application. Now, this might not sound all that bad, but it can have some rather serious ramifications. What happens when the clinic wants to do something that is not built into the EMR? Such as:
- – Export data to a third party (CPCSSN for example)
- – Perform data analytics
- – Run custom reports or queries
- – Convert to a new EMR
If they cannot access their database directly, they may not be able to perform any of the previous tasks. By far, the most serious would seem to be converting to a new EMR, as this could impact the actual business of the clinic. However, being able to access the data for other purposes can also have a big impact. Take for example that fact that we are moving to a new compensation system, where a clinic will not be reimbursed for simply using an EMR, but will have to prove that they are using it properly by generating certain reports for the government. And I believe this is just the beginning of the changes to come. However, if your vendor is slow getting these changes out to your clinic, or goes out of business, how will you be able to generate these reports? Oh that’s right – you will just move to another EMR! But wait – you cannot access the data and the vendor is either out of business, or just VERY slow to respond to you – so you cannot move to another vendor – because your data is ‘stuck’ in the current EMR application. This is the situation for many clinics in Canada right now. They have EMR software where the vendor does not allow them to access their data directly – and will not provide them with the raw database. These are ‘closed’ systems. In effect, some of these systems basically hold the EMR data hostage – forcing the clinic to continue dealing with the current vendor.
There are various ways that this is done. Some vendors will encrypt a few key fields or tables in the EMR, some will password protect an entire database. Others will not provide the administrator password to the machines (administrator in Windows, root in Linux, etc.) – even though the clinic has paid for and owns those machines.
Another way this is done, but not necessarily intentionally – is when you use an EMR that only provides an ASP solution. Basically, the EMR is usually served via a web browser and the application and the database are hosted remotely. While this is not a case of the vendor deliberately making it difficult for the clinic to access their data directly, usually that capability is not there. The questions then revolve around issues like; can the clinic get access directly to their data? If not, can they get a backup or copy from the vendor? And most importantly – how much would this cost the clinic? These costs can be prohibitive (from some vendors) – thus locking the clinic into the vendor’s solution. Don’t get me wrong, there are some huge advantages to using an ASP solution. However, you should also be aware of the pitfalls and possibly hidden costs.
One of the final ways a vendor may lock a clinic’s data is with very restrictive contracts. We have seen some contracts that are so restrictive that they prevent the clinic from doing almost anything with the EMR or data that the vendor does not approve of. One example of a vendor’s contract in Canada, hobbled together almost every nasty contract clause you can find on the internet in an effort to restrict the clinic and protect the vendor. These contracts are not “Good Business” and should be avoided at all costs. Why does a vendor think it is necessary to restrict/handicap the clinic and impose massive penalties if the clinic tries to access their data?
I have heard many reasons as to why a vendor might want to ‘lock’ the data. Most of them revolve around protecting the data from accidental changes. I am sorry – but for the most part this reasoning is just an excuse. Most doctors are not going to use database programs to try to alter the data. They are going to use the EMR – because it is what they are used to. As well, there are not many doctors, or staff, in clinics that have the skill set to do so. Yes – a consultant hired by the clinic could potentially alter the data. But it is unlikely. In fact I have seen more data corruption caused by vendors trying to ‘fix’ something in the data then by any outside consultants. Almost all of the requirements I spoke about above – are really just reading the data! There should be no changing of the data outside of the EMR under normal circumstances.