I have posted a number of blog notes about Software-as-a-Service (SaaS). My own belief is that "renting" software and the necessary associated data storage on the web eliminates many of the problems associated with PC-based applications such as PC failure, data backup, and the necessary periodic software upgrades. I interact with web-based applications for more than 80% of my daily computing activities including the writing and publishing of this blog as well as my email and business-related applications using Gmail and Google Apps.
I fully understand that a hospital executives or hospital-based lab professionals might be nervous about deploying a "pay per use" model for an EMR or LIS. Nevertheless, there seems to be progress in this category of software, as demonstrated by a recent press release (see: Wipro launches pay per use software). Below is an excerpt from the article describing a product that I will refer to as "EMR lite" with boldface emphasis mine:
Wipro Infotech, the India and Middle East IT Business of Wipro, ...announced the launch of Wipro HIS Lite, a Hospital Information System in the SaaS model also known as ‘Pay per Use’ Model at Paras Hospital in Ghaziabad near New Delhi. Wipro HIS Lite is an information system tailor-made for the small hospital and nursing home segment. So far, ‘Pay Per Use’ model, is the first of its kind. It is meant for the small hospital and nursing home community. In the pay per use model the hospitals have to pay just a monthly user based subscription fee, claims the company. The system aims to help doctors maintain patient data efficiently, reduce patient waiting time. It provides strong MIS, business intelligence and integration among all departments of the hospital, according to the company.... All that is required is a dedicated connectivity to the Wipro server in the datacenter and hospitals can use the software on a real-time basis like it is in their own office.”
It should come as no surprise to anyone that an Indian company such as Wipro would launch an SaaS version of an EMR for small hospitals and nursing homes. My guess is that this product will find a ready market outside the U.S. where budgets may be small and society less litigious. It is not clear from the press release exactly where the Wipro servers are located. From a medico-legal perspective, I suspect that potential U.S. hospital and nursing home clients might be more receptive to the product if the servers were located on U.S. soil.
Although the idea may be shocking that EMR and LIS applications and clinical data would be managed in an off-shore server farm, it's worth pointing out that the transcription of medical records from audio tapes and digital files has been occurring off-shore for many years. I discussed this from the perspective of a security risk in July, 2006 (see: Offshore Transcription Services as a Medical Record Security Risk). If hospital executives have been comfortable with off-shore record transcription for years, I don't think that support for an EMR is that different. However, I also suspect that the average U.S. citizen has little awareness of the extent to which his or her personal financial and health information is currently being managed in foreign countries.