Cloud EHR Lessons Learned in Haiti

Strip away preconceptions about why technology doesn't or shouldn't work and people are likely to embrace the change that tech brings. That's what electronic health record and practice management software vendor athenahealth learned when it helped a hospital in Haiti implement a cloud-based EHR system.

Healthcare providers in the United States have preconceived notions about electronic health records—namely, that EHR systems haven't lived up to their promise of transforming healthcare by improving efficiency and cutting costs.

The healthcare industry also has preconceived notions about cloud computing, too—namely, that the cloud isn't secure enough for patient data.

Go to Haiti, though, and the story's dramatically different. There are no preconceptions, no tales of IT implementations gone wrong and no government mandates to adopt technology. As one health worker told Pierre Valette, vice president of content communications for cloud EHR and practice management software vendor athenahealth, "They've got nothing to unlearn."

Treating Spinal Cord Injuries After Haiti Earthquake

The connection between Haiti and Watertown, Mass.-based athenahealth began several years ago, when CEO Jonathan Bush began donating to St. Boniface Hospital in rural southern Haiti, where running water and electricity are scarce.

After the Jan. 12, 2010 earthquake that destroyed much of Port-au-Prince, Haiti's capital, the hospital and the Massachusetts-based St. Boniface Haiti Foundation established the country's first spinal cord injury treatment center.

Spinal cord injuries in the developing world are much harder to treat at all stages of the care process, from transportation to the hospital to inadequate radiology equipment to poor rehabilitation services. While the life expectancy for spinal cord patients in the developed world can be measures in decades, in the Third World, it's mere years.

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As of May 2013, though, only one patient in the spinal cord injury program at St. Boniface had died. To recognize this work, this spring athenahealth gave St. Boniface Haiti Foundation its 2013 Vision Award and athenaClinicals, its cloud-based EHR, to help improve clinical documentation and catalog the program's progress.

Cloud EHR Good Fit For Rural Setting

As Valette notes in a three-part blog series about athenahealth's trip to Haiti, this was the hospital's first EHR system. This "purity" of sorts eased the adoption process, he says. It helped, too, that St. Boniface, while willing to think big, understood that successful EHR implementation requires a methodical approach.

Given the rural setting—it takes planes, buses and automobiles to get to St. Boniface, says Kevin Scheper, vice president of professional services for athenahealth—a cloud-based system made more sense than a client-server EHR deployment.

A single-instance cloud EHR helps connect St. Boniface with the Boston University Medical Campus, where doctors are donating their time to view X-rays and physician notes for patients in Haiti. This offers a marked contrast to the more traditional ASP-based delivery model, in which each practice has a customized version of an EHR system that's often compatible with other instances of the same system, Scheper notes.

Admittedly, bandwidth can be a challenge, but Scheper was surprised to learn that satellite connectivity made the Internet more reliable than the water supply or the electricity grid. (In similar scenarios, where rural healthcare providers may be unable to secure a redundant Internet connection, paper-based backup options may be a disaster recovery necessity, he says.)

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Once the cloud EHR was online, the next step was training the physicians running the spinal cord injury program. Here, end users' "clean slate" and their distinct goal—to document the progress of a single hospital program—made engagement easy, Valette says. So, too, did a schedule that gave physicians time to balance patient care with learning how to use the system, he adds. Once physicians were trained, the rest of the caregivers received their introduction to the system.

Absent Frustrations, Cloud EHR Easier to Accept

One key advantage to the St. Boniface scenario, Scheper says, was that it didn't come with as much of the "psychological change management" that tends to accompany the workflow change management so prevalent in EHR implementation. (This is irrespective of a client-server or cloud-based EHR model, he adds.)

Physicians were willing to start with the end in mind, Scheper says, rather than insist that they continue the same inefficient, paper-based processes. Nor did athenahealth insist that physicians recreate processes that did work in order to conform to electronic workflows.

It helped, too, that the Haitian physicians didn't have the same preconceived notions of, or bad experiences with, EHR systems and cloud computing that many U.S. physicians have. Many suggest that the cloud isn't secure enough for protected health information—the loss of which constitutes a costly data breach under the HIPAA Privacy Rule—but Scheper says vendors such as athenahealth, by developing a single set of security protocols for their customers, can better protect information than an individual healthcare organization can.

As for EHR systems, Scheper suggests that the marketplace is filled with "a bunch of bad options." That, coupled with the $21 billion meaningful use incentive program, which rewards those using EHR technology but will penalize those who aren't using EHRs by 2015, actually makes transforming the marketplace harder.

"Established players don't really have an incentive to fundamentally change their platform, because the government is creating massive artificial demand," Scheper says.

Brian Eastwood is a senior editor for CIO.com. You can reach him on Twitter @Brian_Eastwood or via email. Follow everything from CIO.com on Twitter @CIOonline, Facebook, Google + and LinkedIn.

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