Two Dynamic Modes for Linking Point-of-Care with EMR Systems
Store and Forward vs Persistant
Which method is preferable? The answer depends on an agency’s requirements and priorities. Providers would do well to consider the advantages and disadvantages of both before committing to either one of these effective technologies.
Store and Forward
Advantages
The Store and Forward approach offers Point of Care providers several key advantages. The most prominent is independence. Laptops utilized in this mode are not connected to the Internet, but instead serve as stand-alone devices for storing patient assessment data. The elimination of ‘connection dependence’ offers nurses and therapists considerable freedom and flexibility for conducting full patient assessments wherever and whenever such service is needed. Once an assessment is completed, a caregiver can upload all pertinent medical information to the company EMR at a future time in line with agency needs.
Non-reliance on an Internet connection gives the Store and Forward approach particularly high value wherever online services are either compromised or completely non-existent. These areas include certain rural locations and high-population density buildings, both of which may lack an Internet signal or are limited to an intermittent connection.
Freedom from Internet connectivity also eliminates the problem of session time-outs. Caregivers can devote their full attention to a thorough assessment, pausing as often as needed without fear of disrupting the process or losing information. All sessions stay intact, whether they last one hour or one day.
Disadvantages
If exchanging real time information between Point of Care and a company EMR system is a priority, providers definitely require an alternative to Store and Forward. Depending on the location of an assessment, establishing an Internet connection with an EMR system could take hours, assuming a local connection is possible at all. If waiting is not an option, neither is Store and Forward.
Another delay inherent to Store and Forward is related to the synching process. Numerous caregivers have discovered that synching the complex Point of Care data from laptop to EMR system can be both cumbersome and inconsistent at times. Furthermore, since information isn’t always in synch, some transmitted data may be ancient history by the time it reaches the agency. Again, if timeliness is crucial, its best to opt for an alternate method of data transmission.
Since Store and Forward allows data to linger in limbo for indefinite periods, Point of Care laptops also can become potential targets for privacy compromises. The longer sensitive data resides within a laptop, the greater the chance of info theft. Clearly, this heightened vulnerability could have a major impact on HIPPA compliance.
Persistent Connection
Advantages
As with Store and Forward, a Persistent Connection offers agencies clear-cut advantages. Foremost among these is the method’s built-in capacity for capturing data in real time, thereby providing company EMR systems with a consistent flow of current information. The method is indispensable for agencies that rely on real-time field data.
A Persistent Connection also offers increasingly available and reliable connectivity thanks to advanced technologies such as Wymax and 3G. Despite these advances, however, the required technology and installation is minimal with this method because users need nothing more than a browser to connect.
For agencies intent on maximizing data security, a Persistent Connection is head and shoulders above the Store and Forward process. The reason is simple. With the former technique, data resides in the EMR system, not the laptop. Info theft becomes virtually impossible because data is never stuck in a vulnerable location.
Disadvantages
While the advantages of a Persistent Connection are a boon to health care productivity, agencies should be aware of several key drawbacks inherent to the system.
First of all, availability depends on location. A Persistent Connection clearly is not a viable solution for companies operating in rural or limited-connectivity areas. A continuous, reliable connection is mandatory.
An adjunct to continuous connectivity is a limitation placed on users. Nurses and therapists conducting assessments simply don’t have the option of working offline. Such a restriction can hamper the efforts of professionals who might not have easy access to a network connection.
Another drawback concerns one of the most important components of a Persistent Connection – browsers. In certain cases, the functionality of key assessment applications is limited to the sophistication and compatibility of browser technology. The two must support each other flawlessly. Unfortunately, such mutual support is not always the case. When incompatibilities arise, assessment processes can be severely compromised.
Perhaps the most exasperating disadvantage inherent to the Persistent Connection method is its notorious time limitation. Much to the frustration of numerous health care professionals, the duration of online assessment sessions is strictly limited. The possibility of an ‘untimely’ timeout can put undue pressure on caregivers to wrap-up an assessment before the last precious second ticks away and forces a start-over. Taking a break to resume at a later interval clearly is out of the question, since this action will gobble up valuable chunks of time. In essence, those performing an assessment are forced to remain glued to the spot until their task is completed – hopefully before the session times out.
Choosing Between Two Powerful Solutions
Health Care providers determined to implement the most effective Point of Care data linking solution can choose between two outstanding possibilities. Both Store and Forward and Persistent Connection offer agencies an array of distinct benefits for efficient and reliable communication between laptop devices and EMR systems. Selecting the most appropriate method depends upon a careful evaluation of both the advantages and disadvantages of each in relation to company needs.
Why a Hybrid model may solve most challenges
Currently some vendors may have a hybrid model which would address most of the issues and challenges for either method. That model would operate similar to the persistent mode of communication. Once there would be lack of connectivity to the host sever, it would store the information temporarily on the point of care device. This is important because unlike most store and forward models, it would submit updated data as soon as it can make a connection. This would be transparent to the user and would not require a full "synchronization". More importantly the data then would be removed from the device, eliminating any risk for information to be stolen if the device is lost.
It is recommended when looking for a vendor that you ask if they will support a hybrid model. The challenge is that most do not. It would be in your best interest to see how they address the issues that are predicated by the technology their are deploying.