Selecting the Best Internet Connection- Avoiding Connectivity Lags

With so many practices now converting to EMR and a large number of them using ASP programs, it is important to understand some basics when it comes to your internet infrastructure. By not understanding the basics, you risk spending thousands of dollars on an EMR product that will be ill equipped to perform at its optimum level. Lacking the necessary throughput or bandwidth, will not only slow your office down, but will also put your ASP and wireless applications at a greater risk of crashing.
Throughput and Bandwidth, What do they mean to me?

What do I mean by throughput? It is very simple. You can think back to physics and fluid flow or fluid dynamics as you might recall. The way your internet connection works is similar in many ways to the water hose on the side of your house. The difference is that now your house and all other houses on your block share the same underground supply line that has a 1"i.d. Imagine trying to water your yard at the same time your neighbor four houses down is filling up his swimming pool, hope you have a book because you are going to be there for a while.

This illustration is similar to your internet connection in a variety of ways. With Comcast's cable and At&t's DSL service, you have probably been told that your speed will be up to X megabits per second (Mbps). Well, what does this mean to you? Glad that you asked, and the fact is that it doesn't really mean anything. I do not want to get into the speed or Mbps as much as I want to explain that your maximum download speed, which is most often advertised, does not mean much when talking about consistent upload and download speeds. When you are on the same line as your neighbor who streams videos and music all day, you cannot expect to have a consistently fast internet connection. When the guy next to you is converting to EMR, have you stopped to think about what that might do to your connection speeds? What about the fact that your phones are using VOIP (which I love) technology and are also reliant on your internet speed? Bottom line, without properly thinking about the connectivity issue, you are going to be less productive and frustrated with your IT environment.
Avoiding ASP Potholes

Most EMR solutions have great picture editing software and thousands of templates that if you are an ASP user, all are pulled from a central remote server. I love the ASP model for EMR/PM systems and prefer them over the more traditional client server model. There are a variety of reasons for my preference but the downside to an ASP application is in your reliance on the internet connection and data lines. This and off site security/backups are always the biggest concerns when selecting an ASP EMR solution. The problem is that although the software is great, you will be pulling out what little hair you have left when your pictures are taking forever to load or worse your system freezes in the middle of seeing a patient.
How to avoid the ASP lag?

First off, avoid when finances and circumstances will permit, the use of DSL and cable service providers. You cannot count on a speed with these providers and in most cases they will not guarantee up time or a service interruption response time. Personally, I have used Cable services and DSL services in different offices and have experienced the same quality and service issues with each. You will notice advertisements from Comcast and other providers of download speeds from 6-12mbps(megabits per second) and you may be asking yourself how that is not faster than a single T1 line. The reason that they are increasing their speed is because of constant rise in videos being downloaded and watched online. The increased speed on the part of these providers goes back to my original explanation in the first paragraph. 12mbps sounds great until you and ten other people are put on the same pipeline at which point you are using a connection that varies from .5mbps to 2mbps without any consistency. A far better solution would be a dedicated T1 or maybe two T1s if you have a large office. Personally, I utilize a network of T1 providers to see who can supply me with the connection then evaluating who can give me the best price. I use a company out of Florida that launched a new website to allow you to quickly check prices and availability. Internet Service resellers are essentially the same, in that they are contracted with large data providers like Nuvox, and based upon volume, are able to provide their clients with a cheaper rate than going direct. They also have knowledgeable IT consultants that understand the requirements of different EMR programs and what will work best for your office. A dedicated T1 line will be, in most cases, much faster than the fastest cable connection and will always provide you with a consistent speed and more reliability.

Regardless of what service you use, keep your employees off of the internet and make it a big deal if they are caught on it. Even better, and what I did for a recent client, is to disable the employee’s ability to access the internet from their stations. I designated one computer as our internet computer and it was not part of our internal network. If you only knew what you open your data up to through the internet, you would disable their access tomorrow. It amazes me to find offices that have an internal server and allow their employees on the internet during lunch hours or on breaks. Checking email, the weather, or local news all open your network up to viruses and spyware. You also want to do computer check-ups that make sure there are not applications running behind the scene using up valuable bandwidth.

To understand more about the different EMR applications available you should first comprehend the differences between ASP and Client Server applications. Once you understand the differences, you can then understand what will work best for your organization.

There is also something called a Bi-Directional or Uni-Directional information interchange that occurs between the EMR program and the laboratories/pharmacies. This information exchange is similar to the EDI (electronic data interchange) that occurs with your clearing house and the insurers. This is something else that is often overlooked and is important when considering the time spent by a practice on prescribing and processing lab results.