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ASPs can expand the resources of HIM
Expert offers suggestions on choosing right one
Sooner or later, your HIM department probably will begin the process of moving documentation, communications, and transcription to an electronic process, and may decide to use an application service provider (ASP).
ASPs are Internet-based companies that own and operate servers (computers with large amounts of storage and activity memory) and software applications. These service providers give subscribers access to software applications via the Internet, charging on a per-use, monthly, or annual basis.
ASPs can assist with emergency department data, transcription data, and everything else that can be handled electronically. By using an ASP, a facility does not need to have its own information technology department, because the entire operation of managing servers and information management infrastructure can be outsourced, explains V. Juggy Jagannathan, PhD, chief operating officer and chief technology officer of Careflow/Net of Morgantown, WV, a company that has a software product that is used by companies that want to host ASPs.
Jagannathan, who also is an associate professor of computer science at West Virginia University in Morgantown, spoke to HIM professionals about ASP technology at the 74th National Convention and Exhibit of the American Health Information Management Association of Chicago, held in San Francisco on Sept. 21-26, 2002.
"This way they won’t have the headaches of maintaining a system," Jagannathan adds. "So you are basically sharing the space, the framework, and infrastructure across multiple companies, and it can be a huge cost savings for different enterprises."
Jagannathan offers these guidelines to selecting and using an ASP in a health care setting:
There is a complex set of requirements necessary for successful deployment of an ASP, so it’s important to make certain the potential contractor can answer various questions, including these:
— Can the ASP support your processes?
— How flexible is the ASP in supporting your particular processes?
— Does the ASP contractor adhere to security requirements?
— How reliable is the ASP?
— Does any information get lost or mangled, and how reliable is the infrastructure? Is it fireproof and protected?
— What guarantee is given of the system being repaired as needed?
— What is the policy regarding the ASP’s availability? "How long will the system be available for use, and what are the guarantees?" Jagannathan asks. For example, an ASP that has a downtime of five minutes per year is 99.999% available. "Most people might not need that level of availability, but every organization needs to know what their availability requirements are," Jagannathan adds.
— What happens if there are more users on the ASP and more volume?
— How easy is it to upgrade the infrastructure, and are the hardware needs excessive?
— What benchmarks are available, and how much time does it take to submit and retrieve reports when the system is under a heavy load?
— Can the user manage its own support needs, and is it Web-based?
— Who maintains the software, and how are maintenance and software evolution managed? "Nothing remains static," Jagannathan notes. "Even the small hospital must plan for changes, so you want to know how the ASP will handle these things and what kind of performance guarantees are given."
— What is the technology basis that facilitates maintenance? "ASPs will require routine maintenance to make sure things are handled," Jagannathan says.
— How easy is it to interface to the system, and what kind of data exchanges are supported? "How will it integrate with existing infrastructure and how does it work?" Jagannathan says.
— What is the platform used (e.g., Windows or Unix), and does the system support leveraging the strengths of both platforms?
Keep Internet standards in mind
For example, XML, or extensible mark-up language, is emerging as an important technology, Jagannathan says.
XML-based content tagging has important uses, such as data mining, role-oriented display customization, intelligent searching, and other value-added elements, he says.
For example, all documents could be marked with a tag, and XML permits the user to define which tags are allowable, Jagannathan says. "This allows programs to manipulate information as opposed to having human beings review the data, and this is a fundamental change."
With XML, the user has information that is structured and readable and that is, at the same time, easily manipulated within various programs.
"This is a technology that I look at as one in the future of ASP industries, and it’s evolving," Jagannathan says.
Also, an ASP should meet standards of the common object request broker architecture (CORBA), Jagannathan says.
"This pertains to how programs can communicate over the Internet," he explains.
The advantages offered by CORBA are that it has hardware and operating system independence, language independence, and location independence. Also, the standard specifies the Interface Definition Language that is used to describe interfaces that client objects call and object implementations provide, Jagannathan says.
"These are all technological underpinnings for developing ASP solutions or enterprise-class solutions and those types of technologies," Jagannathan says.
"There are outsourced coding solutions available now," Jagannathan says.
"There is an ASP for coding, which basically is saying that somebody else is doing the coding for your hospital," Jagannathan adds. "Health care providers also are interested in transcription solutions, and there are a number of ASP transcription vendors."
Also, health care providers will want to make certain the ASP meets all privacy regulations, including new rules established under the Health Insurance Portability and Accountability Act (HIPAA).
"HIPAA is a moving target," Jagannathan says.
However, ASPs typically will not permit unencrypted documents to be transmitted over the Internet, and most use a browser device that signifies that the communications between a facility’s browser and the server are encrypted, he says.
"You do have other issues with HIPAA, such as making sure no one outside the organization has access to the information, so there is a concern about access control," Jagannathan says.
An ASP may provide an audit trail that tells who looked at the information and why.
"When considering security issues, this is something that needs to be addressed with the ASP contractor," Jagannathan says. "How they address it is all related to security and making certain HIPAA mandates are being followed."