I was recently asked how Medrium could provide EMR and PMS for such low price while other systems are much more expensive. There is also an assumption that since our price point is low, the functionality of our products was inferior to the expensive systems. Nothing can be further from the truth. So I thought I would take some time to explain why Medrium is able to keep the price lower as compared to whole lot of systems out there. As I mentioned in my earlier post - Medrium Platform, the principles that Medrium's platform was built on not only allow us to keep costs low but also provide much better functionality than most of the systems out there.
Some of the reasons for the low costs are
Single version of the software
Medrium is a true ASP model as such has only 1 version of the software. Our developers can concentrate on developing application functionality and not worry about having to maintain multiple versions or ports onto different Operating systems.
Use of Cloud Computing
Medrium uses of Cloud computing and storage not only reduces costs but also allows to scale computing and storage resources as needed without up front costs.
Leverage the work done by countless developers in the Open Source Community
Proprietary development tools, databases are expensive and these costs need to be passed on the client. Medrium platform is written in Java and we leverage the huge amount of open source libraries. Medrium uses PostgreSQL and does not have to pay expensive developer and production license fees for databases like Oracle or SQL server etc. Not depending on proprietary tools allows Medrium not only to keep costs low but also prevents Medrium from being locked down to a particular technology. When new and better open source tools emerge, Medrium just moves on to these tools/libraries. For example, when Medrium started 10 years ago, technologies like AJAX were not available. As Browser's became more advanced we were able to move on and use the vast number of open/free tools that became available. Medrium's EMR is built using GWT which enables Medrium to leverage the work done by Google and countless other developers. Another example is use of Mirth allows us to leverage the work done by the open source community instead of spending resources on expensive HL7/EDI translation tools or be locked into a vendor's tools. Medrium's usage of all these open source tools leverages the work of thousands of developers and allows our developers to concentrate on developing the application. I would also argue that open source tools and libraries not only reduce development costs, but in most cases are far superior than proprietary software/tools.
Now let's compare Medrium's platform to some of the other systems out there.
Client/Server Systems offered as Saas Models - eclinicalworks, NextGen ...
A lot of the expensive so called "SaaS" systems out there are "client/server" systems which can be bought outright or hosted by the vendor and offered on a subscription basis. These are not SaaS products like say Salesforce.com. They are taking away some of the pain points for the physician practices - IT management headaches - but they have the inherent problems of
Maintain multiple versions of the software. Have to cope with the constant changes required by Stage 1, Stage 2 .. requirements of Meaningful use. Stage 1 goes into effect in Jan 2011 and the ARRA certification bodies are still not announced. Changes would be needed to support ICD-10. It will take a lot of resources to just keep up with all these changes if multiple versions need to be certified as well multiple servers updated.
No ability to share computing and storage resources, increases costs.
Maintain and update each client's server with any new versions. The costs for all maintainces of multiple versions and any proprietary databases and software licenses have to be passed on to the clients. Not to mention that any enhancements or improvements to the system will come slowly to the client.
Web platforms tied to a specific browser or Operating systems - AthenaHealth, PracticeFusion, AdvancedMD ...
These systems are better than Client/Server or Hosted Client/Server systems from a development and maintaince costs but still have issues. Dependence on a OS/browser or proprietary technologies like Flash limits availability of applications to some platforms only.It's one thing to dictate what a Physician should use - Windows platform/Explorer etc, but you cannot dictate what a Patient can use. Note- Stage 1 meaningful use requires providing Patients with online access to their clinical record. So either these vendors have to spend additional resources to maintain multiple versions so the applications can run on different devices or limit themselves to some devices only - there by limiting themselves to advances in technology/functionality.
A platform built using true Web based technologies and takes advantage of cloud computing have greater advantages in terms of price and functionality. None of this is a big revelation. Companies like SalesForce or applications like Google Apps have taken advantage of web based models and cloud servers to provide better functionality at a lower costs. Even Microsoft is embracing cloud based computing and Open Source. Client Server systems and Systems tied to a browser and platform are the way of the past with higher price tags and/or old technology. Healthcare information technology has always been behind in technology but I believe that is changing. In future you will start to see more and more Healthcare applications and solutions that will exploit Web based technologies and Cloud computing to provide better functionality at much lower costs.
Saturday, August 28, 2010
Thursday, July 29, 2010
Medrium's EMR
In my previous blog I talked about the design philosophy and goals we had in mind when we built the Medrium platform. I am happy to say that following these principles had benefitted both Medrium and our clients very well.
Medrium has released EMR to a select list of our clients to get their feedback and the feedback so far has been positive. The EMR functionality was built using the same design philosphy we had. Sticking to our basics - Access from anywhere - any computer with a browser and internet connection had paid off. Our EMR and Practice Managment software are both available not only on PCs/Macs .. desktops/ notebook computers but also on ipad, iphone and other smart phones. Being true to HTML and not using plugins like ActiveX and Flash makes these apps available on tablets and smartphones. There are some changes we may want to make for smartphones to make the interaction on smartphones better but the fact that the application was built using basic HTML made it possible to access Medrium services on these internet browser based devices without any changes to Medrium platform.
While extending Medrium platform to incorporate EMR functionality we also took advantage of new technologies like GWT to make the user experience much better - Pages load faster and no need to jump from page to page. Read more about how we use GWT
As many of you may already know HHS has published the Standards for Stage 1 Meaningful Use requirements on July 28th. The certification bodies who will certify EHRs should be ready in late summer and we are looking forward to get EMR certified so our clients can not only benefit from the additional functionality but also the Stimulus money.
Medrium's EMR is bundled with our Comprehensive service at no no additional cost and any client that wants to use the EMR may contact kdupuis@medrium.com
Friday, May 14, 2010
Medrium Platform
Medrium started as a company in 1999 and built a true “Web Browser” based model to tackle Healthcare Revenue cycle management. Revenue cycle management in healthcare is very complex and is unlike any other industry model. Healthcare has thousands of insurance payers each with their own set of rules. These rules change constantly. In addition, Govt regulations and new requirements cause a great deal of disruption to the workflows in the industry. A web browser based client and an application server is an ideal model to manage these constant changes.
When I started the company in 1999, I realized that a platform based on an application server model and a web browser client was the right model for Healthcare. Medrium's platform was built with the following goals in mind.
Easy to use.
A browser (HTML) based client is easier to use. You don’t need a user guide to surf the web, go to yahoo or buy books on Amazon. The hyperlink model is very intuitive.
Accessible from anywhere – work or home. Any computer with a browser and internet connection.
Medrium always stayed away from proprietary plugins or ActiveX which limits the platform and browser choice for the client. This strategy has paid off for Medrium very well. Ten years ago, Web Browsers has limited functionality and was hard to provide a rich interface. That has changed over the years and Browser technology has progressed very rapidly. A lot of components of HTML5 are already supported by numerous browsers. Medrium envisions that in the near future there will be more browser based internet appliances. It is extremely important that Medrium's services are accessible from these devices.
Fast – Pages should load fast and should work on slow internet connections.
Ten years ago, broadband connection was not prevalent and expensive for small practices. Medrium platform was built to ensure that web pages were small and used Javascript caching to enable fast loading. These days, availability of AJAX on all browsers and toolkits like Google Web Toolkit, eliminates even jumping from page to page and makes the client interaction and experience much better. Medrium platform has evolved to take advantage of these technologies and provide a rich experience for our customers. Medrium's EMR functionality has been built using these state of the art technologies. You can read more about our experiences with GWT.
Ensure security and data integrity.
Medrium platform has a security framework built from the inception, which included both role and IP based security. All calls made to the server are intercepted and authenticated by this framework. Data storage has evolved over time from MySql to Postgresql relational database.
Prevent loss of data on Session timeouts.
Physician office staff is very busy and multi-task quite a bit. So it is important that if a user enters most of the patient demographics and moves on to another task and comes back to complete/save the data this data not be lost if session expired. User should be asked to relogin and once relogged in, system should perform the prior action. Medrium has implemented as “Stickly Session” framework which facilitates this process and has been in use since the beginning.
Rapid development/adaptation to change.
Medrium’s use of Java and open source libraries and tools ensure rapid development. The Application server model in the backend means that Medrium can make changes to the “single version” of the software and every client is updated. This allows Medrium to adapt to constantly changing payor rules, transaction changes, Govt. regulations etc.
Low cost.
Medrium’s use of Java, Open source database – Postgresql and the vast amount of Java libraries, toolkits and testing frameworks keeps development costs low. Data storage uses cloud services to keep runtime costs low. No need for expensive external licenses or dependencies on proprietary technologies.
Medrium’s platform built using the above guidelines has served it well to address the ever changing healthcare requirements and regulations. We spent over 10 years learning the domain, enhancing and optimizing the platform to serve the needs of healthcare professionals. As browser technology evolved and browsers started offering more functionality, Medrium was able to adapt and take advantage of these enhancments. Browser support for HTML5 features would further enhance our client experience and we will take advantage of these technologies as they are supported more broadly across browsers. The EMR integration is a good example of using AJAX and some of the HTML5 features, is browser agnostic and works on any OS with a browser. Even an iPad.
Open Platform
Medrium recently built an infrastructure to open internal interfaces to REST and XML. Java developers can also use Java bindings provided by Medrium for these interfaces to enable rapid development. We are working with a few vendors who will use these interfaces. In the coming months we will start publishing our interfaces and make them available for any vendor who wants to provide additional services to our customers.
When I started the company in 1999, I realized that a platform based on an application server model and a web browser client was the right model for Healthcare. Medrium's platform was built with the following goals in mind.
Easy to use.
A browser (HTML) based client is easier to use. You don’t need a user guide to surf the web, go to yahoo or buy books on Amazon. The hyperlink model is very intuitive.
Accessible from anywhere – work or home. Any computer with a browser and internet connection.
Medrium always stayed away from proprietary plugins or ActiveX which limits the platform and browser choice for the client. This strategy has paid off for Medrium very well. Ten years ago, Web Browsers has limited functionality and was hard to provide a rich interface. That has changed over the years and Browser technology has progressed very rapidly. A lot of components of HTML5 are already supported by numerous browsers. Medrium envisions that in the near future there will be more browser based internet appliances. It is extremely important that Medrium's services are accessible from these devices.
Fast – Pages should load fast and should work on slow internet connections.
Ten years ago, broadband connection was not prevalent and expensive for small practices. Medrium platform was built to ensure that web pages were small and used Javascript caching to enable fast loading. These days, availability of AJAX on all browsers and toolkits like Google Web Toolkit, eliminates even jumping from page to page and makes the client interaction and experience much better. Medrium platform has evolved to take advantage of these technologies and provide a rich experience for our customers. Medrium's EMR functionality has been built using these state of the art technologies. You can read more about our experiences with GWT.
Ensure security and data integrity.
Medrium platform has a security framework built from the inception, which included both role and IP based security. All calls made to the server are intercepted and authenticated by this framework. Data storage has evolved over time from MySql to Postgresql relational database.
Prevent loss of data on Session timeouts.
Physician office staff is very busy and multi-task quite a bit. So it is important that if a user enters most of the patient demographics and moves on to another task and comes back to complete/save the data this data not be lost if session expired. User should be asked to relogin and once relogged in, system should perform the prior action. Medrium has implemented as “Stickly Session” framework which facilitates this process and has been in use since the beginning.
Rapid development/adaptation to change.
Medrium’s use of Java and open source libraries and tools ensure rapid development. The Application server model in the backend means that Medrium can make changes to the “single version” of the software and every client is updated. This allows Medrium to adapt to constantly changing payor rules, transaction changes, Govt. regulations etc.
Low cost.
Medrium’s use of Java, Open source database – Postgresql and the vast amount of Java libraries, toolkits and testing frameworks keeps development costs low. Data storage uses cloud services to keep runtime costs low. No need for expensive external licenses or dependencies on proprietary technologies.
Medrium’s platform built using the above guidelines has served it well to address the ever changing healthcare requirements and regulations. We spent over 10 years learning the domain, enhancing and optimizing the platform to serve the needs of healthcare professionals. As browser technology evolved and browsers started offering more functionality, Medrium was able to adapt and take advantage of these enhancments. Browser support for HTML5 features would further enhance our client experience and we will take advantage of these technologies as they are supported more broadly across browsers. The EMR integration is a good example of using AJAX and some of the HTML5 features, is browser agnostic and works on any OS with a browser. Even an iPad.
Open Platform
Medrium recently built an infrastructure to open internal interfaces to REST and XML. Java developers can also use Java bindings provided by Medrium for these interfaces to enable rapid development. We are working with a few vendors who will use these interfaces. In the coming months we will start publishing our interfaces and make them available for any vendor who wants to provide additional services to our customers.
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