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Over twenty years ago, I started my career in the human services software industry, focusing on public and mental health. Back then, the software was 100% proprietary and was mainly used for billing and reporting systems. They ran software on expensive RISC based UNIX systems and the servers alone, to run the software, were well over $50,000. Old legacy software took large IT departments to run, and if your organization did not have a highly skilled IT department, you most likely struggled on a daily basis with your six figure investment.

The implementation model back then was also a “Do It Yourself DIY tool-kit” implementation model. The vendor would come in and train your IT department on how to setup the hundreds of maintenance tables in the software. Then your IT department would spend the next several years implementing the software for your organization. Clinicians would spend many hours with IT people in very frustrating meetings to design various clinical templates e.g. for family planning, communicable diseases, child health, etc.

Rolling out each program took almost one year. One health department started building their program charts back in 2008 and have yet to build all their programs in 2014. More frustrating, it never really worked properly because “bolt on” charts did not fit into the natural workflow of clinicians. Data would also not flow from one chart to another. This resulted in duplicate data entry and, of course, that resulted in erroneous reports. Further to get monthly board of health report took 42 reports to be pulled to create three needed graphs. A several hundred thousand dollar investment in hardware and software and you still had to do over half of the implementation yourself.

I liken this legacy model to the “DIY house” analogy. Think if you gave a home builder several hundred thousand dollars for your new home. Then the builder would deliver on your land, all of the wood, nails, tools, plumbing, and even the shingles. Then the home builder’s staff would come to your lot and show you how to use the tools and give you a few manuals on building your own home and then you, your family and friends would build your house. This analogy is basically how Electronic Health Records (EHR) software was delivered. In fact, today, there are still legacy vendors, using our “DIY house” analogy, that still expect you to build your own EHR.

However, Cloud and Apps technologies have changed all of that. I’ll explain further. Smartphones came on the scene recently and millions of us started using Apps on our smartphones. From checking the weather, to news, to email, to about any reason your can imagine. Everything is in the cloud; no more expensive IT servers to manage. We go to a website, download the software, enter a few parameters, and we are off using our new Apps on our phone. Today, no one would think of buying an App for our smartphone and spending a year or two “implementing the App”. Our expectations are the vendor does the development and the software is ready to use “out of box”. It should work when I start using or training on it. No more long meetings or years to develop my own clinical templates. No more “DIY-EHR”.

In an always-connected, 24/7 world, organizations expect and demand Electronic Health Record software that is easy-to-use, easy-to-learn, affordable, and ready-to-use, just like my Smartphone App. No more IT effort to build an EHR: just an EHR which simply works directly out of the box. Reports should be available on a Dashboard with graphs.

Legacy vendors are struggling with a huge paradigm shift to cloud and apps. There are many horror stories of local health departments abandoning their EHR after years of wasted efforts and switching to new cloud and apps based EHR. Are your clinicians and IT people frustrated with each other because they cannot get the EHR to work right? Do your nurses want a simple and easy to use EHR?

Are Cloud and Apps technologies changing your expectations? Let us know what you think.