5 Reasons Why Web-Based Software is Not Optimal in EMS

Software as a service (SaaS) and cloud computing have been touted as the most cost-effective and best way to manage business computing needs today. Proponents of SaaS, or simply “web-based” software, claim lower costs, fewer IT requirements, easy updates, high security and almost 100% reliability. The rosy picture may seem quite appealing.

However, savvy EMS leaders are taking a closer look and learning there are some significant disadvantages, if not glaring red-flags, associated with taking this approach to mission-critical electronic patient care reporting in their communities. EMS is not business as usual.

A Closer Look

Web-based, SaaS applications can provide some benefits in the right business or service environment. For businesses or organizations that are doing the majority of their work in an office environment where the Internet connection is strong and reliable, and are primarily using a web-based software program for internal business operations, SaaS can be a good fit. But in a mission-critical, highly regulated EMS environment where the primary users of the application are first-responders who are mobile, and delivering the highest level of patient care is paramount, web-based software can fall drastically short.

Here are five reasons why EMS leaders should reconsider web-based ePCR:

1. Reliability

In a mobile environment, access to web-based ePCR software can be sporadic. Web-based software providers claim almost 100% “up-time” for their servers, but the problem lies in an EMS agency’s access to a continuous, uninterrupted Internet connection. Even with expensive cellular air cards, connections can be spotty and weak, especially in rural communities. (Have you ever been dropped from a cell phone call?) In a scenario where your Internet connection is down, often the software is also down, or limited at best. Uninterrupted completion of run reports, access to previously seen patient incident history for efficiency and proactive care, and viewing and integrating 12-lead EKGs in the ePCR software become major challenges with software that relies on an Internet connection.

2. Flexibility and Customization

In most web-based, SaaS ePCR models, agencies are at the mercy of their vendor for customization and upgrades. This is because most vendors are hosting more than one organization’s data. EMS administrators do not have the liberty to make tweaks to the “out of the box” application so that it fits with their department’s needs. The ability to change, delete or add text in tabs, fields and drop-down boxes is extremely limited in most cases, or the customer must wait on the vendor and incur steep fees for these kinds of changes. This scenario often forces field users to document important patient treatments, medications and protocols in the narrative field, which is not only time consuming for them, but a QA/CQI nightmare for administrators later. We have heard the story time and time again of an EMS department requesting a simple drop-down list customization or new report for QA/CQI purposes and their vendor telling them that the change can only be made if it’s a high priority among the majority of the customers in the industry. “We’ll add it to the development list for our next upgrade,” they say.

3. Control of Data & Access

In a web-based “cloud” environment, your software vendor hosts your department’s ePCR application and data. In many cases, the hosting is actually sub-contracted by the software vendor to a third-party data hosting company. They not only host your data, but the data of hundreds of other businesses and organizations throughout the United States and even internationally.

Advocates of having highly sensitive patient data hosted in the “cloud” with a third-party provider say it’s almost 100% accessible, highly safe and secure and that your IT department or contractor no longer has to worry about it. However, "out of sight, out of mind" is not an option in EMS. Back to accessibility: not only is the data no longer under the watchful eye of your trusted IT department, but even the service provider needs a continuous, reliable Internet connection to access it. Your data is now in the hands of that third-party hosting provider’s employees, and also your software vendor, who is providing you with access to the data through their ePCR software application for use through the Internet, either via a browser like Internet Explorer, or an application that sits on your desktop but requires a connection for use. As far as security goes, yes, measures are taken to protect your data from hackers, but the reality is that DDoS (denial of service) attacks are on the rise, putting some of the most well-known consumer and commercial web-based applications like WordPress, and data center giants like CloudFare, at risk of being out of service with no user access. Web-based software glitches reported by a multitude of customers, as in the recent case of GotoMeeting, can affect your department’s ability to operate even if you’re not experiencing problems.

4. Total Cost of Ownership

Proponents claim that SaaS is more “cost-effective” than an on-premise solution, but savvy EMS leaders are digging deeper to look at total cost of ownership. True, in some cases you may have a larger up-front capital investment for an on-premise solution that you own versus leasing a SaaS product. However, over time, if you are doing an apples-to-apples comparison to include any integrations or add-ons like CAD, cardiac monitors, billing and more, you’ll often find that the on-premise ePCR solution will end up being more cost-effective. SaaS ePCR solutions often require additional fees for major upgrades, and there’s not a business or organization that I know that has abandoned the idea of having local IT services just because they are using a SaaS product. Computers and non-technical staff still need IT support on a daily basis. That won’t change.

In addition, EMS agencies that take a closer look at what they will actually be saving in time, money and staffing resources when moving to a flexible, highly reliable and customizable on-premise solution find the return on investment is much higher than with a web-based system.

Remember that with SaaS you can’t always rely on having access, which results in duplication of effort when down. Also, you’re essentially leasing the software without ever owning anything, paying an annual subscription rate for access to a program that later could be discontinued or inaccessible if your vendor goes out of business, leaving you with nothing or forcing you to move to a new, less desirable product offered by a company that may have acquired your software vendor. Tread carefully… With an on-premise solution, you always have access to the software and your data, even if the company ceases to exist.

5. Employee/User/Customer Experience

Perhaps the most underrated but important reason that EMS leaders should reconsider web-based solutions is the experience for those who are using it out in their communities to support the delivery of the best patient care, and those who are benefiting from that service.

Time and time again we talk to EMTs who are on the trucks in their communities using web-based ePCR software products that have them pulling their hair out. They often say web-based products are rigid, unreliable and difficult to use. They say they can often make their jobs more difficult than they need to be. The first responders, focused primarily on providing the best care possible in the most efficient manner possible, say that having access at all times to the ePCR program is critical. Having access to previously seen patient incident history, allergies, medications, warnings and 12-lead EKGs, without an Internet connection, would make being prepared, proactive and efficient a lot easier. They say having ePCR software that goes down when an Internet connection is not available is just not acceptable.

Also, imagine the experience from the patient’s end. If I’ve called 911 in the past or I have a chronic condition that requires me to rely on the response of EMS repeatedly, I want the EMTs to remember me, to understand my condition and my challenges—and when they do, I am more willing to trust them to provide care because they are informed and ready.

Today’s EMS leaders are being held more accountable than ever before. At the same time, they are thinking more strategically about how their organization will serve their communities now and in the future, and how technology and access to data will play a role. Mission critical patient care can’t be left to chance…or the Internet.

Pam Sefrino is a seasoned technology, software and business intelligence professional with extensive experience in both SaaS and on-demand software environments. She is the vice president of sales and marketing at OCI Software, the developers of AmbuPro EMS. You will find the AmbuPro EMS ePCR solution at leading ambulance organizations and fire departments across the country that demand uninterrupted access to and control of their ePCR software and data. To schedule a consultative call to learn how the AmbuPro EMS ePCR system addresses the concerns mentioned in this article, please call the AmbuPro EMS team at 508/678-3330 or e-mail sales@ambupro.net.