This article explains how LEMR integration works to a technical audience. If you are an IT Support Engineer or a Managed Service Provider, this article will give you some insight into how LEMR can be used for your clients.
There are two software components used for LEMR integration:
- Electronic Medical Record (EMR) System Interface
For Best Practice (Bp Premier) the EMR interface is called LEMR Server.
For MedicalDirector the EMR interface is called the MD LEMR Sidebar. - Device Software Interface called LEMR Client.
The two components relay information securely through our cloud server, allowing great flexibility in the configuration of the LEMR integration. LEMR integration works in environments where the EMR System Interface and the Device Software Interface are on the same computer, or when they are on completely different computers, even on different networks (for example in a Remote Desktop solution). As long as the computer running the EMR system and the computer operating the device software are connected to the internet, it will be possible to link the systems using LEMR.
¶ How LEMR Works in Practice
- The user opens a patient in their EMR system.
- The user schedules a test (e.g., ECG, Spirometry, ABPM) using the LEMR interface for their EMR (LEMR Server in Bp Premier and Zedmed or MD LEMR Sidebar in MedicalDirector). The user will then select which computer (with LEMR Client installed on it) to perform the test on.
- The LEMR / EMR System Interface encrypts the relevant patient demographic information for the test and securely sends it to our cloud server.
- On the local workstation where the test is to be performed, LEMR Client is notified of the new test and securely downloads the patient demographic data from our cloud server.
- LEMR Client launches the appropriate test software for the test type. LEMR Client imports the patient demographic information into the testing software and configures the software to start the test.
- The user performs the test using the test software for their device. When the test is complete, a test report is generated.
- The test report is collected by LEMR. The test data is encrypted and securely uploaded to our cloud server.
- The LEMR / EMR System Interface is notified of the test completion and securely downloads the test results. The test results are automatically imported into the patient's record in the EMR.
¶ LEMR in a Remote Desktop Solution
The software that operates diagnostic medical devices (e.g., ECG, Spirometer, ABPM, ABI) typically runs on the local workstation-- it must directly connect to the device by USB, Serial, or Bluetooth. When the EMR system (Bp Premier, MedicalDirector) is operated in a remote desktop environment, it becomes challenging to integrate the EMR with the medical device software. LEMR provides a solution for this.
LEMR's EMR System Interface (LEMR Server for Bp Premier and Zedmed or MD LEMR Sidebar for MedicalDirector) runs alongside the EMR. It relays patient demographic information securely through the cloud to the LEMR Client software, so the EMR and the medical device software do not need to operate on the same computer or even the same network. No need for firewall exceptions or complex VPN configurations. LEMR's EMR System Interface can run anywhere the EMR is accessed; on a remote desktop server or on an app server (when the EMR is accessed through a remote application container). We are even planning integration for forthcoming cloud-based EMR systems (e.g. MedicalDirector Helix) that will build upon our current system.
LEMR Client operates alongside the medical device software on a local workstation in the clinic. The computer that operates the medical device software must have a local Windows environment to run the software (must be a “thick client” or “fat client” machine, a “thin client” in most cases will not work). LEMR Client relays information securely through our cloud server to LEMR's EMR System Interface, so the EMR can operate on any system, it does not need to be on the same system as the medical device software.
¶ LEMR on a Single Workstation
¶ Components Installed on the Local Workstation
- Electronic Medical Record (EMR) System
Best Practice (Bp Premier), MedicalDirector or Zedmed Client Application. - Electronic Medical Record (EMR) System Interface
For Best Practice (Bp Premier) and Zedmedthe EMR interface is called LEMR Server.
For MedicalDirector the EMR interface is called the MD LEMR Sidebar. - Medical Device Software
The software provided by the medical device vendor (for ECG/Spiro/ABPM/ABI/etc). - Device Software Interface called LEMR Client.
¶ LEMR with a Dedicated Testing Laptop or Tablet
¶ Components Installed on Triage Computers
(where the patient record is accessed and the test is scheduled)
- Electronic Medical Record (EMR) System
Best Practice (Bp Premier), MedicalDirector or Zedmed Client Application. - Electronic Medical Record (EMR) System Interface
For Best Practice (Bp Premier) and Zedmedthe EMR interface is called LEMR Server.
For MedicalDirector the EMR interface is called the MD LEMR Sidebar.
¶ Components Installed on the Testing Laptop or Tablet
- Medical Device Software
The software provided by the medical device vendor (for ECG/Spiro/ABPM/ABI/etc). - Device Software Interface called LEMR Client.
¶ LEMR on a Remote Desktop Server or Remote Application/VDI Server
¶ Components Installed on Remote Server/VDI Master Image
- Electronic Medical Record (EMR) System
Best Practice (Bp Premier), MedicalDirector or Zedmed Client Application. - Electronic Medical Record (EMR) System Interface
For Best Practice (Bp Premier) and Zedmed the EMR interface is called LEMR Server.
For MedicalDirector the EMR interface is called the MD LEMR Sidebar.
¶ Components Installed on the Local Workstation
- Medical Device Software
The software provided by the medical device vendor (for ECG/Spiro/ABPM/ABI/etc). - Device Software Interface called LEMR Client.
¶ What data is captured by the LEMR Software?
When a test is scheduled, LEMR uses patient demographic information relevant to the test including:
- patient ID number
- name
- date of birth
- birth sex
- ethnicity
- height
- weight
- smoking history
When a test is completed, the test report is also relayed through the LEMR integration back to the EMR software.
We only collect and use data that is relevant to the test when initiated by the user.
¶ How is patient data secured?
All LEMR patient demographic and test data is encrypted with AES-256, with unique encryption keys for each LEMR customer (site). This data remains encrypted while at rest in local and cloud databases and when in transit--everywhere between LEMR Client and LEMR Server.
¶ Does LEMR data stay in Australia?
LEMR data is hosted by Serversaurus and does not leave Australia.
From https://serversaurus.com.au/privacy-policy/
¶ Data Sovereignty
All Serversaurus infrastructure (virtual machines, physical hardware, switches, racks) is located wholly within Australia (Melbourne/Brisbane). Customer data uploaded to Serversaurus based servers is wholly kept onsite within Australian shores. Serversaurus does utilise some cloud services within its business which may reside offshore. These include accounting systems, support systems and some internal company email. Further details can be made available upon request.
¶ Does LEMR store the test data?
We currently retain all the test data and reports on our host, encrypted at rest with encryption key specific to the individual customer (site), should this information be required by the practice in the future. We are respectful of the privacy and confidentiality of data provided. Refer to our EULA for more information.
LEMR integration makes it easy for test reports to be stored directly in the patient's record in the EMR system. This makes the final test reports available to authorised users of the clinic's EMR system. Since the test data is stored in the EMR system, it will be included in any backups of the EMR database.
Inside the LEMR Client software there is limited access to archived reports from the last 14 days, providing another backup option if a recent test needs to be recovered.
¶ Is any proprietary hardware required for LEMR integration?
Nope! LEMR was created to extend the functionality of diagnostic medical devices through software integration. Our software and service make use of the hardware you already have to provide a better workflow for medical testing.
¶ Is the support team based in Australia?
Our company and all staff are based in Australia. We work remotely from various locations in NSW and QLD.
¶ Can the medical device software run on a remote machine using a USB-over-IP solution?
We do not recommend this solution. USB medical devices are not designed to be robust to the latency and jitter of network communication. Further, many USB medical devices have internal USB-to-Serial adapters that are very sensitive to timing issues when communicating with the device. Even if the device does connect by this method, the integrity of the data cannot be guaranteed.
- Network jitter of any kind can have an impact on the quality of the ECG trace and risk improper interpretation of the ECG.
- If the USB device malfunctions, you are connected directly to the Terminal Server which can cause system instability and may crash the system.
- The device is fixed where the network point and power are and cannot easily be moved to other areas in the building.
- It is not a configuration that is supported by the medical device vendor.
In these instances, we recommend using a dedicated laptop or tablet computer to run the medical device software. A portable testing cart can be setup that can easily move around the medical clinic. The medical device software runs locally on the portable testing computer. LEMR connects this system to your remote EMR so the EMR software does not need to be installed on the testing computer. See LEMR in a Remote Desktop Solution for more information.
