Lifting the ‘fog’ of EMR

EyeMD Electronic Medical Records 2.0 offers the benefits of browser-based cloud and server-based computing.

For years, paper charts were an effective method of documenting and storing patients’ medical records. While paper charts were tangible, they took up space, and the content couldn’t easily be shared between practice locations. Electronic records, particularly browser-based cloud EMR systems, resolved the cumbersome nature of paper charts, but, like clouds, they move slowly and are ethereal. A client/server-based system allows a practice to host its own content. However, that valuable information remains on-site, inaccessible from elsewhere.

Fog computing architecture, such as that offered by EyeMD EMR Healthcare Systems Inc., presents a solution, bringing the clouds to ground level and proposing the best of both worlds. EyeMD EMR 2.0 implements fog computing using an app that securely communicates with any type of server, regardless of where it is physically located.


“The greatest benefits of browser-based cloud computing systems are that practices don’t have to invest in the purchase and maintenance of a server, and the user can access the system from any web browser, anywhere,” according to Abdiel Marin, CEO of EyeMD EMR. However, browser-based cloud systems require constant, reliable and fast internet connectivity to be effective, so they run the risk of reduced productivity in the event of a lost internet connection, impacting clinical operations. They also have security restrictions to prevent internet assaults, which may limit speed and productivity.

The EyeMD EMR 2.0 fog computing architecture

With client/server-based systems, an on-site server allows a practice to continue functioning self-sufficiently in the event of an internet outage or slow internet connection. Client/server-based EMR systems work particularly well for the transfer and viewing of high-resolution medical images.

“Server-based systems offer practices direct access to their own databases, which allows them to directly query data for clinical research purposes, workflow optimization, and data migration,” Mr. Marin says. These systems are not affected by over-subscription and offer practices control over their hardware, customization and updates. Additionally, they better meet the needs of rural clinics with unreliable internet. However, the patient records in these systems are grounded to one location, unless you use VPN or remote desktop technologies to access them.


“Fog computing architecture is like an app on your phone,” Mr. Marin explains. “You can easily add it to any device, and you can access it from anywhere. It differs from a typical mobile app, however, by allowing you the option of hosting your data on your own server.” In other words, fog applications feature innovations typically found in browser-based cloud systems but can communicate with a centralized server in any location.

“EyeMD EMR 2.0 is offered in two ways. Our cloud-hosted offering allows practices to avoid investing in and maintaining a server, while the on-premise offering allows practices to host their data on their own equipment. The best part is that there are no discernible performance differences between them,” says Mr. Marin.

A practice can choose the hosting platform that best suits its needs, with the ability to easily change architecture as computing requirements evolve, removing the anxiety associated with making complex computing decisions.


EyeMD EMR was initially released in 2009. With more than a decade of experience and customer feedback, the company has been able to make incremental improvements to its software. These have included usability enhancements like reduced clicks, easier access to clinical data and improved usability for tablet devices in version 2.0, according to Mr. Marin.

Stephen E. Smith, MD, of Eye Associates of Fort Myers, Fla., has used EyeMD EMR since its inception and converted to version 2.0 in September 2019. He notes that the transition was seamless, with no downtime for the installation. “The new version is faster, with less waiting,” Dr. Smith says. “There is a slightly different layout, but once my staff and I figured out where to click, we were up and running in less than a day.” EyeMD EMR offers an e-learning course prior to the upgrade, as well as unlimited one-on-one training sessions, if needed.

EyeMD EMR 2.0 with fog computing satisfies Dr. Smith’s practice needs. His main location in Fort Myers utilizes an onsite server to host his data, allowing for rapid upload and download speeds of ophthalmic images, while his satellite practice in Naples uses desktop apps that seamlessly access patient records and images from his server in Fort Myers.

David D. Tran, MD, of A Better Vue Eye Physicians, LLC in Naples, Fla., updated to EyeMD EMR 2.0 in 2019. “The system is significantly more efficient than before, particularly with respect to one-click coding and toggling between sections of the eye examination,” says Dr. Tran, who has multiple offices and invested in a server for each.

“I’m not comfortable with any EMR vendor having complete control over my data or having internet outages disrupt my clinical operations, but I appreciate being able to access my data from elsewhere, including home,” Dr. Tran says.

As early adopters, both Dr. Smith and Dr. Tran initially noted a couple small glitches with version 2.0. Notification of these bugs can be sent as a ticket directly to EyeMD EMR and a system is in place that allows the sender to track their progress to resolution.


The hybrid computing offered by EyeMD EMR 2.0 with fog architecture removes the stress associated with making a long-term decision regarding browser-based cloud or client/server-based systems. “It has helped me gather the information I need to make clinical decisions more quickly,” says Dr. Tran. OM