Comparison, Pros and cons of Client/Server and ASP-based EMR software
ASP or Web Based EMR has as advantages and disadvantages. The same statement can be made regarding Client/Server based EMR. With no simple answer on which is better you’ll need to decide what’s important to your practice and what’s not. In this article we’ll explore the advantages and disadvantages of each model so you’ll be able to make an educated decision when the time comes to purchase an EMR.
ASP is a remotely hosted software system accessed via an internet web browser, similar to the model used in online banking. This remotely hosted system is accessed by paying a rental or service fee. The server is secure and HIPAA compliant and is not located in your office. All technical aspects of the server are managed by a professional IT company, and you pay a monthly access fee (or per occurrence fee) for the services of this IT company. The cost of an ASP-based system is relatively low in the beginning, however because the fees never stop the cost over the long term adds up and is usually ends up being more expensive than using a Client/Server-based system. One of the other benefits of the ASP based system is that almost all computing is done on the remote server, thereby reducing the minimum computer hardware requirements on the clients/workstations. The benefit to this model is that the cost becomes an operating cost versus a capital expenditure.
ASP allows you to access all of your information at any time, from any place with internet access. Like all comparisons with advantages come disadvantages. Loss of customizability; the host server is being accessed by many different users. Although your data is secure, your individual customized needs are not met as readily as you may desire. Your thoughts must be turned to integrations between current office automation and the new ASP model of EMR. Unless the practice is doing away with all existing computer automation and a total replacement is in mind, you will need to keep up with the integration needs in the very near future. Tell the EMR vendor what systems you have in place, (which you plan to keep) and be sure to get (in writing) from the EMR vendor that they have an HL7* interface to integrate your existing system(s) with the new EMR system.
The ASP model, while allowing for certain freedoms, does not move as quickly as a Client/Server. This is an important factor to consider as well. If you are seriously considering and ASP model make sure you properly test the speed of the system in a live environment to ensure that the speed is sufficient. Think of your practice; the number of patients seen daily, the time spent while in the exam room and time spent completing the final note. There may be vital seconds everyday that are spent waiting for data to transfer over the internet; assuming the internet is in full operability.
Accountability issues are a deep consideration to ASP. Company service degradation is felt more acutely and such things as vendor bankruptcy, which could have a more drastic impact on the practice as a whole. Periodically check the stability of the EMR vendor, and ask for a backup copy of your data for your records.
New features and enhancements are usually built into your monthly access charge and can be added your system instantly without your involvement.
The pros and cons of using an ASP system include:
ASP for EMR Pros
- System is maintained by IT professionals remotely, reducing the cost of maintenance
- Online backup service
- Accessible anywhere in the world from any computer with an internet connection
- Low initial cost of ownership
ASP for EMR Cons
- Risk of data being inaccessible in the event company goes bankrupt. You don’t control your data
- Risk of company not performing routine maintenance (backup, updates, performance enhancements) as promised
- Dependant on internet connection. If your internet connection goes down you cannot use your system
Client/Server models allow for quicker response times in the application as the data from the server to the client is transmitted much faster (usually 100 Mbits/second). The newer client/server products developed in Java and Microsoft .Net are capable of offering the “best of both worlds” as they have the speed of a local system plus the accessibility from a remote location. Where traditional client/server products required practices to use MS Terminal Services or Citrix technology to access their data from remote locations, these newer systems can be accessed from any internet browser. Client/Server also boasts the benefits of practice having the control over there data. However with this control comes responsibility; the responsibility of being responsible for your data as you are now open to the risk of theft, fire, hard-drive failure and data corruption.
The pros and cons of using a client/server system include:
Client/Server for EMR Pros
- Faster overall operational speed
- Control over your own data
- No dependency on internet connection
- Better integration with imaging devices (scanners, printers) and on-site resources
Client/Server for EMR Cons
- Higher upfront cost of ownership as a server and software must be purchased upfront
- Manual product updates are usually required (not in all cases)
- Online backup must be purchased as add-on 3rd party software
- Remote access to EMR is limited in functionality and is more complex
Many IT futurists consider ASP based systems to be the future however many offices find they don’t have the need for remote access and don’t want to put their data in the hands of another company making client/server systems still a popular option. In most cases, if an office has multiple locations an ASP system should always be considered but if an office requires high-performance and doesn’t have multiple locations the client/server system may be the better option.
If the Client/Server model is the model of choice, keep in mind the expectation of additional hardware and IT service networking expenses. You will need to purchase a Server or designate one of your existing workstations/server to be the server in the new system. Servers can take up a significant piece of your EMR budget, costing as little as $2500 for a single provider office and as much as $100,000 for large organizations. The client/server model usually requires a business quality workstation. This may require you to upgrade the hardware or operating system in your existing computers as the standard Microsoft Windows Home Edition may not provide you with the strength and speed needs to operate your EMR. As mentioned previously, it is highly recommended you research, review, and purchase your EMR before buying the anticipated computer hardware. Once you have selected the EMR vendor, they will provide you with the minimum computer hardware specifications to operate the system. If you settle for the minimum, keep in mind your practice may need to buy additional memory in the near future to handle increased patient loads.
An important consideration regarding Client/Server is the purchase of the software. Once purchased, you now own it. Software is a “fluid” product (meaning always in motion). After purchasing the software, keep in mind the vendor is continuing to modify and program new enhancements and features. How will you get access to these new features? With the ASP model, the practice will access the new feature almost immediately upon release. The Client/Server software requires updates for the new features.
Your EMR vendor will make you aware of these enhancements and sell you the new update in version releases. The new version release may be annual or semi annual, or enough enhancements (as determined by the vendor) to go to the customer base. The cost of these new releases is as varied as the initial purchase. How will you know if you are buying a release with substance, or just a “fresh coat of paint”? Simple; schedule a demonstration with the vendor. Ask to see the differences. Develop a series of questions. What if you decide to “pass” on buying the new version? Read your contract language. The vendor (in many cases) has contractual language that allows them to “no longer support” the current version if there have been two additional version releases that were not purchased. This is designed to allow the company to focus their efforts on the fluidity of the ever changing needs within the market.
Electronic Medical Records is still in the early adoption phase by private practice physicians. With noticeable migration at this point, there is no one true model in the lead, ASP vs. Client Server. Only time will tell. However, with the ability to look at our past and the direction that major companies such as Microsoft are heading in, the signs are pointing to ASP.
Seeking outside help can assist you in making an informed decision. Do you need this upgraded version? In a buyers market, the practice can negotiate additional versions included at no charge or a percentage off retail. This type of negotiation strategy should be employed prior to commitment. Some EMR vendors will give away version releases while others will not.
NEXT: Final Considerations
