Electronic Medical Record (EMR) and digital billing systems offer substantial clinical care, financial, practice workflow, and compliance benefits to doctors, insurance companies, and patients. But half of medical practices that purchase EMR software fail to successfully implement it.
Rapid development is a salient feature of this technology market: eighteen news items published by technology vendors of electronic medical record and billing systems were listed in May 2006 alone on BillingWiki/Technology. The eighteen news items split seven-to-eleven between web-based Application Service Provider (ASP) solutions and Client Server (CS)-based technologies. Upon briefly reviewing key factors defining each technology, we compare them along two criteria, namely implementation success likelihood and costs.
Client Server Architecture
CS model has been around since the early eighties of the twentieth century. Its architecture includes a central server deployed at the doctor’s office and multiple client stations to allow the users to interact with the application. The central server typically runs the database and some of the application logic, while the client stations perform much of the processing locally.
Such distributed processing architecture facilitates relatively high application performance, minimizing waiting time. The downside of CS architecture is that it requires the practice owner to establish necessary infrastructure upfront and to continuously manage it down the road. The infrastructure includes a central server, client terminals, and local network connecting the computers. The management tasks include installation, configuration, backups, restores, and periodic upgrades.
Therefore, a typical CS charge model involves upfront investment in infrastructure and application license and subsequent monthly support costs as well as significant time spent on completing the required tasks and maintaining the knowledge level required for successful operation of hardware and software.
To justify an investment, CS solution vendors offer traditional five-year return on investment (ROI) analysis. Such analysis compares EMR benefits derived from reduced office workload, clerical and clinical errors, improved coding, and faster cash flow, to infrastructure ownership costs.
The pitfall of this approach is that it ignores both technical and financial aspects of technology aging. Technically, Moore’s law of digital technology development tells us that chip density doubles every 18 months. Therefore, computer hardware and technology developed on it becomes obsolete every 36 months. Can you justify an investment using five-year horizon in a technology, which might become outdated in three years?
Financially, investments make sense in goods that appreciate in value. Otherwise, renting business-necessary equipment or software often offers the double-pronged advantage of both freeing up cash flow and tax deductible business expense.
Application Service Provider Architecture
ASP model was introduced just before the turn of the new century. It is based on leveraging Internet. ASP architecture places the database server at the vendor’s site instead of the doctor’s office and allocates the majority of application logic to the server, reducing the amount of code needed to run the client. Such an approach allows the users to interact with the application directly via Internet browser, entirely eliminating the need for local office infrastructure and its management. The vendor manages all of the technology centrally and for all offices, including compliance, disaster recovery, installation, upgrades, backups, and restores.
The ability to configure systems and train and support personnel without ever visiting the practice sites, provides one of the most cost-effective EMR solutions. Deployed remotely over the Internet, ASP methodology avoids time-intensive, on-site disruptions. Online training allows physicians and staff to schedule for convenience, further minimizing practice disruption.
Obviously, ASP model creates major economies of scale eliminating the need for local IT staff. Typical charge model of modern Vericle-like solutions consists of monthly access fees and avoids investment in and ownership of associated infrastructure.