As a business development person in the healthcare industry, I spend a considerable amount of time talking to medical practice managers and providers. When it comes to acquiring Practice Management and Electronic Medical Records software the question I hear repeatedly is: “Do I go with an ASP or Client\Server solution?”
In an ASP (Application Service Provider) solution the software and your patient data is not installed locally, instead it is hosted on a server located outside your office. In this case, the software is accessible through the internet. You are probably more familiar with the Client\Server solution. The software is installed on a powerful computer called a server. The server is located on your premises along with all your patient data.
So which solution is better? Well it depends on a number of factors. Like everything in life there are strengths and weaknesses with either solution.
ASP
Strengths:
In many cases, the practice has to pay one flat monthly fee to access the software. Typically the fee includes maintenance and support for the software. The practice does not have to worry about the cost associated with the purchase, maintenance and support of the server (which can be considerable). The upfront cost for an ASP solution is lower since you are basically renting the solution. In addition, because you are accessing the software through the internet you can get to your patient information from anywhere without any additional software or equipment. At least in theory, (based on what your contract looks like) you can potentially change your mind and stop using the software if you are not happy with it. Again, in theory, you could ask for your patient data and go somewhere else.
Weaknesses:
You are paying a monthly fee for as long as you use the software. It’s like buying a house except the payments never stop. In some cases, the monthly payment is reduced after a number of years. Access to data can be problematic especially if you want a third party to generate special reports based on your patient data. You never have access to the raw data in the patient database because the data is hosted on a server you don’t control. As a result, cost of customized reports generated by the software vendor can be very expensive. Also, what happens to your data if the software vendor goes out of business? If you decide to stop using the software, what format will you get your data in? Will it be in a legacy format that no one knows how to read? In other words, would the data format be easily imported into a new system or will you need to spend a lot of money to convert your data to a standard format?
Another issue is connectivity. If your internet goes down “you are toast!” (bad weather). In other words, you can no longer access the software until the internet comes back up. The truth is that down time is becoming less of a problem if you are using a special communication line called a T1 line. A T1 line is more reliable but also more expensive than a normal phone line. In addition, the performance of your software is dependent on the speed of your software vendor’s server and the telephone lines coming into your building. So, if for some reason the telephone line slows down during peak hours then interacting with the software will become sluggish.
Client/Server
Strengths:
Once you pay for the software licenses and implementation services the only payments you may have to make are for software yearly support and maintenance. Because your are accessing the software directly on your network software performance is usually better and you don’t have to worry about losing access due to internet interruptions (bad weather). Since your data is housed locally on your server you may be able to have your IT support partner tap into your patient data and generate whatever report you need without dependency on the software vendor. In this case, you have more control over your patient data. In some cases, having the software and your data local allows your IT support vendor to interface it to other systems such as lab and imaging machines as well as other software applications. The Client\Server model may help you introduce more automation to your office workflow.
Weaknesses:
You have to purchase the server upfront and have to worry about the cost associated with the purchase, maintenance and support of the server and network. Typically, the upfront cost for this solution is higher. In addition, if you need to access your software remotely you would need technology such as VPN or remote access software (such as LogmeIn, GoToMyPC). If you don’t like the software you are stuck with an “ugly baby”.
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