Comments on: Client/Server vs. ASP/Web-Based in Healthcare IT

By: drhasuz

drhasuz — Tue, 19 Jan 2010 23:28:47 +0000

Hi here I am a medical doctor..cum IT manager for my hospital in malaysia.We have been using EMR and THIS for the past 10 years.Until today we are still using our client server based application..the vendor offered us an upgrade to web based however we are very,very sceptical about it.My view is that i believe client server application is still the best solution to THIS or hospital based application rather than web based application..it is faster,upgrades can be controled,there is no bottle neck in the web servers and u can have multiple screen openeing up at the same time without compromising accessability speed to the database..opening up multiple screen is necessary becoz u need multiple input before any decisions can be made to treat patient ie u need blood test,radiological,ulrasound,biopsy results etc.. at the same time in order to decide your next step of management..worse still if the emr allows data to be stored in image,video and audio form..accessing the EMR during clinic days would be very painstakingly slow..but much appreciate if you could give your views..

By: drhasuz

drhasuz — Tue, 19 Jan 2010 16:28:47 +0000

By: Elyse

Elyse — Sat, 06 Jun 2009 19:15:04 +0000

Great and insightful post! I have happened to see an increased move to a hosted solution for clinical and financial processing over the last several years. I would be interested in hearing why the perception is that there is increased downtime for ASP solutions. In my experience, I have found this not to be the case.

The “on premise” model also has risks, and can experience downtime. In the field, these unplanned outages occur due to a variety of reasons, supporting old equipment, not having a fully redundant power design for the local datacenter, not monitoring the application, not performing basic monitoring on the database, and variety of other reasons. Often these risks are responsibilities are transferred to the ASP.

Looking forward to hearing your response,
Elyse

By: HealthBlawg

HealthBlawg — Thu, 19 Mar 2009 18:04:48 +0000

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By: Larry Singer

Larry Singer — Tue, 17 Mar 2009 23:04:35 +0000

There is another alternative!

Java Web Start gives you the simplicity of the web with all the advantages of a thick client. Web Start is a Java deployment mechanism that delivers Java desktop applications using the web. Go to a web page, click a link and your program launches. It can also be launched via an icon on your desktop.

With recent releases of Java 6 update 10 and Java FX you now also have this available in the browser. Embed your application in a web page. http://javafx.com/

The server can then be either dedicated or ASP (SaaS). It does not even need to be Java.

By: The PACS Designer

The PACS Designer — Mon, 16 Mar 2009 20:55:43 +0000

The ASP Model is definitely the way to go if you are going to add flexibility to your client/server system and attract new customers. Additionally, there are other enhancements that can be added to work offline when the phone service is interrupted. Of course you will need to input data that is created while working offline but it should not be a huge task if service interruptions are brief.

By: Shahid N. Shah

Shahid N. Shah — Thu, 12 Mar 2009 22:11:27 +0000

Great question, Kevin. The real way to think about it is like this: if you’re going to use a utility (like electricity) you’re going to pay much less money than if you didn’t use a utility (like you have your own power generator). For this price reduction you are going to rely on other people and the reliance comes at more risk but the reason you’re choosing to go with more risk is that the price is lower.

So, if you want ASP you want it because it lowers your cost for management, purchase, etc. But, it also means that you risk being down every once in a while. Usually that means keeping paper backups for that day’s patients or a day or two in advance if you can’t live without any downtime whatsoever. Now keeping paper is also a cost — which, again, you’re bearing to reduce to risk.

Basically, it boils down to a customer choice: if they are willing to live with zero risk and full control of data and servers in their own office they should use the “on premise” model.

If they are willing to live with a little risk then they should choose the ASP model.

This is why I mentioned in the my article that vendors shouldn’t think that “the cloud” or “ASP” or any specific deployment model will fit all needs for all customers. Create a flexible approach using modern web techniques that lets your users tell you how they want things deployed.

No single model will work for very long or for a large number of customers. Some customers will want on-premise because they accept zero risk and want full control; others will accept a little risk and go with ASP or cloud computing.

By: Kevin Puscas

Kevin Puscas — Thu, 12 Mar 2009 19:55:17 +0000

So here is my question/issue with the ASP model. Friend of mine use to call it “Guy on a Backhoe” problem. As most smaller practices don’t have multiple telcom providers or redundant channels available, what happens when their telecom capability gets disrupted (ex guy backhoes though the cable). Now they don’t have access to their patient records. How does that impact their operations? Do they close their doors till things are restored? A similar issue came up with the VA as they looked at various forms of ASP models for Vista. But in the end they still needed to have some local EHR capabilities in order to ensure patient care if they are ever forced off the grid.