One of the all time favorite topics of discussion here at EMR and HIPAA is around SaaS EHR software versus client server EHR software. They each go by many other names and the technical among us might know the hard core technical difference between each, but most doctors don’t know and don’t care. SaaS EHR software is often called hosted EHR software or ASP EHR software or even Cloud Computing if you want to use a general term. Client Server EHR software is sometimes called in house EHR software or self hosted EHR software. I’m sure there are other names I missed.
Regardless of what you call it, many people (usually those from SaaS software vendors) believe that client server software will lose out to the cloud. It’s hard to argue with them since in almost every other industry cloud based software has won.
Here’s why I don’t think we’re going to spell the death of client server software for a long time to come. Client server is going to be here for a long time because of such wide adoption by so many doctors. Not to mention, many of the client server EHR systems are really large implementations that would be hard to displace. Plus, there are many doctors who don’t care about the mobile benefits of a SaaS based EHR software. Quite a few doctors want to only use their EHR software in their office.
Certainly there are others on a client server based EHR system which will want to access their EHR outside of their office. Unfortunately, instead of EHR replacement we’re likely to see a hybrid environment that supports client server and some sort of app environment come out of the various client server EHR vendors.
Sure, a lot of doctors will also use Citrix or other remote desktop environments and hate the user experience, but it will pacify them until the hybrid EHR environment is built. In fact, that hate towards the remote desktop environment on a mobile device will drive the development of this hybrid approach. The advantages of a client server environment with an app connection will keep the client server environment around for a while.
So, while many want to declare the death to client server, I’m not ready to do so. Sure, SaaS EHR software has its advantages, but client server software isn’t going to go down without a fight and they’re going to be around for a while since in many cases they hold the high ground.
SaaS tends to make sense in a small office.
I’ve seen larger offices come to a grinding halt on a SaaS system.
This is a cycle I’m sure, remember main frames? Remember when thin clients were the end to desktops?
That said, vendors should be smarter about their client/server setup. The more they require an office to upgrade their server hardware, the more they will frustrate docs and push them to SaaS…could that be the point??
An EHR should be able to run on a linux server of “medium” power. Anything beyond this just gets ridiculous.
Hi John.
I don’t see cloud computing and client/server as competing because the decision to use either usually breaks down to a business decision about what makes financial and practical sense.
How cloud computing is defined also makes a difference. For generic purposes I interpret cloud computing as being similar to an application service provider (ASP). This model has been around for at least a decade. Other cloud computing implementations only involve archiving and storage.
With consolidation of clinics and healthcare providers cloud computing makes a lot of sense as you aren’t restricted to a geographic location. Some physicians travel to more than one location and would see a lot of value and benefit from cloud computing as they can conceivably to their work anyway.
Even organizations that use a server for local application hosting still use a remote desktop function as it makes a lot of sense regarding cost and administration. Would you rather upgrade one application on a Citrix server or 100 thick clients scattered around a hospital? If you are talking about a clinic environment with only a handful of workstations, then certainly a thick client install makes the most practical and financial sense.
My experience with remote desktop implementations with Citrix has been very positive, with the applications responding very well. As long as the Citrix farm and database have the appropriate amount of horse power there shouldn’t be too many issues.
Another factor would be managing risk. In a cloud computing environment, if your internet connection goes down, you’re out of luck. Redundant ‘lines’ would need to get put in and of course that drives up costs as well.
Thanks for the discussion topic!
don,
One of the major problems people are seeing with the Citrix model is that they don’t work on mobile devices with a touch interface very well. Sure, they work, but not like a native app. That’s one of the main drivers I see against the remote desktop environments right now.
I agree though that there are pros and cons to both approaches. No doubt we’ve had ASP models for a long time and they haven’t killed off client server. So, we can be certain to have client server around for a while to come.