ASP v. Client-server

An important decision to make when comparing different EMR systems is where you want the software hosted. If you run it in-house, the solution is usually referred to as a client-server system; vendor-run EMR applications are referred to as application service provider (ASP) solutions or online medical records. Both options provide distinct advantages: consider which are more important to you.

Client-server solutions
Most software used today is locally hosted — the program runs on your computer and stores the data either on your hard drive or on a network server in your office. This familiar setup gives you the greatest control over every aspect of your EMR applications. Client-server solutions also tend to offer more comprehensive feature sets.

However, installing and maintaining the necessary SSL security and firewalls requires technical expertise and effort. In addition, keeping the data in-house gives you the responsibility of making regular backups — preferably daily — in case of a system crash.

Client-server proponents point out that EMR applications are generally quite stable and require little maintenance. And you can create scheduled backups that copy your data to off-site computers fairly easily. (Interested in remote backup services? Get a free quote today)

If you choose the client-server route, you'll pay a lump sum upfront to buy and set up the system, including software and servers.

ASP solutions
In an ASP solution, both the application and data reside on the vendor’s servers, and your staff accesses them via the Internet, through a web browser or specialized client software.

The main advantage of ASP solutions is that they are maintained by IT professionals at the vendor’s office. Multiple layers of firewalls and security, uninterruptible power supplies, fail-over (instant switching from one computer to another in case of a crash), and reliable backups are all standard operating procedures for these vendors. They combine to virtually guarantee that your application and data will always be secure and available.

With proper security in place, online medical records also give your staff the ability to check in from remote locations if necessary. This can be a huge help when key doctors are out of the office.

The biggest risk of online medical records solutions is that they require a broadband Internet connection at all times. Since no Internet connection works 100% of the time – your internal network may fail, your ISP may experience an outage, or an Internet worm may cause congestion – you may not always be able to access the system. These types of outages are rare but possible.

With online providers, payment is based on a smaller setup fee and ongoing monthly payments based on usage.

Which is right for you?
Client-server software is a much more familiar setup to most users, and it makes up the vast majority of currently installed systems. However, the ASP model is gaining popularity, particularly among smaller practices. Here are some areas you should consider:

• Can your employees handle it? If you have in-house staffers with computer expertise, a client-server solution may be your best option – but make sure you involve them in the purchasing decision. Smaller practices with little to no computer expertise are probably better off choosing an ASP solution.
• Do you need extensive customization? ASPs can easily make basic changes in appearance and functionality, in effect giving you more control over the application than you would get from an internal IT team. However, if you need extensive customization, client-server can provide more flexibility. If long-term integration with other systems is your ultimate goal, client-server solutions are probably the way to go.

Since both options provide secure, reliable options, a final way to make the choice is to consider which of the potential downsides you fear more: being unable to access your system while your Internet connection is down, or losing data and time because your server crashes.

You can also start off with a hosted service, then move to an in-house solution: ASPs should offer a seamless migration path that will allow you to easily export your data. If you’re unsure of which direction you should go, this can be an easy way to get started without committing fully to either direction.