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ASPs - How the Internet is changing EMR

Divyang Da’ve

Divan (Divyang) Da've CEO of ISM/OmniMD

March 11, 2002 – Healthcare, along with construction, education and retail are ranked as being the slowest adopters of IT. With more pressure than ever from government, insurers and patients, why is healthcare still so far behind?

As health care becomes more integrated, electronic medical records (EMRs) have become an integral part of any practice.

In its simplest form, the concept of EMR is electronic storage and instant availability of clinical information to authorized users at the point of care. Increased efficiency is one of the foremost benefits. Because of increasing technological advances, we are seeing the delivery and implementation model of EMR changing with the times.

Practitioners today have an option to choose either EMR on “Client-Server” or an ASP platform.

Traditionally, EMRs had been deployed directly in the clinic on a Client-Server platform using a main computer (a “server”) located in the clinic. The data is then accessed using a “client” i.e. another computer connected directly to the server through the local area network (LAN).

However, with the increased demand for cost-effective EMR solutions, and advances in Web based technology, many vendors are now offering EMR on ASP platform.

The Application Service Provider (“ASP”) model is a way of providing EMR to medical practices that takes advantage of the Internet. An ASP replaces the on-site server at a physician’s office with a server installed and managed at a central data center. Physicians and practice staff can access the software applications remotely via PCs connected through the Internet. It is an effective EMR solution for Solo and Medium Medical Practices.

The increase in demand and interest in the ASP model is attributed to the various advantages it offers over the traditional Client-Server model:

Low cost of ownership: The foremost advantage to the practice is the reduction of hardware, software and maintenance costs. Software installation, maintenance, upgrades, back-up etc. are carried at the vendors end. The clinic does not require hiring of specialized IT staff to manage the day to day activities related to EMR. The user has to pay a fixed or transaction-based fee, mostly on monthly basis which also reduces the cost.

Easier accessibility of data at multiple locations: The ASP based solution allows the physician to access patient data at multiple locations via PCs connected to the Internet. This is very useful for clinics having multiple locations: the physician does not have to stick to a particular PC or location to access patient data.

Easier Upgrades & maintenance: The EMR vendor can centrally update the existing software at his end rather than going to each site for upgrades. This results in fast and effortless upgrade without interfering with the day-to-day operations of the clinic. Upgrades to a Client-Server platform could also require upgrading the existing hardware. This adds to the cost further. With an ASP model, the EMR vendor upgrades the hardware as needed at his end rather than requiring the physician to purchase additional hardware.

Greater Flexibility: ASP platform is far more flexible than Client-Server systems. Most Client-Server EMRs require the practice to buy the application outright rather than choosing a step-by-step implementation. Once the clinic has chosen a Client Server platform, it is difficult to switch to a different vendor because the cost incurred during the initial implementation for hardware and software is high. As ASP based EMR platforms have enjoyed an increase in demand, vendors offering these solutions have to address certain issues in order to increase the acceptance of ASP based EMRs over Client-Server solutions:

Security & Privacy of Medical Records: Since all the medical data is transmitted over the Internet, patient privacy issues are vital. In fact, ASP systems can be more secure than most Client-Server systems. HIPAA Complaint ASP systems are professionally managed data centers with high level data security systems in place. Data moves through a secured and encrypted pathway across the internet with standards such as SSL-128 in use. Firewalls installed at both ends stop unauthorized access to the network. In addition, Digital Certificates and PINs are some of the other measures being implemented by vendors.

Ownership of Medical Data: Because the patient data is stored at a site outside of the clinic, prospective ASP clients often ask the question ‘Who owns the Data?’ In most cases Service Level Agreements or other legal agreements are formulated and put in place to ensure that the ASP users can retrieve their data upon the termination of services, if they chose to do so.
Availability of Internet Connection: Since ASP platform is web based, it requires a stable and fast Internet connection at the clients end. The physician might not be able to use the solution if the connectivity is slow or interrupted. Most vendors recommend T-1 or DSL lines, both readily available in most locations, to ensure seamless flow of information and uninterrupted workflow.

In summary, ASPs offer an effective alternative to traditional Client-Server applications with the promise of lower cost of ownership, greater flexibility, easier implementation and maintenance. Physicians have come to realize that ASPs have grown up, and more practices will begin to migrate to the ASP model in the future as the concept gains increased acceptance.

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