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Onsite vs. ASP vs. Blended
ARCHITECTURAL
CHOICES - Where is The Server?
One of
the difficulties (and barriers) to the adoption of EHRs is the variety of approaches
that have been used to implementing them. You will need to decide how you want
to approach your implementation. For example, you may decide to use an Application
Service Provider (ASP) to host the actual software at a remote site you access
over the Internet. Choosing both a good ASP and a decent EHR program requires
you to learn the least, and can be implemented quickly and tends to keep your
focus on practicing medicine, rather than computer and network management. It
also leaves you vulnerable to Internet disruptions. The ASP approach tends to
minimize hardware required for the implementation. Other implications of the
ASP model are discussed in the table below.
If you want to have the
system in your office for security and management purposes, you can choose either
a "thick" or "thin" client-server model.
Some practices
choose a blended or hybrid approach. They go for an ASP model but have a server
in their offices also that receives a backup every night from the ASP provider.
In that way, if the Internet is disrupted, the office can operate off of their
backup copy and local office server during emergency situations. This scenario
however requires an office server and also requires you pay more attention to
what computers are implemented around your office, because in an emergency your
system will revert to an in-office, client-server model and each workstation
in the office must be able to support that backup mode.
The following articles
offer insight into these different methods of approaching EHR.
To access this information, Register Now!
| Application |
Synopsis |
Registered Users Only |
| Client Server |
This article gives basic definitions that accompany thin and fat client
servers as well as advantages and topics such as maintenance and life cycle,
security and other topics. |
Fat
or Thin? Is the Verdict In? |
| This article explains what a thin client server is and how it differs
from a thick client server. It discusses how they evolved and the advantages
to this approach. The later part of this article is a bit technical. |
Thin
Client Server Computing |
| Basic and succinct definition of client server. |
Client Server
Definition |
| The Centers for Medicare & Medicaid Services (CMS) announced
VistA, the VA hospital EHR, has been put into the public domain and is free
to all physician group practices. Whether it is a competitive solution however
is a matter of some debate. Stay tuned. Remember the old adage, "Beware
of Governments offering Gifts!" Larger physician practices will be
offered a client server and smaller physician practices, an ASP. |
HHS To Offer
"Free" Software |
| ASP |
The American Academy of Family Physicians' (AAFP) Center for Health Information
Technology (CHiT) studied barriers to EHR adoption and found that
smaller physician practices did well with the ASP approach. The ASP
model was the only approach offered to the six 1-6 physician practices who
were then asked to report their findings. |
EHR Pilot Project Shows ASP
Model Has Benefits for Small Physician Practices |
| The American College of Physicians-American Society of Internal Medicine
article, although written five years ago, offers a guideline for assessing
the cost of an ASP as well as what to look for with this approach. |
A
look at the real costs of using Web-based software |
| Beyond the pros and cons of the ASP approach, this presentation issues
warnings that "these systems are no more "plug and play"
than those acquired under traditional licensing agreements." It also
points out the need for clarity for the service level agreements that are
part of the ASP model and the key considerations for these agreements. |
Application
Service Providers. Friends or Foes |
| A "bottom line" outline form of the advantages and disadvantages
of the ASP model provided by Family Practice Notebook.com |
Application Service Provider |
| Blended |
We believe the blended approach has a lot going for it. During routine
operation it is the least disruptive to the office, minimizes hardware investment,
minimizes maintenance requirements and provides TWO locations where all
patient records reside. The key is to get a good ASP and a good EHR to run
remotely. Sometimes your EHR vendor will also offer an ASP model and host
your site for you. |
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| Decision Making |
This is a PDF presentation that takes physicians through a process of
deciding what system is right for their practice and highlights the advantages
of the client server approach and the ASP approach. Also, tips on vendor
selection and more. |
Choosing
an EHR System That's Right for Your Practice |
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