| Electronic Medical Record (EMR) and digital billing | | | | clerical and clinical errors, improved coding, and |
| systems offer substantial clinical care, financial, | | | | faster cash flow, to infrastructure ownership |
| practice workflow, and compliance benefits to | | | | costs. |
| doctors, insurance companies, and patients. But | | | | The pitfall of this approach is that it ignores both |
| half of medical practices that purchase EMR | | | | technical and financial aspects of technology aging. |
| software fail to successfully implement it. | | | | Technically, Moore's law of digital technology |
| Rapid development is a salient feature of this | | | | development tells us that chip density doubles |
| technology market: eighteen news items published | | | | every 18 months. Therefore, computer hardware |
| by technology vendors of electronic medical | | | | and technology developed on it becomes obsolete |
| record and billing systems were listed in May 2006 | | | | every 36 months. Can you justify an investment |
| alone on BillingWiki/Technology. The eighteen news | | | | using five-year horizon in a technology, which |
| items split seven-to-eleven between web-based | | | | might become outdated in three years? |
| Application Service Provider (ASP) solutions and | | | | Financially, investments make sense in goods that |
| Client Server (CS)-based technologies. Upon briefly | | | | appreciate in value. Otherwise, renting |
| reviewing key factors defining each technology, | | | | business-necessary equipment or software often |
| we compare them along two criteria, namely | | | | offers the double-pronged advantage of both |
| implementation success likelihood and costs. | | | | freeing up cash flow and tax deductible business |
| Client Server Architecture | | | | expense. |
| CS model has been around since the early eighties | | | | Application Service Provider Architecture |
| of the twentieth century. Its architecture includes | | | | ASP model was introduced just before the turn |
| a central server deployed at the doctor's office | | | | of the new century. It is based on leveraging |
| and multiple client stations to allow the users to | | | | Internet. ASP architecture places the database |
| interact with the application. The central server | | | | server at the vendor's site instead of the doctor's |
| typically runs the database and some of the | | | | office and allocates the majority of application |
| application logic, while the client stations perform | | | | logic to the server, reducing the amount of code |
| much of the processing locally. | | | | needed to run the client. Such an approach allows |
| Such distributed processing architecture facilitates | | | | the users to interact with the application directly |
| relatively high application performance, minimizing | | | | via Internet browser, entirely eliminating the need |
| waiting time. The downside of CS architecture is | | | | for local office infrastructure and its management. |
| that it requires the practice owner to establish | | | | The vendor manages all of the technology |
| necessary infrastructure upfront and to | | | | centrally and for all offices, including compliance, |
| continuously manage it down the road. The | | | | disaster recovery, installation, upgrades, backups, |
| infrastructure includes a central server, client | | | | and restores. |
| terminals, and local network connecting the | | | | The ability to configure systems and train and |
| computers. The management tasks include | | | | support personnel without ever visiting the |
| installation, configuration, backups, restores, and | | | | practice sites, provides one of the most |
| periodic upgrades. | | | | cost-effective EMR solutions. Deployed remotely |
| Therefore, a typical CS charge model involves | | | | over the Internet, ASP methodology avoids |
| upfront investment in infrastructure and application | | | | time-intensive, on-site disruptions. Online training |
| license and subsequent monthly support costs as | | | | allows physicians and staff to schedule for |
| well as significant time spent on completing the | | | | convenience, further minimizing practice disruption. |
| required tasks and maintaining the knowledge level | | | | Obviously, ASP model creates major economies |
| required for successful operation of hardware and | | | | of scale eliminating the need for local IT staff. |
| software. | | | | Typical charge model of modern Vericle-like |
| To justify an investment, CS solution vendors | | | | solutions consists of monthly access fees and |
| offer traditional five-year return on investment | | | | avoids investment in and ownership of associated |
| (ROI) analysis. Such analysis compares EMR | | | | infrastructure. |
| benefits derived from reduced office workload, | | | | |