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10 pts.
 Thoughts on a recent post- client server supreme?
I read a recent a post today by a hybrid EMR provider consultant that stated "Over the long term, a client-server offering often costs far less than a web-based subscription offering, and a well-designed client-server EMR always delivers productivity-enhancing benefits that save physicians both time and money."

Thoughts on this? What if your practice simply does not have the infrastructure or upfront resources for a client-server model?

Software/Hardware used:
ASKED: May 5, 2010  8:38 PM
UPDATED: June 22, 2010  1:29 pm

Answer Wiki:
The answer is - as - always - it depends... With web based systems, customers basically accept the system as it is, with minor opportunities to adapt system behaviors to workflows and customers needs. This has the advantage of leveraging established best practices, but often requires a more significant change in the way business is conducted. Owned client server systems may provide more opportunities to adapt the system to business realities, but often with a higher level of effort in the beginning of the implementation. The IT industry as a whole tends to make swings between owning and running systems to hosting and outsourcing and back. The current buzz around cloud computing tends to favor hosted systems, but I would imagine that the confidential nature of patient records will lead many providers to keeping things on premises. There is no good, universally true answer. As always, your mileage will vary and it depends on what you're trying to do. Florian Becker twitter: <a href="">@florianbecker</a>
Last Wiki Answer Submitted:  May 18, 2010  2:54 pm  by  FlorianB   195 pts.
All Answer Wiki Contributors:  FlorianB   195 pts.
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I agree with FlorianB’s answer. Another factor to consider is the IT staff of the hospital or physician office. Is there an existing staff that can handle the increased workload of a client-server model? If not, what is the cost of adding IT staff?

 40 pts.


For most solo physicians or a small practices, a SaaS/VPN solution is the first option I would consider. A good summary of the difference between client-server and the various types of ASP models can be found here. A good solution will enable the existing staff to provide the necessary local IT support – no additional staff will be needed. The vendor will handle all the upgrades, backups, interfaces with labs and code directories, and ongoing support. In addition, a good solution will be highly configurable to the specific requirements of the users. With regard to security, the VPN addresses the vulnerability to malicious attack, and vendors of SaaS solutions are typically well- prepared to protect the integrity and privacy of the data entrusted to them. The main drawback to a SaaS solution is the dependence on a network connection. Getting the network service provider involved in providing sufficient bandwidth, reliability and availability is an important element of the implementation.

 385 pts.


As Florian said – It depends.
Client server architecture and internet both have their pros and cons. Unless it has lots of benefits – A hybrid is not always good. I have given the pros and cons for comparison here to make any user make the bet.

Disadvantages of Web based Application:
1. Lack of Rich User Interface: Mitigation – Latest systems with Microsoft Silverlight and Adobe Flex, it is manageable to give similar user experience. But it is still in its infancy.
2.For every transaction, the client’s page will get refreshed loading the page from scratch: Mitigation – Latest systems have Ajax enabled applications, which has capability to refresh the right part of the page.

Disadvantages of Client-Server Application:
1. For every release for bug fixes or new feature, the client has to face “software update” or “migration”, which virtually stops the operation of a client involving staff from the software vendor to other users at client facility: Mitigation – Latest software have the facility to do “auto update”.
2. Not easily flexible for migrating to new architecture / version: To update or migrate for example 1000 installations from version 1 to version 2, the software vendor has to manually fix it in 1000 installations one by one; which is a time consuming process for both the client as well as the software vendor. And every software goes through the update cycle almost every 6 months. This is the worst part of client-server applications.
3.User have to install the client software in every machine that they want to use: If the physician’s machine crashed or wants to use a new facility / computer; without spending few hours it is not possible to work on this architecture.

Looking at these points, client-server architecture has major drawbacks – with only advantages of a Rich User Interface. To create a web based application from scratch is a time consuming process getting rid of the old client-server application. Vendors use “hybrid” model, where they mix and match new feature and technology in the back office.

The users need to understand what exactly is mixed and understand the “hybrid” to avoid major upgrades to their software in short time period.

On a personal note, I will prefer a “hybrid” solution with thin client, with all the transactions happening over HTTP protocol, and with SaaS enabled back office.

 200 pts.

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