When referring to the deployment models of EMR’s or EHR’s we refer to C/S, B/S or SAAS. All have valid places in the marketplace and all have an industry need. I will explain all 3 in some further detail and list some of the major pro’s and con’s for each.

C/S versions or Stand Alone platforms, these are basically an EMR/EHR that is deployed in a practice or hospital and have no direct access to the internet, they run internally within the practice on an internal network or intranet. They do in most cases have some built in features that do interface with the internet, usually using a web service. An example of this would be sending and receiving Lab orders from lab companies such as Lab Corp or Quest, sending electronic claims and also e-prescriptions would be another use for the web service. However, the system is not accessible using a web browser and the users of the system must physically be in the practice to logon. Many languages can be used for development but some common ones include, VB, C#, C++.

Pro’s

• High level of security, these systems are generally very difficult to break into and the data stored within is safe 
  
• High speed as there is no need to use the internet (which depends on bandwidth to load pages) therefore the page load time of C/S systems is instantaneous.

Con’s 

• Cannot be accessed from anywhere outside of the practice, which means the convenience level is degreased. Practitioners must be in the office to add any data, read messages or logon.

B/S or browser based platforms are installed on a server and have direct access to the internet, this means that practitioners are able to logon to the system from their home, office, mobile phone or any remote location. All interactions with external systems are integrated easily as the system is directly connected to the internet, e-prescriptions, lab orders, electronic claims it means that integrations with these systems can be instantaneous and in real time. The beauty of this kind of system is that it can also be adapted to a C/S model, just remove the internet accessibility and it becomes a C/S version. Good systems will be deployed using ASP.NET but other internet based code environments can be used.

Pro’s 

• Convenient usage from any location 
  
• Easily integrated with external systems and data transfer can be real time 
  
• Can be adapted as a C/S

Con’s 

• Security, as it has direct internet access this means that potentially its security could be breached. Of course this is not an easy process and there are always high level security measures in place.
  
• Slower loading time. As its deployed on a server and is served over the internet, how fast pages load and data is displayed depends directly on the internet speed of the user. So sometimes it can be slow to use.

SAAS model, this refers to EMR/EHR systems that are setup on a central server and customers can purchase a membership to use the software platform. The customer once registered has their own account and section in the database on the central server, they can login each day and use the service, download data to their computer use and download reports. The customer pays an annual or monthly subscription fee to use the server, they never actually own the software or system they use. So this kind of platform is best suited to small-medium practices. Systems like this can be deployed using a number of internet languages, ASP.NET, PHP, Ruby on Rails, Perl, CGI, the list goes on. We prefer ASP.NET but Ruby on Rails is growing in popularity and is a very interesting and easy to use language.

Pros; 

• Minimal start-up costs, only requires an annual subscription fee which is much less than purchasing and installing a customized system. 
  
• The customer can easily change systems if they think the service or system is no longer suited to them

Cons; 

• The customer never owns the software 
  
•  The system is not customized for them and will always be a standard platform that all subscribers use 
  
• Can have slow loading times as it depends on internet usage and how many users are logged into the server at the one time
  
• The service provider can go out of business and essentially the system will shut down

It is my belief that there is room for each and every one of these 3 models in the market, not only that I think it’s wise for EMR/HER vendors to provide at least 2 of these models to capture as much of the market share as possible or to offer customers a choice as to how they want their system deployed.

We have worked on each of these models and know the in’s and out’s of their operation development and what makes them successful, if you would like to find out any more information on them please contact us. Or contact me directly, I would be happy to hear from you.

Best Regards

Christian Solomon
chris@intechnochina.com
Skype: christian.intechno