Electronic Medical Billing Software – Client-Server Versus Application Service Provider (ASP)

Electronic Medical Record (EMR) and digital billing systems offer substantial clinical care, financial, practice workflow, and compliance benefits to doctors, insurance companies, and patients. But half of medical practices that purchase EMR software fail to successfully implement it.

Rapid development is a salient feature of this technology market: eighteen news items published by technology vendors of electronic medical record and billing systems were listed in May 2006 alone on BillingWiki/Technology. The eighteen news items split seven-to-eleven between web-based Application Service Provider (ASP) solutions and Client Server (CS)-based technologies. Upon briefly reviewing key factors defining each technology, we compare them along two criteria, namely implementation success likelihood and costs.

Client Server Architecture

CS model has been around since the early eighties of the twentieth century. Its architecture includes a central server deployed at the doctor’s office and multiple client stations to allow the users to interact with the application. The central server typically runs the database and some of the application logic, while the client stations perform much of the processing locally.

Such distributed processing architecture facilitates relatively high application performance, minimizing waiting time. The downside of CS architecture is that it requires the practice owner to establish necessary infrastructure upfront and to continuously manage it down the road. The infrastructure includes a central server, client terminals, and local network connecting the computers. The management tasks include installation, configuration, backups, restores, and periodic upgrades.

Therefore, a typical CS charge model involves upfront investment in infrastructure and application license and subsequent monthly support costs as well as significant time spent on completing the required tasks and maintaining the knowledge level required for successful operation of hardware and software.

To justify an investment, CS solution vendors offer traditional five-year return on investment (ROI) analysis. Such analysis compares EMR benefits derived from reduced office workload, clerical and clinical errors, improved coding, and faster cash flow, to infrastructure ownership costs.

The pitfall of this approach is that it ignores both technical and financial aspects of technology aging. Technically, Moore’s law of digital technology development tells us that chip density doubles every 18 months. Therefore, computer hardware and technology developed on it becomes obsolete every 36 months. Can you justify an investment using five-year horizon in a technology, which might become outdated in three years?

Financially, investments make sense in goods that appreciate in value. Otherwise, renting business-necessary equipment or software often offers the double-pronged advantage of both freeing up cash flow and tax deductible business expense.

Application Service Provider Architecture

ASP model was introduced just before the turn of the new century. It is based on leveraging Internet. ASP architecture places the database server at the vendor’s site instead of the doctor’s office and allocates the majority of application logic to the server, reducing the amount of code needed to run the client. Such an approach allows the users to interact with the application directly via Internet browser, entirely eliminating the need for local office infrastructure and its management. The vendor manages all of the technology centrally and for all offices, including compliance, disaster recovery, installation, upgrades, backups, and restores.

The ability to configure systems and train and support personnel without ever visiting the practice sites, provides one of the most cost-effective EMR solutions. Deployed remotely over the Internet, ASP methodology avoids time-intensive, on-site disruptions. Online training allows physicians and staff to schedule for convenience, further minimizing practice disruption.

Obviously, ASP model creates major economies of scale eliminating the need for local IT staff. Typical charge model of modern Vericle-like solutions consists of monthly access fees and avoids investment in and ownership of associated infrastructure.

The Client-Server Model is the Key to Web Design

Each day literally hundreds of millions of people view billions of Web pages on the internet. But how does it work? Where do web pages come from? Where are they stored? How are they stored? And how does a Web Browser know how to find the correct Web page and display it?

This article answers the above questions, by explaining the Client/Server model of web design.

The Client/Server Model

The Client/Server model of web design is very important. All web pages are displayed as a result of cooperative interaction between Web clients and Web servers. Thus, there are two key concepts:

  1. Client. For the purposes of this article, a client is a Web browser. The job of the client (Web browser) is to request Web pages from a server, and display them to a user.
  2. Server. A server is a computer someplace on the World Wide Web that contains one or more Web pages.

What the Web Client (Browser) Does

A Web client, as previously stated, is just an everyday Web browser. Some examples of Web clients are Microsoft Internet Explorer, Mozilla Firefox, Apple Safari, and Google Chromei.

Basically all Web clients do the same thing. They request Web pages from servers, and they display the pages. Most modern browsers are also capable of running “client side” programming languages, like JavaScript, but that is beyond the scope of this article.

What the Web Server Does

A Web server, as previously stated, is a computer located someplace on the World Wide Web, that is able to provide a Web page, upon request. The browser requests a page, and the Web server provides it. Web pages are typically stored as files on the Web server, although sometimes they are produced by “server side” programming languages (for example PHP) but that is beyond the scope of this article.

How Clients and Servers Interact

Based on the definition of a client and the definition of a server, it is not hard to understand how the display of Web pages works, starting from when a user clicks on a link on a Web Page.

Here is what happens:

  1. The user of a web browser (client) clicks on a link.
  2. The link contains the address of a page the user wants the browser (client) to display.
  3. The client then sends a digital message over internet to the server. The message is called an http request. The http request tells the server that the client would like to see the contents of a web page.
  4. Now the server needs to respond to the client request, by sending what is called an http response. Normally, the response will contain the contents of the web page requested by the client

Example

Suppose you click on a link that is supposed to take you to an article posted on the Ezinearticles site.

What happens? According to the explanation of the Client/Server Model given above, the following happens:

  1. First you click on the link for the article on the ezinearticles site.
  2. The client (your browser!) reads the contents of this link and, based on the contents of the link, knows the address of the server that contains the web page you want to see. In this case, the server address is the location of the ezinearticles site, and the page that the server needs to return is the actual page of the article you want to read.
  3. Your browser sends an http request to the EzineArticles server.
  4. The server checks to see if the the article page exists (it should!); and returns the contents of the article page to your browser in an http response message.

Summary

Web browsers and Web servers work together as a client/server team to deliver content on the World Wide Web. Users are more familiar with browsers than servers, but both are essential to delivering billions of pages of content every day.

Electronic Medical Billing Software – Client-Server Versus Application Service Provider

Electronic medical billing is an automated method of managing document and billing flow. Electronic billing makes the whole process of billing more easy and manageable. It also provides substantial clinical care, financial, practice workflow, and observance benefits to doctors, insurance companies, and patients.

Rapid development is a salient feature of technology. According to a survey last year there were eighteen new items presented by vendors of electronic medical record and billing systems, eighteen new items split between Application Service Provider (ASP) solutions and Client Server (CS)-based technologies. Some features of Client Server and ASP architecture are given below:

The Client Server Architecture

Internet revolves around the client-server architecture. Where your computer is the client and it interacts with different servers located at remote locations. The client is usually a browser; Browsers interact with the server using a set of instructions called protocols. These protocols help in the accurate transfer of data through requests from a browser and responses from the server.

Client/Server models allow for quicker response times in the application as the data from the server to the client is transmitted much faster (usually 100 Mbits/second). The newer client/server products developed in Java and Microsoft.Net are capable of offering the “best of both worlds” as they have the speed of a local system plus the accessibility from a remote location. The newer systems can be accessed from any internet browser. Client/Server also boasts the benefits of practice having the control over their data. However with this control comes responsibility; the responsibility of being responsible for your data as you are now open to the risk of theft, fire, hard-drive failure and data corruption.

Advantages and Disadvantages of using a client/server system

Advantages of Client/Server for EMR

– Overall operation is faster
– Better control over Data
– It is not dependent on Internet
– Better integration with imaging devices (scanners, printers) and on-site resources

Disadvantages of Client/Server for EMR

– It cost much more as you had to buy your own server and software.
– Product updates are usually required.
– You need 3rd party software for online backups.
– Don’t have more functionality to offer, if you have to access it remotely.

Application Service Provider Architecture

ASP architecture places the database server at some other end instead of the doctor’s office and allocates the majority of application logic to the server, reducing the amount of code needed to run on the client side. It allows users to interact with application directly via Internet browser, entirely eliminating the need for local office infrastructure and its management overheads. There is no need of any office infrastructure and management to handle the technical detail of the software because all of the technical things will be handled on the vendors end, centrally and they are going to responsible for everything including compliance, disaster recovery, installation, upgrades, backups, and restores.

Advantages and Disadvantages of using an ASP system include:

Advantages of using ASP for EMR

– Online backup service.
– Reduces the cost of maintenance as the technical details are handled by IT professional.
– You can access it from anywhere in the world all you need is a internet connection
– Cost less because u doesn’t have to hire any technical staff.

Disadvantages of using ASP for EMR

– You don’t control your data because it is not handled on your end.
– Risk of company not performing routine maintenance (backup, updates, and performance enhancements) as promised.
– Dependant on internet connection.

Purchasing the right software is the most important thing to be considered. As we all know new things just keep on adding in the software even after purchasing, it will be continuously modified as it is an emerging technology new features will be keep on adding. With the ASP model, the practice will access the new feature almost immediately upon release. The Client/Server software requires updates for the new features.

Electronic Medical Records is still in the early adoption phase by private practice physicians. So far at this point, there is not a single model to lead. Only time will tell. However, with the ability to look at our past and the direction that major companies such as Microsoft are heading in, the signs are pointing to ASP.