ASP or Client-Server: Which Is Better for You?

Last year I discussed the basic rules to keep in mind when shopping for an electronic medical record system, and last month's column included a discussion of the advantages of adding Web-based messaging to your EMR system. (If you missed those columns, you can find them on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

First, the difference: You have a choice of where you want the software hosted. If it is to be run on hardware within your office, that is a server-based, or client-server, system. If you rely on a vendor to run the software on its hardware via the Internet, that is a Web-based system, or, in industry jargon, an application service provider (ASP) system. Both options provide distinct advantages and disadvantages.

Client-server systems run and store data on hardware you own and keep on your premises. You pay up front for hardware, software, and setup, and usually a monthly maintenance fee thereafter.

Such a system gives you greater control and fewer worries about interrupted access or breach of confidentiality, but up-front equipment costs are high and the responsibility of maintaining and securing your database is entirely yours. Obviously, regular backups are essential. You can either create backup tapes or disks yourself and physically store them elsewhere, or—a far better option, in my view—you can hire a service that regularly and automatically copies your data to off-site computers. A growing number of remote backup services are available at reasonable prices. (As always, I have no financial interest in any product or enterprise discussed in this column.)

In an ASP system, both the application and data reside on the vendor's servers, and your office accesses them through a Web browser or other specialized software. The up-front setup fee is comparatively small, and ongoing monthly payments are based on frequency of usage and the complexity of your data.

The main advantage of an ASP is that your data are maintained by computing professionals at the vendor's facility.

As one vendor explained, you would consider it foolish to keep your money under a mattress at home. Instead, you entrust it to a bank that is staffed by security professionals. So why not do the same with your medical records? You also typically get access to far more sophisticated hardware and software features than you could afford to buy yourself.

The glaring disadvantage of the ASP is the active Internet connection it requires. No Internet connection works 100% of the time; your Internet service provider or internal network may fail, or a virus, worm, Trojan horse, or hacker can wreak havoc with your records.

If you go this route, there are several essential features to ask about. These include multiple layers of security, uninterruptible power sources, instant switchover to backup hardware in case of a crash, and frequent, reliable backups. In short, you need reliable assurances that your records will always be secure and available.

So which is right for you? If you have a multiphysician practice and you are an expert with computers (or have ready access to one), client-server may be your best option. Smaller offices with little to no computer expertise are probably better off choosing an ASP, at least to start.

An ASP has more sophisticated equipment, additional layers of security, and larger, specialized staffs than your office does. In smaller practices, the ASP is often easier to customize than an internal system. In a large practice with numerous and diverse subspecializations, client-server systems often provide more flexibility. You will pay a premium for the extra customization work, however.

In the end, it may come down to which of the potential downsides you fear more: being unable to access your records while your Internet connection is down, or losing data and time (or worse) if your hardware crashes or gets damaged in a fire or other calamity. One option to consider is starting with a hosted ASP service, then moving in-house if that becomes necessary or advantageous.

Last year I discussed the basic rules to keep in mind when shopping for an electronic medical record system, and last month's column included a discussion of the advantages of adding Web-based messaging to your EMR system. (If you missed those columns, you can find them on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

First, the difference: You have a choice of where you want the software hosted. If it is to be run on hardware within your office, that is a server-based, or client-server, system. If you rely on a vendor to run the software on its hardware via the Internet, that is a Web-based system, or, in industry jargon, an application service provider (ASP) system. Both options provide distinct advantages and disadvantages.

Client-server systems run and store data on hardware you own and keep on your premises. You pay up front for hardware, software, and setup, and usually a monthly maintenance fee thereafter.

Such a system gives you greater control and fewer worries about interrupted access or breach of confidentiality, but up-front equipment costs are high and the responsibility of maintaining and securing your database is entirely yours. Obviously, regular backups are essential. You can either create backup tapes or disks yourself and physically store them elsewhere, or—a far better option, in my view—you can hire a service that regularly and automatically copies your data to off-site computers. A growing number of remote backup services are available at reasonable prices. (As always, I have no financial interest in any product or enterprise discussed in this column.)

In an ASP system, both the application and data reside on the vendor's servers, and your office accesses them through a Web browser or other specialized software. The up-front setup fee is comparatively small, and ongoing monthly payments are based on frequency of usage and the complexity of your data.

The main advantage of an ASP is that your data are maintained by computing professionals at the vendor's facility.

As one vendor explained, you would consider it foolish to keep your money under a mattress at home. Instead, you entrust it to a bank that is staffed by security professionals. So why not do the same with your medical records? You also typically get access to far more sophisticated hardware and software features than you could afford to buy yourself.

The glaring disadvantage of the ASP is the active Internet connection it requires. No Internet connection works 100% of the time; your Internet service provider or internal network may fail, or a virus, worm, Trojan horse, or hacker can wreak havoc with your records.

If you go this route, there are several essential features to ask about. These include multiple layers of security, uninterruptible power sources, instant switchover to backup hardware in case of a crash, and frequent, reliable backups. In short, you need reliable assurances that your records will always be secure and available.

So which is right for you? If you have a multiphysician practice and you are an expert with computers (or have ready access to one), client-server may be your best option. Smaller offices with little to no computer expertise are probably better off choosing an ASP, at least to start.

An ASP has more sophisticated equipment, additional layers of security, and larger, specialized staffs than your office does. In smaller practices, the ASP is often easier to customize than an internal system. In a large practice with numerous and diverse subspecializations, client-server systems often provide more flexibility. You will pay a premium for the extra customization work, however.

In the end, it may come down to which of the potential downsides you fear more: being unable to access your records while your Internet connection is down, or losing data and time (or worse) if your hardware crashes or gets damaged in a fire or other calamity. One option to consider is starting with a hosted ASP service, then moving in-house if that becomes necessary or advantageous.

Last year I discussed the basic rules to keep in mind when shopping for an electronic medical record system, and last month's column included a discussion of the advantages of adding Web-based messaging to your EMR system. (If you missed those columns, you can find them on the SKIN & ALLERGY NEWS Web site at www.skinandallergynews.com

First, the difference: You have a choice of where you want the software hosted. If it is to be run on hardware within your office, that is a server-based, or client-server, system. If you rely on a vendor to run the software on its hardware via the Internet, that is a Web-based system, or, in industry jargon, an application service provider (ASP) system. Both options provide distinct advantages and disadvantages.

Client-server systems run and store data on hardware you own and keep on your premises. You pay up front for hardware, software, and setup, and usually a monthly maintenance fee thereafter.

Such a system gives you greater control and fewer worries about interrupted access or breach of confidentiality, but up-front equipment costs are high and the responsibility of maintaining and securing your database is entirely yours. Obviously, regular backups are essential. You can either create backup tapes or disks yourself and physically store them elsewhere, or—a far better option, in my view—you can hire a service that regularly and automatically copies your data to off-site computers. A growing number of remote backup services are available at reasonable prices. (As always, I have no financial interest in any product or enterprise discussed in this column.)

In an ASP system, both the application and data reside on the vendor's servers, and your office accesses them through a Web browser or other specialized software. The up-front setup fee is comparatively small, and ongoing monthly payments are based on frequency of usage and the complexity of your data.

The main advantage of an ASP is that your data are maintained by computing professionals at the vendor's facility.

As one vendor explained, you would consider it foolish to keep your money under a mattress at home. Instead, you entrust it to a bank that is staffed by security professionals. So why not do the same with your medical records? You also typically get access to far more sophisticated hardware and software features than you could afford to buy yourself.

The glaring disadvantage of the ASP is the active Internet connection it requires. No Internet connection works 100% of the time; your Internet service provider or internal network may fail, or a virus, worm, Trojan horse, or hacker can wreak havoc with your records.

If you go this route, there are several essential features to ask about. These include multiple layers of security, uninterruptible power sources, instant switchover to backup hardware in case of a crash, and frequent, reliable backups. In short, you need reliable assurances that your records will always be secure and available.

So which is right for you? If you have a multiphysician practice and you are an expert with computers (or have ready access to one), client-server may be your best option. Smaller offices with little to no computer expertise are probably better off choosing an ASP, at least to start.

An ASP has more sophisticated equipment, additional layers of security, and larger, specialized staffs than your office does. In smaller practices, the ASP is often easier to customize than an internal system. In a large practice with numerous and diverse subspecializations, client-server systems often provide more flexibility. You will pay a premium for the extra customization work, however.

In the end, it may come down to which of the potential downsides you fear more: being unable to access your records while your Internet connection is down, or losing data and time (or worse) if your hardware crashes or gets damaged in a fire or other calamity. One option to consider is starting with a hosted ASP service, then moving in-house if that becomes necessary or advantageous.