The difference between an ASP and LCS
EMR and what solution is right for you.
Introduction
There are numerous benefits that an Application Service Provider (ASP) EMR can offer over a Local Client Server (LCS) such as lower cost, greater efficiency, lower maintenance, ability to share and manipulate data and much more.
If the benefits of an ASP outweigh the benefits of an LCS then why is there still a debate over which application is the right solution for physicians? The debate is over the concern some physicians have with the safety of their patient information and the reliability of the Internet. The purpose of this paper is to provide a brief explanation on the two solutions, the strengths of an ASP based EMR and address common concerns and questions.
Background: A brief explanation
Application Service Provider (ASP)
An application hosted [managed] by an organization that resides on its own servers and is housed in their own facility or hosting provider’s facility. The application can be accessed over the Internet or through another network.
Diagram 1: ASP platform example
Local client server (LCS)
An application installed on a hard drive of a PC or browser based. An LCS is accessed from a server that physically sits in the same location as the customer. An LCS cannot be accessed over the Internet unless a virtual privacy network is used.
Diagram 2: LCS platform example
Local Server PC PC
Hosting Center Firewall
Public or Private Network
Firewall
Firewall Firewall
Location ‘A’
Location ‘B’
Mobile PC
Home
PC PC PC PC PC PC PC
PC PC
Location ‘A’ Location ‘B’ Local Server PC PC
Strengths of an ASP EMR
Less expensive and greater efficiency
Generally, the cost of an ASP EMR application is less expensive than an LCS even though the quality and functionality of both solutions are the same. Vendors are able to set a lower price for an ASP than an LCS since an ASP does not require all the additional costs associated with running an LCS.
The table below outlines the one time set up and recurring monthly costs associated with implementing a third party LCS solution versus the Nightingale ASP solution.
Solution types
LCS - Other Vendor
ASP Nightingale One time setup costs
Hardware
PCs $3,000 $3,000
Printer 1,000 1,000 Server(s) 5,000 N/A Server Backup Unit 600 N/A Server Setup Cost 600 N/A Modem 37 N/A Tapes (daily/monthly/yearly) 1,360 N/A
Total $11,597 $4,000
Software & Setup
Software for Server $3,279 N/A
Print Control License 2,713 N/A Secure Web Protocol (SSL) 131 N/A Backup Software 800 N/A Lab software 125 N/A
Total $7,048 $0
Grand total - One time setup costs $18,645 $4,000 Monthly Operating Costs
Software
EMR&PM Software $400 $400
Equipment
Dedicated Analog Phone Line (Billing Only) $45 N/A Dedicated Phone Line (Lab Results) 45 N/A Amortization of Server 83 N/A Server Maintenance 600 N/A Internet Service 45 90
Total $818 $90
Administration
Billing $100 N/A
Backups 100 N/A
Total $200 $0
Anywhere, anytime EMR access
ASP offers a significant advantage over LCS as it provides secure anytime, anywhere, remote access to a physician’s EMR. When using an ASP a user can login into their EMR application from any computer as long as an Internet connection is present.
Remote access increases the efficiency and speed of care provided to patients by allowing users to work outside of their work environment and office hours.
For those healthcare providers who work in multiple locations, an ASP EMR is the ideal solution as it provides a continuous connection to their EMR files. An LCS solution can prevent a user from accessing their EMR once they are outside their office location unless special access has been setup such as a virtual private network.
Lower maintenance
An ASP offers lower maintenance costs since there are no local servers to run or office networks to maintain. Plus, product upgrades can be easily completed remotely over the Internet when using an ASP solution.
Easily share patient data
With an ASP physicians and other healthcare providers can easily share patient information since this information all sits in the same database or location as opposed to having to physically transfer data. The ability to have immediate access to all patient data within a practice or group increases the efficiency and quality of the care provided.
Manipulate information and create reports
Physicians and healthcare providers who use an ASP can also easily manipulate and create reports on the data stored in their EMR. This may be especially useful in the event of a drug recall when there is a need to quickly generate a list of patients who are taking a particular drug. This type of reporting may not be easily accomplished or even possible with an LCS.
Greater cost efficiency
Since an ASP based EMR is typically provided on a subscription basis, an organization can scale up or down according to their individual needs. An LCS requires wide scale
organizational planning and requires a lengthier set up process.
Common questions & concerns over an ASP EMR
Uncomfortable having patient data off-site
Some physicians have expressed concern over how patients would perceive the security and privacy of their medical records if stored off-site. The fact is that data is more secure off-site than it is when stored in an office or clinic. Medical offices and clinics are just as susceptible to hackers, theft or acts of God as any other business.
ASP solution
ASP providers typically house the servers containing customer data in their own secure facility or partner with a third party hosting specialist. Nightingale has chosen to partner with Fusepoint Managed Services to house its servers. The data facility requirements that Fusepoint provides is highly sophisticated and would be very difficult, if not impossible, for a medical clinic, office or hospital to replicate. Security and reliability are of the upmost importance and multiple physical and
integrity and operations of the data facility.
• Bullet proof glass facility entrance and security areas • Card access control for all secure zones
• Multiple biometric and PIN code access areas • Custom, steel mesh-reinforced walls
• Video monitoring, remote monitoring and image capture systems • Vibration and motion detectors in walls and ceilings
Data facilities must also meet certain design criteria.
Servers must be protected from fire by a computer-safe fire suppression system and housed in a computer room that is constructed with fireproof materials
The power supply, temperature and humidity control systems for the server room are safeguarded with an uninterrupted power supply.
Building is able to withstand NEBC 3, Zone 4 earthquakes.
A complete description of Nightingale’s privacy and security policies is available upon request.
LCS solution
Storing data in a medical clinic or office means that the healthcare provider or administrator must perform backups on a daily basis and ideally store these backups off-site in case of fire or theft. If a backup is not performed and data in lost there is no way to retrieve the data. With an ASP solution a user will never lose more than 24 hours of data.
Internet speed and performance is too poor to run my practice
The speed of an Internet connection as well as its connectivity is generally related to the quality of the Internet Service Provider (ISP), existing telecommunications infrastructure in place within the medical facility or building, office size, connection type and other factors. To obtain the best possible Internet speed and performance it is highly recommended that an ASP user follow the technology recommendations, especially the networking and hardware requirements, prescribed by their ASP vendor. Click here to view the Nightingale technology recommendations.
Nightingale recommends that all clients have a redundant connection in case the primary Internet connection temporarily goes down. For example, if a clinic normally connects to the Internet using Rogers then a redundant connection with Bell should be set up. The Service Level Agreements (SLAs) for both Rogers and Bell guarantee network performance of 99.9% annual availability outside of Acts of God or an interruption due to scheduled maintenance. To view your SLA call your ISP provider or if you are a Rogers user click here and for Bell click here.
Traditional ISP service is not good enough
If a user or groups’ service requirements are not being meet by a traditional ISP provider a potential solution would be the purchase of a T1 connection. A T1 line refers to a specific type of fiber optic telephone line that can carry more data than traditional copper telephone lines. While standard copper telephone lines can transfer data and voice at a rate of about 30,000 bits per second (30 kbps) using a dial-up modem, a T1 line can transmit 1.544 megabits per second, or can be used to transmit 24 digitized voice channels. A T1 connection can be used for phone service in a commercial building or for data transfer on a network, providing service up to 60 times faster than a traditional modem. Pricing for the T1 line will
depend on the distance of the loop, or the mileage between the telecom and the place of business.
Currently the Smart Systems for Health Agency (SSHA) does offer free T1 connections to Ontario based physicians who qualify. To learn more about the provincial government initiatives click here.
Hybrid server option
Some providers have asked why the industry doesn’t widely offer an EMR solution that combines the benefits of both an ASP and LCS solution, where the EMR runs locally and data is backed up automatically and uploaded to a remote server.
Some EMR vendors do offer this solution, however, this type of setup essentially cancels out the cost and operational efficiencies that are achieved with an ASP based EMR. The provider would still be responsible for the maintenance and security of the local server and all of their data. It would also be just as difficult to transfer data between locations or providers.
What if my ASP vendor ceases operations
In the unlikely event that an ASP vendor such as Nightingale ceases operations a user and their data are protected. A Nightingale user would receive a full electronic data extract of all of their files and patient data which could be transferred for use with another vendor or installed locally on a server.
In fact Nightingale users can have access to their data whenever they wish. Nightingale specifically stipulates in its contract that it understands and agrees that it receives no ownership rights to the data or records furnished by a client. All material and information provided by a client or related to their practice, policies or procedures, including but not limited to patient data is designated as confidential and proprietary and therefore must legally remain confidential. These terms are enforced by the Personal Information Protection
More information
If you are interested in learning more about this topic or Nightingale products or services there are several ways to contact us.
Email: [email protected] Phone: 866.852.3663
About Nightingale
Nightingale is one of the fastest growing health care service and software companies in North America with over 5.3 million patient records under management in a hosted (ASP) environment. It is recognized as an industry leader in Web-based clinician and community based electronic medical records (EMR) serving the needs of small primary care practices, multi-physician outpatient clinics, and large scale regional health organizations and networks. Coupled with integrated practice management, transcription and revenue cycle management, Nightingale’s comprehensive service offering allows customers to enhance patient care, increase revenue opportunities and optimize operations. Nightingale is continuously innovating and enhancing its services to meet the needs of its growing and diverse customer base.
