The difference between an ASP and LCS EMR and ... - CanadianEMR

White Paper – January 2009The difference between an ASP and LCSEMR and what solution is right for you.

Nightingale White PaperDifference between ASP and LCS EMR 2IntroductionThere are numerous benefits that an Application Service Provider (ASP) EMR can offer over aLocal Client Server (LCS) such as lower cost, greater efficiency, lower maintenance, ability toshare 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 overwhich application is the right solution for physicians? The debate is over the concern somephysicians 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 strengthsof an ASP based EMR and address common concerns and questions.Background: A brief explanationApplication Service Provider (ASP)An application hosted [managed] by an organization that resides on its own servers and ishoused in their own facility or hosting provider’s facility. The application can be accessedover the Internet or through another network.Diagram 1: ASP platform exampleHostingCenterFirewallLocation ‘A’PCPCPCFirewallPublic or PrivateNetworkFirewallHomeMobilePCFirewallLocation ‘B’PC PC PC PC PC PCLocal client server (LCS)An application installed on a hard drive of a PC or browser based. An LCS is accessed from aserver that physically sits in the same location as the customer. An LCS cannot be accessedover the Internet unless a virtual privacy network is used.Diagram 2: LCS platform exampleLocation ‘A’Local ServerLocation ‘B’Local ServerPCPCPCPCCopyright © Nightingale Informatix Corp. 2009

Nightingale White PaperDifference between ASP and LCS EMR 3Strengths of an ASP EMRLess expensive and greater efficiencyGenerally, the cost of an ASP EMR application is less expensive than an LCS even though thequality and functionality of both solutions are the same. Vendors are able to set a lowerprice for an ASP than an LCS since an ASP does not require all the additional costs associatedwith running an LCS.The table below outlines the one time set up and recurring monthly costs associated withimplementing a third party LCS solution versus the Nightingale ASP solution.Solution typesLCS - OtherVendorASPNightingaleOne time setup costsHardwarePCs $3,000 $3,000Printer 1,000 1,000Server(s) 5,000 N/AServer Backup Unit 600 N/AServer Setup Cost 600 N/AModem 37 N/ATapes (daily/monthly/yearly) 1,360 N/ATotal $11,597 $4,000Software & SetupSoftware for Server $3,279 N/APrint Control License 2,713 N/ASecure Web Protocol (SSL) 131 N/ABackup Software 800 N/ALab software 125 N/ATotal $7,048 $0Grand total - One time setup costs $18,645 $4,000Monthly Operating CostsSoftwareEMR&PM Software $400 $400EquipmentDedicated Analog Phone Line (Billing Only) $45 N/ADedicated Phone Line (Lab Results) 45 N/AAmortization of Server 83 N/AServer Maintenance 600 N/AInternet Service 45 90Total $818 $90AdministrationBilling $100 N/ABackups 100 N/ATotal $200 $0Grand total monthly operating costs $1,837 $90Copyright © Nightingale Informatix Corp. 2009

Nightingale White PaperDifference between ASP and LCS EMR 4Anywhere, anytime EMR accessASP offers a significant advantage over LCS as it provides secure anytime, anywhere, remoteaccess to a physician’s EMR. When using an ASP a user can login into their EMR applicationfrom any computer as long as an Internet connection is present.Remote access increases the efficiency and speed of care provided to patients by allowingusers to work outside of their work environment and office hours.For those healthcare providers who work in multiple locations, an ASP EMR is the idealsolution as it provides a continuous connection to their EMR files. An LCS solution canprevent a user from accessing their EMR once they are outside their office location unlessspecial access has been setup such as a virtual private network.Lower maintenanceAn ASP offers lower maintenance costs since there are no local servers to run or officenetworks to maintain. Plus, product upgrades can be easily completed remotely over theInternet when using an ASP solution.Easily share patient dataWith an ASP physicians and other healthcare providers can easily share patient informationsince this information all sits in the same database or location as opposed to having tophysically transfer data. The ability to have immediate access to all patient data within apractice or group increases the efficiency and quality of the care provided.Manipulate information and create reportsPhysicians and healthcare providers who use an ASP can also easily manipulate and createreports on the data stored in their EMR. This may be especially useful in the event of a drugrecall when there is a need to quickly generate a list of patients who are taking a particulardrug. This type of reporting may not be easily accomplished or even possible with an LCS.Greater cost efficiencySince an ASP based EMR is typically provided on a subscription basis, an organization canscale up or down according to their individual needs. An LCS requires wide scaleorganizational planning and requires a lengthier set up process.Common questions & concerns over an ASP EMRUncomfortable having patient data off-siteSome physicians have expressed concern over how patients would perceive the security andprivacy of their medical records if stored off-site. The fact is that data is more secure off-sitethan it is when stored in an office or clinic. Medical offices and clinics are just as susceptibleto hackers, theft or acts of God as any other business.ASP solutionASP providers typically house the servers containing customer data in their ownsecure facility or partner with a third party hosting specialist. Nightingale haschosen to partner with Fusepoint Managed Services to house its servers. The datafacility requirements that Fusepoint provides is highly sophisticated and would bevery difficult, if not impossible, for a medical clinic, office or hospital to replicate.Security and reliability are of the upmost importance and multiple physical andCopyright © Nightingale Informatix Corp. 2009

Nightingale White PaperDifference between ASP and LCS EMR 5LCS solutiontechnical security features are present in Nightingale’s centres to ensure theintegrity 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 ceilingsData facilities must also meet certain design criteria.Servers must be protected from fire by a computer-safe fire suppressionsystem and housed in a computer room that is constructed with fireproofmaterialsThe power supply, temperature and humidity control systems for theserver 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 availableupon request.Storing data in a medical clinic or office means that the healthcare provider oradministrator must perform backups on a daily basis and ideally store thesebackups off-site in case of fire or theft. If a backup is not performed and data in lostthere is no way to retrieve the data. With an ASP solution a user will never losemore than 24 hours of data.Internet speed and performance is too poor to run my practiceThe speed of an Internet connection as well as its connectivity is generally related to thequality of the Internet Service Provider (ISP), existing telecommunications infrastructure inplace 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 thatan ASP user follow the technology recommendations, especially the networking andhardware requirements, prescribed by their ASP vendor. Click here to view the Nightingaletechnology recommendations.Nightingale recommends that all clients have a redundant connection in case the primaryInternet connection temporarily goes down. For example, if a clinic normally connects to theInternet using Rogers then a redundant connection with Bell should be set up. The ServiceLevel 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 clickhere.Traditional ISP service is not good enoughIf a user or groups’ service requirements are not being meet by a traditional ISP provider apotential solution would be the purchase of a T1 connection. A T1 line refers to a specifictype of fiber optic telephone line that can carry more data than traditional copper telephonelines. While standard copper telephone lines can transfer data and voice at a rate of about30,000 bits per second (30 kbps) using a dial-up modem, a T1 line can transmit 1.544megabits per second, or can be used to transmit 24 digitized voice channels. A T1 connectioncan 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 willCopyright © Nightingale Informatix Corp. 2009

Nightingale White PaperDifference between ASP and LCS EMR 6depend on the distance of the loop, or the mileage between the telecom and the place ofbusiness.Currently the Smart Systems for Health Agency (SSHA) does offer free T1 connections toOntario based physicians who qualify. To learn more about the provincial governmentinitiatives click here.Hybrid server optionSome providers have asked why the industry doesn’t widely offer an EMR solution thatcombines the benefits of both an ASP and LCS solution, where the EMR runs locally and datais backed up automatically and uploaded to a remote server.Some EMR vendors do offer this solution, however, this type of setup essentially cancels outthe cost and operational efficiencies that are achieved with an ASP based EMR. The providerwould still be responsible for the maintenance and security of the local server and all of theirdata. It would also be just as difficult to transfer data between locations or providers.What if my ASP vendor ceases operationsIn the unlikely event that an ASP vendor such as Nightingale ceases operations a user andtheir data are protected. A Nightingale user would receive a full electronic data extract of allof their files and patient data which could be transferred for use with another vendor orinstalled locally on a server.In fact Nightingale users can have access to their data whenever they wish. Nightingalespecifically stipulates in its contract that it understands and agrees that it receives noownership rights to the data or records furnished by a client. All material and informationprovided by a client or related to their practice, policies or procedures, including but notlimited to patient data is designated as confidential and proprietary and therefore mustlegally remain confidential. These terms are enforced by the Personal Information Protectionand Electronic Documents Act (PIPEDA).Copyright © Nightingale Informatix Corp. 2009

Nightingale White PaperDifference between ASP and LCS EMR 7More informationIf you are interested in learning more about this topic or Nightingale products or servicesthere are several ways to contact us.Email: info@nightingale.mdPhone: 866.852.3663About NightingaleNightingale is one of the fastest growing health care service and software companies inNorth 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 communitybased electronic medical records (EMR) serving the needs of small primary care practices,multi-physician outpatient clinics, and large scale regional health organizations andnetworks. Coupled with integrated practice management, transcription and revenue cyclemanagement, Nightingale’s comprehensive service offering allows customers to enhancepatient care, increase revenue opportunities and optimize operations. Nightingale iscontinuously innovating and enhancing its services to meet the needs of its growing anddiverse customer base.Nightingale – Healthcare connected. www.nightingale.mdCopyright © Nightingale Informatix Corp. 2009