Cloud or local server based Software? Tips4EyeDocs Daily – 24 Jan 2012 -.No. 34

There is little argument that a variety of business,  governmental and even professional organizations are rallying together for the wholesale adoption of electronic medical records software (“EMR”) by providers of many disciplines.  The dust has settled somewhat and two architectures have arisen to fight for top billing.  This installment of Tips4EyeDocs, is a brief overview of cloud and local server based software  architecture for the eye market.

The most signicant difference between the two architectures is the location of the processing servers. In a cloud,  the servers are housed in a “farm” away from the end user customer. In the local, the servers are located at the end user’s actual location

Data centers are physically secure and are locked. No one without proper authorization can enter. They are also thoughtfully located in areas with ample electricity and space and housed in temperature-controlled rooms.  Most local servers are not physically secure and often share a room where other activities occur. Many times, they are located in a back office without regard to adequate ventilation or temperature conditions

Adding a user to a cloud application is relatively easy; even more so if it is the 100th one. The servers and software configurations  are standardized so that one configuration will work with most, if not all, clients.   In contrast, a local application usually requires an onsite visit to install.  Computers  are probably different than those in the data center and vary with each end user. Every installation becomes unique without the benefit of economies of scale.

A cloud application is easy to upgrade. There are no CDs or software to download and all users are upgraded at the same time. Customer service easier because every is theoretically on the same version.  A local application allows a user to skip upgrades making customer service difficult because a user may have an older versions.

Two choke points of cloud applications are their dependence upon a good internet connection and simultaneous failure. Both are not usually so critical for local servers.

Internet connection is a foregone conclusion for most businesses but they can vary greatly across the country.  Bandwidth is important because transactions are performed on the internet. Adequate bandwidth, howev cannot be guaranteed to be equal for all users with some users experiencing better performance than others. In fact, uptime (the time duration that the internet is working) may be different simply because of network infrastructure or traffic.

Cloud applications fail like any other piece of software. Failures occur either by serendipity or by human error or mischief.   Regardless,  a failure in the application can affect all users at the same time.  Application slowdown is also a failure. If internet traffic is exceptionally high due to a hacker, then it impacts all users.

In summary I like cloud applications.  They lessen my anxiety or concern for physical security, is available outside of the office from any computer and generally performs as fast as a local server application.  For the individual doctor, a cloud application makes a lot of sense. While it may not be the perfect solution or have the exact features or have the same sense if ownership as a local server application,  overall it is a good  alternative to the local server application.

About Richard Hom OD, MPA

Dr. Hom holds Doctor of Optometry and Masters in Public Administration degrees and practices family eye care and consults on public policy, health information technology and program evaluation.
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4 Responses to Cloud or local server based Software? Tips4EyeDocs Daily – 24 Jan 2012 -.No. 34

  1. Richard, I’d like to pitch in on your cloud-based comments. I agree that things are moving to the cloud and that this is a good direction. But the cloud can become the fog. Cloud-based systems, even if they’re new, can take the limitations of old EMR systems and simply move them to the cloud. Old systems moved paper to computers, exchanging paper work for computer work … slightly better but not much of an improvement. Cloud-based is a delivery method not a guarantee of the fundamental software change needed in today’s EHRs for the transformation of healthcare. If cloud-based software still simply records results in data entry fields and slows the doctor down in the exam lane, it’ll still kill the business. The big thing in eye care that cloud-based systems don’t admit very well is their limitations around instrument linking. That’s huge for ECPs, a major time factor that again speaks to the survivability of the business at a time when doctors need to see more patients in less time and for less money.

    • Alistair,

      Thanks for the comment.

      I agree that Cloud is a delivery mechanism. However, it is a delivery mechanism that places some kind of requirements on the architecture of the application. But agreed that an application on a local server based model can be delivered by a cloud. In that circumstance, though, it is simply a virtual session host like VNC or GoToMyPC.

      Good point about instrument integration. This is a weak point for all software because as of this time, there is only the beginning of a single standard. While there may be DICOM or HL7 standards, these are layers that software talk to. Since a piece of software may not share the same meta data design as another, they need some fudging to really make information sharing seamless.

      The challenge will be whether the buzz word of “cloud” application will completely capture the imagination of the market place and force all vendors to play in that sand box. Undoubtedly, there may be a signficant proportion of eye care customers who may not or cannot participate in this regard because of the practice environment they operate in.

  2. Bruce says:

    I have conducted end-user research on the cloud vs. hosted tradeoffs. The cloud-based approach is only going to get better, and will eventually overcome most hurdles, like instrument integration pointed out above. The real advantage to a health care practitioner, especially those in small practices, is that the cloud approach frees up his or her time to focus on patients, not IT issues. Upgrades are made continuously and sometimes invisibly, and you do not need a local resource (i.e., employee or Geek Squad) to resolve software problems. From a patient perspective, EHR’s stored on the cloud have a real potential for convenience; they can be (someday) conveniently accessed by any of his/her HCP’s, anywhere, leading to quicker and better diagnosis and treatment. The question is how soon can all this happen and impact mass audiences in a positive way.

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