In a web based system the EMR vendor has created a website that functions as an EMR. The web server is owned and operated by the vendor. To access the site you use a web browser. (Internet Explorer, Firefox, Chrome, etc.). The web browser knows nothing about the application so the web server is responsible for receiving the request from the browser, building the resulting web page and sending it all back to the browser to be displayed. This results in a lot of data flowing between the browser and the web server.
The diagram below shows how this is structured. Note that many of the Web Vendors clients share the same server and internet connection.
Client Server Based
In a Client-Server based system you have a very similar architecture. Just swap out the Web Server for an Application Server and the Web Browser for a Client Application. In this scenario the server typically belongs to you and you have full control over the server and the data stored on the server. Modern client server systems are fully internet capable. This means that you can install the client software on any computer, go anywhere in the world, and access your data at your office. This can all be done without having to use terminal server or one of the many different remote access solutions that are available. The most familiar example to a modern Client Server based system would be Apple iTunes. You install the iTunes application on your computer and it talks to the Apple App / Music Store Server on internet.
One of the advantages to the client server environment is that the client software has full understanding of the data model. The client can talk to the server and the server can send back just the data since all of the screens, buttons, graphics, business logic etc. are built into the client. The client has the full power of the computer and isn’t restricted by the limitations of the web browser.
In a modern client server system the client software will automatically update when the server updates eliminating one of the so called advantages to web based software.
A diagram of a typical multi-clinic practice operating a client server based system can be seen below:
Hosted Client Server
A hosted client server is a hybrid between Web Based and Client-Server based systems. In this environment we take responsibility for your server software and install it on one of our servers. You install the client software on your computer and it talks to our server. We take responsibility for doing backups and keeping your system up to date.
With Clinic Controller you can migrate to or from the Hosted Client-Server at any time. If you start with our Client-Server system and want to migrate to a hosted environment we can copy your data to our server and we will take over from there. Conversely if you are in a hosted environment and want to bring it in house we will install the server software on your server and copy the data from our server to yours. This leads to another point, data ownership.
Odds are right now, based on the fact that you are here reading this document, you are in the process of looking for new practice management software. If you are currently on a web based system you have to be asking yourself, “How do I continue to access my past medical records as required by law?”
In a client server based system you have the software and would continue to run your server and have access to your data. In a hosted client server based system you would migrate your server in house and possibly run everything off just one computer since it will be used just for record access.
Under a web based system your options are limited. Most web based vendors will charge you to continue to access their system. This can go on for 7 to 10 years or in the case of pediatrics up to 18 years from the time you quit using their system. Many web based vendors have an export option where they will give you a CD/DVD or Hard Drive with all of your data on it. However; they typically have no way of giving you any way to read this data since the program used to read the data is actually the web server application to which you would no longer have access. In the end you do have your data, but it is thousands of PDF files and excel spread sheets with no way to query or report on this data.
One of the key features that the industry preaches regarding Web Based system is that you do not have to worry about updates. This is not true on several fronts. Firstly, with Clinic Controller’s Client-Server model all updates are handled automatically when a client logs into the server. We have removed the headache of having to update each client computer manually. The second fallacy in this argument is that even with a web browser you should be regularly updating your system to keep up with the latest Microsoft Widows Security Updates, as well as Security Updates for Internet Explorer, Chrome, or Firefox.
The final limitation to the typical Web Based system is the lack of customization that can be offered to the end user. With all of the clients typically accessing one massive system the ability to customize for each client is very difficult if not impossible in most cases.