The two most widely used platforms for practice management and electronic records software is ASP (Application Service Provider) or Locally Hosted or Client Server.

Software that utilizes an ASP platform are sometimes referred to as On Demand Software or SaaS (Software as a Service). You may hear the term SaaS so we will give you a brief overview of this as well.

Software as a Service (SaaS, typically pronounced ‘sass’) is a model of software deployment whereby a provider licenses an application to customers for use as a service on demand. SaaS software vendors may host the application on their own web servers or download the application to the consumer device, disabling it after use or after the on-demand contract expires.

The other option is for clients to host the software on their internal server and purchase the licenses outright. This requires substantial capital and an internal IT department that can constantly stay on top of maintaining the server. Servers are typically out of date within 3-4 years so this model is only for those clients that can afford to update and repair the internal network.

With an ASP, the EMR application, the database (where all the patient data is stored), and computer responsible for running it (called a server) all reside in a central location outside the physician’s office, and are maintained by the EMR vendor or other third party. Clinicians and staff use a secure log-in over the Internet to access the EMR — not unlike the way they would access a secure banking site (although ASPs offer much tighter security). In contrast, with a client-server EMR system, the practice purchases and maintains the server locally.

Functionality

In terms of functionality, ASPs work pretty much the same as the traditional client-server system. In fact, most of the leading EMR vendors offer you the choice of either ASP or a client-server.(Eclipsys and AdvancedMD have both of these options)

ASP systems don’t eliminate all of your hardware chores (you still have to take care of printers, scanners, and workstations), they do allow you to outsource the care and repair of the all-important server to IT professionals. This can be a significant time and money saver which is one reason for the sharp increase in ASP systems out there. EMR software updates (which can be really challenging for a client-server) are done by the ASP and included as part of the monthly service charge. The ASP also is responsible for doing nightly backups of your patient data — a crucial function that is done poorly (if at all) by small practices maintaining their own systems. And with an ASP, since you don’t need an EMR server, which is typically the most expensive piece of hardware in an EMR system, you don’t have to worry about the cost and hassle of replacing it when it runs out of steam every three to four years.

Hospitals have figured out that ASPs are easier to support so almost without exception, those that are offering EMRs to their local docs (as part of the Stark Law provision) are only offering them via ASP.

Financial

However, from a financial perspective, ASPs and client-servers are quite different. With a client-server, one purchases a perpetual license to the software, much like you do when you buy a copy of QuickBooks. Assuming that you finance the EMR, after the payments are done, your remaining financial obligation to the vendor is your annual support payment, which typically covers new updates and help desk support. Annual support fees range from 18 percent to 20 percent of the retail cost of the software.

In contrast, with an ASP, there is no upfront cost for the software. You pay a monthly fee, just like the fees you pay to get DSL or cable Internet access. And like DSL and cable, you pay the monthly ASP fees as long as you are using the service. The fees range from $350 to $750 per provider, per month. In addition, many vendors recommend purchasing either a full or fraction T-1 line to ensure a reliable, high bandwidth connection to the Internet. This can run another $500 or more, per month, depending on the size of the practice and the number of workstations.

The ASP fee is inclusive, covering help-desk support, software upgrades, daily database backups and any server maintenance. Training and implementation costs — which are typically one-time fees — are not usually included in the monthly fee for an ASP. Our preferred contracts give us ability to utilize an ASP model but we actually own the license after 3-5 years. This is an exclusive agreement that we have in place which makes it feasible for us to offer the licensing for free so long as they utilize our billing service.

What’s the Bottom Line?

Which is better? Well, like most things in life, it all depends. From our perspective we feel that the ASP vs. client-server decision primarily revolves around how much IT support a practice is willing to take on. For practices that have the wherewithal and staff to maintain a server, do the backups religiously, attend to the details of technical troubleshooting, and managing complex software upgrades, a client-server is a great choice — and sometimes can be less expensive in the long run. But, if the tasks described above are daunting or terrifying, then ASP is a better choice for your practice. PWO recommends the ASP model to our clients because we have found that even if a client has the wherewithal to handle these things, it is still does not prove to be financially advantageous.