Browser-Based vs. Client-Server EMRs: Productivity is King

Last week’s blog evoked some spirited comments, to which I will respond collectively. I encourage you to keep this conversation going by continuing to share your thoughts on this clearly hot topic.

First, let me clarify some terminology, so that we are all on the same page. Some responses to last week’s post confused browser-based applications with hosted ones. Any application can be hosted—the server can reside anywhere. However, software that runs by opening a browser (like Internet Explorer) and going to a website cannot possibly deliver the speed and crispness afforded by software installed on a PC.

There is no question that there are some advantages to browser-based applications, as was pointed out by readers. A few of these are indisputable, while others are debatable, but the overarching issue is the two models’ very different effects on physician productivity. Rather than debate the merits and drawbacks of the various alternatives, I refer anyone interested to “The Evolution of the Productivity-Focused EMR User Interface,” a white paper that explores those issues and suggests ways to overcome the respective drawbacks.

No matter how you balance the arguments in favor of one approach or the other, the fact remains: there is an undeniable difference in impact on physician productivity. This is something EMR vendors do not want to discuss and Wall Streeters do not take into account, but physicians need to consider it carefully. I’ve talked about productivity many times because of its critical importance to high-performance physicians, particularly high-volume specialists. (See the EMR Straight Talk posts on healthcare reform and government incentives.) A 30-second productivity differential per patient visit can allow a 3-physician practice to generate an incremental $700,000 in patient revenue over 5 years. For a 30-physician practice, the incremental difference climbs to $7 million.* This impact dwarfs the IT-related savings delivered by browser-based applications.

* These results use the Productivity Calculator to estimate the value of 30 seconds for each physician, assuming: 125 exams/week; 24 exam-room hours/week; 47 weeks worked/year; and revenues of $1.1 million/year.

2 thoughts on “Browser-Based vs. Client-Server EMRs: Productivity is King

  1. I think everyone can agree that any EMR is going to decrease productivity to varying degrees, worse so in higher volume clinics. The biggest risk to any offsite cloud computing or subscription model is that you are physically removed from ownership of the data and risks involving loss of ownership or control of that information.

    It is (as I’ve argued) overly simplistic analysis that make estimates of productivity hits with 30 second blocks merely multiplied by time to come up with a figure. A clinical encounter and flow just does not function in such blocks of time, and capturing 30 seconds here or there is not an additive phenomena for more office visits. There surely is some incremental savings with some time block saved with efficiency (1 minute, 5 minutes, etc….), I’ve just never met anyone who would believe 30 seconds would be the sweet spot. OTOH, I suspect an EMR like yours would save MUCH more then 30 seconds per encounter based on my prior experience with other systems.

    Keep up the great blog!

  2. I tend to disagree with Mr. Oliver about the time saved. if a emr/epm is implemented correctly it will increase productivity. However, it has to be done in a manner in which the clinical process within the clinic has to be changed. This has to be done through customizable hpi, cp, and vitals (depending upon the specialty). Then there has to be a definitive work flow: meaning the process has to evolve such that the physician does as little data entry as possible.
    Ok, now in the real world does this really happen?

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