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.

Which Is Best: Client-Server EMR or Web-Based EMR?

Three things initially attract people to web-based EMRs over client-server EMRs: they are easier to deploy and upgrade, demand less IT support, and require less hardware. While it is true that web-based deployment and upgrades are easier, client-server technology actually delivers far superior benefits and long-term cost savings on the second two criteria.

For a start, the IT support argument ignores the significant trade-off between physicians’ time and IT staff time. Physician productivity is a crucial part of any practice’s bottom line, which amplifies the limitations imposed by EMRs whose architecture relies on the Internet. Anyone who’s compared the speed and performance of PC-installed Outlook with Outlook’s Web mail accessed through Internet Explorer knows that client-server software affords a richer, crisper user interface that outperforms browser- or web-based software in terms of the number of clicks and the ease of use. Gaining just 30 seconds of productivity per exam with a fast and robust client-server solution can generate an additional $50,000 per year or more for high-volume specialists.

Internet lag/latency can also be very costly, particularly during the “Internet Rush Hour” when millions of teenagers come home from school to play online games, view YouTube videos, and communicate with each other on Facebook. This may result, over the course of a typical patient exam, in repeated several-second delays between the physician’s web-based EMR and the server where the patient’s data exists, increasing the time it takes to pull up patient information, make a prescription, retrieve a document, or display an image. These protracted, productivity-sapping delays can have a significant impact on revenue.

When it comes to hardware, web-based vendors tout their cost savings by claiming that all you need is a computer with an Internet connection to be up and running. This is not quite true—like all client-server offerings, a web-based EMR requires exam-room PCs, tablets, and laptops, as well as computers at the nursing stations, a wireless networking infrastructure, and a Windows server to manage logins and network security. In fact, the only difference in hardware between the two solutions is that the client-server solution needs an in-house, plain-vanilla Microsoft Windows server, which costs just a few hundred dollars per year per physician when amortized over the life of the server. In contrast, practices using web-based EMRs must absorb the frequently exorbitant fees that are built into the subscription model to cover the cost of the web-based company’s sophisticated data center. Over the long term, a client-server offering often costs far less than a web-based subscription offering, and a well-designed client-server EMR always delivers productivity-enhancing benefits that save physicians both time and money—something they sorely need in an era of lower reimbursements and higher patient volumes.