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    der would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the

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    Software as a Service (SaaS) is the new generation of ASP model designed to reduce the exorbitant costs of specialized medical practice management software. SaaS model is available for all aspects of medical practice management, including scheduling, billing, and electronic medical records (EMR), which are mission-critical for high quality clinical service, business operations, and regulatory compliance. SaaS model extends the advantages of Application Service Provider (ASP) model, which in turn evolves from the traditional Client-Server model. This article briefly defines key concepts and outlines a set of guidelines for SaaS vendor selection.

    Client-Server (CS) Model

    CS model involves central servers for database and application logic and multiple client modules connected to the central servers via local area network. This architecture allows allocation of significant application logic on the client computer.

    Applications architects considering CS model must weigh performance and security advantages against increased maintenance costs. CS benefits stem from local control of application logic and data. CS shortcomings too stem from localizing logic and data because local arrangement requires the user to take responsibility over application maintenance, including data security, redundancy, disaster recovery, upgrades, backups, etc.

    The medical practice utilizing CS model must develop in-house expertise and manage numerous services, including

    1. Internet connectivity, bandwidth, and routers
    2. Servers for Web server software, email, and firewalls
    3. Database management
    4. Data feed management
    5. Capacity management
    6. Redundancy management
    7. Application upgrade management

    Financially, CS models require the software user to make significant upfront investment in hardware and licensing and justify the business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

    Application Service Provider (ASP) Model

    ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the

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    lection.

    Client-Server (CS) Model

    CS model involves central servers for database and application logic and multiple client modules connected to the central servers via local area network. This architecture allows allocation of significant application logic on the client computer.

    Applications architects considering CS model must weigh performance and security advantages against increased maintenance costs. CS benefits stem from local control of application logic and data. CS shortcomings too stem from localizing logic and data because local arrangement requires the user to take responsibility over application maintenance, including data security, redundancy, disaster recovery, upgrades, backups, etc.

    The medical practice utilizing CS model must develop in-house expertise and manage numerous services, including

    1. Internet connectivity, bandwidth, and routers
    2. Servers for Web server software, email, and firewalls
    3. Database management
    4. Data feed management
    5. Capacity management
    6. Redundancy management
    7. Application upgrade management

    Financially, CS models require the software user to make significant upfront investment in hardware and licensing and justify the business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

    Application Service Provider (ASP) Model

    ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the

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    maintenance, including data security, redundancy, disaster recovery, upgrades, backups, etc.

    The medical practice utilizing CS model must develop in-house expertise and manage numerous services, including

    1. Internet connectivity, bandwidth, and routers
    2. Servers for Web server software, email, and firewalls
    3. Database management
    4. Data feed management
    5. Capacity management
    6. Redundancy management
    7. Application upgrade management

    Financially, CS models require the software user to make significant upfront investment in hardware and licensing and justify the business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

    Application Service Provider (ASP) Model

    ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the

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    business case using ROI-based arguments, which make little sense because of software and hardware innovation pace.

    Application Service Provider (ASP) Model

    ASP model shields the medical practice from high cost of specialized software and data maintenance responsibilities but not from upfront investment in hardware and in software licenses. Early ASP applications were created from traditional CS applications by moving centralized data and application servers to a third-party hosting service provider and allowing access to the application via HTML user interface as an afterthought. The third-party hosting service provider would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the

    Crap I Hate My Co-Workers
    Attitude - Some days work sucks! But to a person that needs an attitude adjustment every day makes it that much worse, so much that you wonder if he/she made the right choice in careers. I am a strong believer in trying to limit the amount of negative things you say out in the open especially around clients. If you are always complaining, whining and criticizing something or some one, it is simple you are sucking the life out of people and making yourself a chore for anyone to be around. If you have that many things to be in a negative puddle about get a therapist or enlist the advice of a friend on your personal time. Clients, co-workers and bosses don’t need to hear about your unraveling personal life they have things of thei
    der would take the responsibility for application maintenance and data protection.

    The medical practice using early ASP model manages two costs:

    1. Licensing and monthly support fee to software vendor
    2. Software hosting fee to hosting vendor (typically a "pay-as-you-use model")

    Software as a Service (SaaS) Model

    SaaS model extends ASP benefits from outsourcing of system maintenance to simplified financial responsibilities. SaaS vendors eliminate the upfront costs to medical practice by making the upfront investment in hardware and licensing on behalf of all medical practices using the application.

    To make such a financial commitment, the hosting vendor must develop thorough expertise in application maintenance and new feature development. Such a requirement became feasible with recent technology progress in terms of security (128-bit SSL encryption) and browser-based client performance along with AJAX coding methodology. The new generation technology now compensates for earlier CS model deficiencies and justifies network-native SaaS software development by design.

    Because of higher specialization, SaaS vendor is able to focus on client business requirements, resulting in more responsive service and higher client satisfaction.

    SaaS Vendor Selection

    Medical practice in search of SaaS vendor must focus on the following topics:

    1. Functionality: Does the application deliver all required functionality? Have you documented functional requirements subject to practice business goals, including financial, practice workflow and personnel objectives? Have you considered integrated practice management functionality including patient scheduling, SOAP notes, and billing?

    2. Training Plan: Will the vendor provide sufficient training? What drives the training process: practice workflow changes or available software functionality?

    3. Third-Party Application Interface: Does the application work with existing applications already deployed in the office? What data exchange requirements must be satisfied if you decide to purchase another application later?

    4. Performance: How do you measure application and service performance? Are formal performance metrics available continuously?

    5. HIPAA Compliance: What controls are in place to enable access only on a "need to see" basis? Is every access instance logged using secure mechanism?

    6. Service Level Agreement: What minimum service levels does the vendor guarantee to the client? What are the penalties for violating SLA?

    7. Problem Resolution: Is there a formal process to communicate problem identification and resolution? How is it tracked?

    8. Data Access and Ownership: Who owns the data? Keep in mind that according to HIPAA, the patient is the ultimate owner of health data. How secure and private is the connection? Does it have Role based Access Control (RBAC)?

    9. Disaster Recovery: How long would it take to recover from a disaster? Is a secondary data ce

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