The Software as a Service (SaaS) model of deploying software has come of age and is gaining traction in medical practices. Physicians are adopting this Internet-centric model to offload the burden of servermaintenance and data backup, while expanding access to their system and provide their staff with an intuitive user interface. While some physicians might remain skeptical of new technology and question a third-party’s ability to safeguard patient data, many of the early challenges with SaaS have been overcome.

To assess the SaaS model, it is important to first understand what it is and how it differs from traditional software deployment models. Most physician practices have heard of SaaS or “web-based” software, but few understand the details of how a SaaS system differs from a traditional client/server system or the hybrid web-enabled model. Moreover, while many people use SaaS and web-based interchangeably, there is even a subtle difference between those terms.

What is a SaaS system?
SaaS refers to a type of software deployment in which all of the system’s software and data is hosted and managed at a central data center operated by the software vendor. The physician practice simply uses the system through their web browsers and a broadband Internet connection. The practice will typically pay a monthly subscription fee to use the service, rather than purchase the software up front. Examples of SaaS software products include AdvancedMD, OfficeEMR and Waiting Room Solutions.

Then what does web-based mean?
While SaaS and web-based have pretty much become synonymous, a subtle difference can be drawn. Some systems are web-based in that users access the system through a web browser; however, the server that hosts the system is maintained in, and by, the medical practice (i.e. “on-premise”). Some providers - typically very large groups - prefer this model. In this scenario, “web-based” refers to the software architecture - the system’s design - rather than the deployment model. InteGreat is an example of a system with a web-based architecture that is installed on-premise by larger group practices.

Examples of web-based systems include:

OfficeEMR is a fully-integrated, web-based electronic medical record and practice management system.

CollaborateMD features an exclusive claim tracking and claim control system, allowing physicians to completely oversee and reduce claim denials.

Sevocity EHR is an Internet-based solutions that supports physician practices of all specialties.

What is client/server?
The alternative to SaaS or a web-based system is the traditional standard of client/server, on-premise software. The vast majority of practice management and EMR systems remain client/server systems. In this model, software is installed on the server and on each computer in the office. The server hardware is located in the medical office and is accessed on the PCs used by physicians and their staff. Typically the software is purchased up front and there is an annual support fee to cover upgrades and customer support services. Leading products like Greenway’s PrimeSuite 2007, iMedica PRM and Practice Partner are all client/server systems.

Examples of client/server systems include:

Q.D. Clinical EMR is a comprehensive EMR that comes with hundreds of templates, macros and phrases that each user can customize.

MedEZ features modules specially designed for doctors, billing companies, behavioral health facilities, rehabilitation racilities, specialty hospitals, and correctional facility medical offices.

A.I.med is a an electronic medical record and practice management system designed with the small to medium sized practice in mind.

What is a web-enabled system?

Web-enabled refers to a hybrid model in which a traditional client/server system is augmented with an added feature that allows users to connect to the system over the Internet using tools such as Citrix or a special browser-based user interface. This web-enabled option might be used as a way for the physician to access the system from home or the hospital. Alternatively, some practices choose to use the web-enabled model to offload server maintenance to a third-party hosting company. Most client/server systems provide a web-enabled option.

Examples of web-enabled systems include:

iMedica is a power web-enabled EMR and PM solution that allows for on-the-fly customizations without IT staff intervention.

Practice Partner is a CCHIT certified EHR featuring single screen progress note entry to eliminate extra clicks and unnecessary navigation.

FreeDOM is the only client/server system engineered for use over the internet, supporting all the advantages of the SaaS model without the limitations of a browser.

What are the advantages of a SaaS system?

• Limited IT burden. A key reason why many practices choose the SaaS model is that their data is secured at a centralized location and monitored by IT staff that handle routine back-ups, upgrades, modifications, installations and necessary maintenance. The security and maintenance is typically far superior to what a practice could implement in their own office. Moreover, there’s no need to buy server hardware.

• Ease-of-use. SaaS and web-based systems are often easier to use. Since the user interface is essentially a web page, the user experience is often on par with making a purchase online. If you’ve successfully made a purchase on Amazon.com or eBay, you can probably figure out how to use a SaaS or a web-based EMR or a practice management system fairly easily.

• Remote access. Many physicians appreciate the ability to access their EMR or practice management system from outside the office. This might be while doing rounds at the hospital or updating records in the evening at home. With a SaaS system, users can access their system from anywhere they have Internet access.

• Subscription pricing. Practices often like the subscription model of SaaS. Subscription pricing means that the upfront costs are low as the fees spread out over time. Thus, these expenses become an operational expense versus a capital expenditure.

When is SaaS not right for a practice?
While the SaaS model is very compelling, here are some of the reasons we hear when practices choose not to select a SaaS system.

• Poor Internet access. With the SaaS model, it is important to have a quality Internet service provider (ISP) that is optimized for speed and has dependable bandwidth. If the Internet goes down, the system is down. Of course, on-premise systems can go down too when there are networking, electrical or hardware failures.

• Complex customization. Because SaaS systems are typically designed to serve numerous practices from a single, centralized “code base,” there have traditionally been fewer options for complex customization. This, of course, is changing over time as SaaS vendors build out more advanced configuration capabilities.

• Fewer vendors. While there are hundreds of EMR and practice management systems, very few of them are SaaS. The SaaS model is still relatively young and so only a few innovative firms have come to market with feature-complete, dependable SaaS solutions. Many of the leading specialty-specific systems remain client/server.

• Long-term pricing parity. While the subscription pricing model reduces up-front costs, those regular fees add up over time. In the long-run, SaaS fees will typically equate to those paid up front for a perpetual license for a client/server system.

Is SaaS right for your practice? We encourage medical software buyers to consider at least one SaaS product in their “short list” of systems. While SaaS won’t work for every practice, the benefits are compelling enough to merit serious consideration.