Examples of Cloud-based platforms are Facebook, Google, Linkedin and so forth. To use any of these you need to open your browser, type their domain name i.e. facebook.com and then log into it to start using the software.

So it implies you need an internet connection in order to be able to use a Cloud-based system.

Desktop systems on the other hand are those that are installed on a local computer or a laptop. In order to access it, you simply go to your desktop and click on the icon. Internet connection is not necessary.

Desktop systems were popular early on as internet connectivity was not reliable, and cloud technologies could not match up in terms of speed and feature set as compared to desktop solutions.

However all of that has changed now, with broadband as well as internet connectivity on mobile i.e. 2G, 3G (and soon 4G too, thanks to the largest startup in the world Reliance JIO) are easily available. Internet is quite stable and very affordable. Cloud technologies have also evolved considerably and there is nothing now that you cannot do on the cloud that you can do on the desktop. In fact, there is a lot of stuff you can do on the Cloud that you cannot do on the desktop anymore.

Let us go over the disadvantages of using a Desktop Solution

1. Database License and Limits
Most desktop solutions use free versions of the back-end database. A database is a software that actually stores all the data you have entered into a software. Free databases come with limits to their size. Once your total database size hits that mark, you will be faced with a very, very stiff bill. The limit is usually a large number (10 Gigabytes for SQL Server 2012 Express), but what is a large number for a clinic with 2 users may not be so large for a Clinic with 10+ users. DICOM Imaging, Videos, before and after High-resolution images, geospatial data, and aggregation from multiple devices into a single data store are rapid advancements in technology that are hurtling your clinics closer to such limits. As technology progresses, so do such caps on the database size. However, the point of concern is the lack of transparency. Most vendors do not mention such limits in their product literature, and Doctors are left in the dark. Next time when presented with a quote, specifically, ask

• Which database do you use?
• Is it a free one?
• What is the database size limit?
• How much does it cost to upgrade to the next edition?

 

On the Cloud, however, databases are always commercial grade, so nothing is free. Therefore it is built into the price you are being asked to pay from Day 1. No surprises at any point. Cloud vendors too may have a size limit, however, such limits can be typically raised by paying a negligible charge. Storage costs on the cloud are a fraction of what they used it be and still dropping.

 

2. Hardware Costs
Desktop Solutions comprise 2 parts
2a. Server – there is 1 designated computer on which the desktop solution along with the database it needs, gets installed. This computer is typically of a higher configuration, as all of the desktop clients will be connecting to it to access the database. This is called the Desktop Server.

2b. Client – For every computer from which you want to use the software, you need to install a Desktop Client. Both Desktop Servers and Clients come with recommended hardware specifications from the software vendor. You are required to ensure that you purchase the necessary hardware.

Hardware is an add-on cost, which is not relevant for Cloud-based solutions, which typically run off any browser-based device. There is no add-on hardware or associated cost of maintenance of that hardware, or the need to upgrade it periodically.

 

3. Maintenance Overheads
With a desktop solution, maintenance is your responsibility. You must backup your database periodically to ensure in case of a hardware failure, you have a database backup you can restore data from. You must make sure the backup is on an external hard disk or computer and not the same one which is running your desktop software. This is to avoid the risk of hardware failure. If your backup and your software are both on the same computer and the hard disk fails, despite having taken backups you will still end up with data loss.

You need to ensure you have the necessary protection of a firewall and antivirus to protect your clinic network from viruses and malware. You must have usage policies in place to avoid a user in your network from infecting a computer and thereby the entire network, by navigating to sites and installing programs. You must build hardware redundancies and upgrade your hardware in a phased-out manner, to reduce the risks of hardware failures.

In the event that there is an adverse event, you should have the technical skillset at call who can restore systems from a backup and get your Clinic back up and running in a few hours. Phew! You really think you can do all of this?

Cloud frees you from all such responsibilities. Failures in hardware are completely transparent to you. Backups, firewalls, virus protection, or any other new threat that comes about is the headache of those offering you the Cloud service. You focus on what you are best at – managing your Patients. This compartmentalizing of work and then a delegation of the same to those who are experts at it, is what lead to the birth of outsourcing. It is cost-efficient, and as Thomas Friedman said, it made our world flat.

 

4. Be Left Behind
New trends in the healthcare technology field are moving towards data aggregation (from multiple sources) and data access (across multiple devices). Let me explain with a couple of examples

• Online appointment booking – For it to work, your schedule needs to be available in real-time, online, so that as appointments are being booked by your receptionist in the clinic, your availability online is simultaneously reflected to the Patients coming to your website to book appointments with you. With Cloud, this is easy, but if your data is locked in a desktop server in your clinic, how will others access it?
• Patient Portals – You use an EMR in your Clinic, have recorded years of consults on it, but it is like the locked underground nuclear silo of the cold war era, accessible to no one but you. Should you want to share this with your patients, how will you do it on a desktop server? Desktop solutions do not come with a Patient Portal. More on that in later chapters. Cloud-based current systems make this a breeze again.

 

Disadvantages of Cloud-Based Clinic Management System

So much for desktop. There are 3 arguments that typically go against Cloud-based solutions.

1. Recurring subscription price you need to pay every month.
   I know of a lot of Doctors who are averse to this. They rather pay once and be done with it. However, do remember, even with a desktop solution, you are required to pay anywhere from 20-50% AMC (Annual Maintenance Contract, that guarantees you access to new version upgrades and support). However, let us think this through, as once you have paid all you needed to, to a software vendor, and the service or software is not up to the mark, what are your options? What leverage do you have left over him after having made your single one-time payment? On a Cloud-based subscription model, the vendor needs you as much as you need them.Moreover, with reduced maintenance overheads, avoidance of hardware costs, and availability of commercial-grade databases, typically Cloud solution will cost you 33% of what a desktop solution will cost you over a 5-year period.

 

2. Security is an issue on the Internet, as I have some high-profile clients
   Desktop solutions are more secure, whereas things on the internet can get hacked. This is the most common misconception I come across and nothing can be further from the truth. Let’s say you are on a desktop software –
   – Have you blocked DVD write and USB access ports on your computer which run your Desktop Server to prevent staff from downloading the entire patient list?
   – Have you set up a firewall to prevent access to sites like mailbigfile.com using which someone can compress your entire database and upload it to his email id?
   – Do you have someone maintaining security at your clinic’s network, and ensuring all the computers are up to date with the latest security patches and anti-virus software?
   – Do you have physical safeguards in place for the room housing your desktop server to prevent unauthorized access to it?
   – Do you keep your database and its backup encrypted, to ensure that even if someone does manage to copy it, they cannot read it?You may answer, well it is just me and my staff at the clinic, but then you can have staff attrition, or new staff. All it needs is one person to test your security perimeter to realize there is none.Share your concern on security with your software vendor and they can address it logically with facts. Just because you are not on the internet does not make you safe, in fact, more than likely, your server is connected to the wifi which does have you online. Only the lack of knowledge gives you a sense of comfort and a false one for that matter.

 

3. Internet Connection is always required
   It is required during your business hours. If you are worried that the internet is really unstable, then take a secondary backup connection. If so, opt for a different ISP and different medium i.e. if the first connection is wired broadband, for the 2^nd use a wifi dongle. Or just enable 3G/4G on your mobile, as it too can act as a router if you use a smartphone. This really is more of a mindset of fear than reality, as I personally now have dealt with clients in Lagos – Nigeria, Kampala – Uganda, Nairobi – Kenya, Kigali – Rwanda, distant places where too, in spite of far worse infrastructure than India, the internet has not to lead to 1 day of downtime in the last 3 years.

 

Summary

In conclusion, if you have a reasonable internet connection, you must opt for a cloud-based clinic management system.

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