The Practice Administrator: My Head’s in the Cloud

An important choice you’ll make in practice management is whether to use cloud-based computing or not. Here are some thoughts on the pros and cons of cloud computing and a recent experience we had with problem resolution based on our choice.

First, what is “cloud” computing? Essentially it means you are “served” your application, whether billing, scripts, or even word processing, via the Internet. Hardware-wise, you will only need desktop or laptop computers in your office - the clients - and you won’t need to house any servers. Cloud computing evolved from Application Service Providers (ASPs), to Software as a Services (SaaS) and although there are technical differences, the presentation doesn’t differ to the end-user. As a result, many outside the technical world use the terms cloud and SaaS interchangeably. Of course the differences should be considered by end-users since they write the checks, but that’s a subject for a later blog.

First, the pros to cloud computing:

1. Staffing: As you can guess, you need far fewer staff, either internal or, if you’re small, under contract, to help manage your IT if you use the cloud application model. In my experience as an experienced IT professional, problems are a tenth of those from a client-server model.

2. Upgrades, Releases, Patches: When a new release comes out for a cloud application, upgrades are basically “painless” and happen during our normal downtime. By comparison, if you manage the server yourself, you’ll need to come in yourself during downtime to avoid any disruption in operations. In addition, everything is tested and retested by the service provider before it hits production. Finally, the only part I play in patches is to click “OK’ to a reminder before a patch comes out that night around midnight.

3. System Monitoring: It’s in the best interest of service providers to make sure our system is working the way it should.

4. $$$: Insurance expenses are less and network equipment expenses are less because there is no need to worry about storing (additional disk space) and protecting (firewalls) data on a server. My downtime is minimal and our only large requirement is for bandwidth, which is cheap; in our area the cost is about $50-100/ month for speeds of 5 Mbs to 20 Mbs.

5. Disaster Recovery and Patient Portals: We live and work in a hurricane zone and our emergency plan is far simpler with cloud computing. If a hurricane or other disaster hits, we only have laptops and desktops to worry about, no tape backups or important data on servers in our offices. If needed, we can access all our data from another computer away from the office. Having data housed by a service provider also serves our patients, who can access “our” data over their network connection.

Now, the Cloud Cons:

1. One Line Reliability: The broadband line is now a “single point of failure.” To address this, we purchased a second DSL modem from AT&T and keep it handy. A mobile broadband card also will suffice.

2. Control: Using a cloud solution means you give up a bit of control over the development and production cycle, but in most cases this is minor, but sometimes this can cause a problem.

3. Speed: Speed is reduced by perhaps milliseconds. I don’t appreciate that level of difference, luckily.

We use a cloud solution and recently I experienced an issue where we needed support with the way the system was working. If I had a client-server solution, the problem resolution process would have been the same in that the developers work to a resolution: call in the problem and they test on their systems until it works. There, the experience diverges from the cloud model, however. In cloud, the problem would be resolved at that point. Done! With client server, I would still need to test the patch on my end and go back and forth with customer support on anything that didn’t work on my system, on the phone, until resolution.

In my experience, the pros definitely outweigh the cons for cloud, particularly for smaller offices. It’s simple, cost effective, and very feasible, and your focus can remain on caring for patients and not servers or networks. And, it just makes sense.

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