04/14/2016
A Brief Overview: The prohibitive startup costs of an electronic healthcare record system
can be a substantial barrier for a healthcare facility. In addition, physical space needed for
the equipment that comprises a client-server system is not always available in facilities still
bogged down and occupied by reams of paper files.
Starting with a cloud-based system offers a practical solution to meet the above
challenges. A cloud-based system with its inherently low startup cost minimizes the need for
separate servers and in addition allows a gradual migration to an electronic record. A later
conversion to a server system would be an option as space for equipment is cleared in the
current paper chart storage area upon migration to a predominantly electronic record, as the
amount of storage needed for paper charts decreases. A vendor that offers both the option of
client-server or cloud based systems would be worth considering.
Component
Example:
Database Server
Current System
Two redundant
database servers
Application Server
Billing only.
Planned System
Could be upgraded
later as noted
above.
Upgrade would be
to the 4D Web
Application Server.
Rationale/Explanation
Current database
system is capable of
handling the traffic
for the planned
system, but requires
more memory to hold
all the patient
records.
As the conversion to
EHR progresses, and
space in the area
currently occupied by
paper records is freed
up, this can be
addressed if it is
decided to change to a
client-server system.
4D Web is great for
web/services client.
Accessible on Cloud;
practitioners can get
information off site.
It runs on Windows
and Macs. Size can
be customized to a
facilitys needs.
Web Server
Staff Workstations
None. Currently
with cable Internet
access ((Windows 7
/ server IIS 7.5.)
with WiFi available
to staff and
patients.
Front/back office
desktop
workstations
Start with a
minimal one, for
the purposes stated
in rationale, then
upgrade to
Windows IIS 10.
if converting to
client-server system
Simple desktop in
each exam room.
Front/back office
workstations with
web access
Desktop
workstations.
Desktop
workstations.
Physician
Workstations
Printers, fax,
copier, scanner,
hub, WiFi router
Peripheral Devices
Software
Application(s)
Printers front/back
office. Either
separate fax/copier
or a single device
that serves as both.
Scanners to scan
outside hard copy
records to interface
with patients EHR,
hub, WiFi router
their demographic
and history
information prior to
their initial
appointment.
LAN
Network
clinic, receive
messages from us,
and schedule
appointments. A web
link e-mailed to new
patients would allow
them to fill in
demographic and
history information
prior to their initial
appointment and save
time for them and
staff.
Cloud backup would
allow the clinic to
continue to operate in
the event of a system
crash if converting to
a client-server system.
Off-site access portal
for staff would allow
access to patient
records without
having to come to the
office after hours or
weekends for on-call
person. .