There are three primary systems available in the industry that will be reviewed:

  1. Server-based
  2. Web-enabled
  3. Web-based

Server-based system: (Example: Chirotouch, Rapid with ACOM, Therassist)
This is the traditional system – the program comes through a disc or is downloaded from the web and runs on your computer CPU (processor).

You will need the following in order to run these programs correctly:

  • A computer with a minimum CPU speed.
  • Specific Operating system (Windows 98 or 7, XP, Vista, or Mac compatible) that is consistent for each computer and software used. If you upgrade your OS you will need to upgrade your program software.
  • If using several computers, a joint network must be established so the computers communicate with each other. A network administrator is also needed to manage the joint network.
  • The program software and any software updates must be installed separately on each computer’s hard drive, which takes time to install on the network and perform any software updates.
  • It is also necessary to maintain a back-up of your system via USB storage, CD/DVD, or Internet storage. The company or individual is also responsible for maintaining the necessary back-ups.
  • Each computer needs data and anti-virus protection to protect your computer and the software.

The advantages of a server-based system:

  • As an older technology, the system is stable due to extensive testing and improvements.
  • There is no need for Internet access.
  • The system responds quickly.
  • Typically the doctor purchases the system up front and pays an annual fee for updates and maintenance.

Limitations of a server-based system:

  • Linking two offices on one system is difficult and often you need separate offices and program licenses.
  • You are unable to run a patient portal (via the Internet) that would allow patients to access their own password-protected account and assist in the collection of information, such as the ability to complete forms at home. With a server-based system the patient is unable to complete these forms and this inhibits the productivity of the office.
  • It is not possible to centralize appointments between two separate locations on the server. For example, the office appointment book is not visible to the doctor from their own home.
  • Likewise, the office therapist, etc. is unable to check his/her appointments outside of the office.
  • It is not possible to install any other software on your computer without first verifying that there is no potential conflict between the separate pieces of software.
  • You need high-speed computers at every station to ensure the responsiveness of the program.
  • You need to maintain a network of computers, including a network administrator.
  • The system is sensitive to virus and software conflicts when installing any new program on the computer.

Web-enabled system: (Example: Future Health with econnect)
The web-enabled system installs the program on each computer, like the server-based system.

Your computer CPU runs the program (the same restriction for the server-based system) but patient data is stored on the web, meaning that as long as the computer has the software installed:

  • You can access data from anywhere.
  • You can set appointments from anywhere.
  • Your data is automatically backed-up offsite.

Limitations of a web-enabled system:

  • The computer CPU runs the calculations and the restrictions associated with a network apply to the web-enabled system. The system requires reliable hardware, a network, and a specific OS.
  • Patient portals are not an option.
  • It is not possible to run the system using a tablet device, such as the iPad©.

Web-based system: (example: WebPT, DocuRehab)

  • There is no software to install on the computer.
  • The program “application” runs on a web browser where it is accessible from virtually any piece of hardware (desktop, laptop, tablet, smartphone) with an internet or WiFi connection.
  • The system runs similar to Facebook© and you simply need an email and password to sign in. All data is stored on the cloud and usually backed up by an array of other computers.
  • You do not need a specific OS, specific hardware, or upgrade to utilize the program.
  • Your appointments are shared with everyone authorized to access the office site information.
  • Patient portals permit patients to access their own data and complete forms from home.
  • Several offices may simultaneously use the same system, eliminating the cost of several licenses.
  • You may install (or deploy) a system via ten doctors and several clinics almost instantly (no need to install a program on every computer).
  • Your billing company is able to directly access the system via password (no need to fax billing and insurance information).
  • If you lose your cable connection, your system will run off of a 3G connection or your iPhone/iPad, thus making it virtually impossible to lose contact with your data.

Limitations of a web-based system:

  • It is a newer technology and will continue to improve.
  • It is sensitive to the speed of the internet connection, so certain rural areas without cable may have difficulty connecting to the program.

Frequently Asked Questions
What about the data if you decide to quit any of these systems?

  • For the server-based system: the data is stored in the computer and you own the program. When you need the data you can continue to open the program and retrieve patient data by exporting and importing PDF documents.
  • For the web-based system: Typically the company is provided with a “viewer” so that you can see previously entered data, even if you are not able to enter new information. Most web-based systems allow you to export patient files separately and then re-enter the information in the new system.

Most software companies are now focused on web-based applications. The advantages to this are overwhelming: greater efficiency, lower maintenance costs, and ease of implementation. It is likely that in the next few years, 90% of all systems sold, will be web-based. If you still have doubt just observe the major players in the software industry: Microsoft, Google, Adobe all have moved toward web based applications.


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