Client/server: where are we really? - impacts of client/server technology on the healthcare industry

Health Management Technology, May, 1995 by Greg Anderson, Brad Armstrong

Deployment of Client/Server technology is gaining momentum in most industries, including healthcare. In the last 24 months, several major healthcare players have incorporated client/server architectures into the center of their information strategies. They have embraced client/server as the new computing paradigm and are scheduled to migrate mission-critical administrative and clinical systems to client/server architectures over the next several years.

For these healthcare organizations, the client/server vision is set. Many pilots have been completed. However, a major question remains: Can these client/server pilots expand into the enterprise systems that are envisioned to support the next generation of healthcare financing and delivery?

The vision

Health plans, physician groups and hospitals are consolidating and forming alliances to provide an entire spectrum of low-cost, quality healthcare. As these consolidations and alliances emerge, patients are forced to navigate a maze of health plans, administrative departments, physicians and clinics that each have distinct information, policies, procedures and processes. Similarly, healthcare executives are frustrated by multiple incompatible, inefficient patient accounting, care management and insurance systems.

Tomorrow's healthcare winners will be those who reengineer administrative and clinical processes and related systems across health plans, physician groups, hospitals and other providers to provide a continuum of effective healthcare. Because of its promise of flexibility, integration and functionality, client/server technology should play a key role in enabling the industry's transformation.

What does the future hold? Electronic medical records, 24-hour member & patient services as well as administrative and clinical decision-support systems are a few of the strategic applications on the drawing board.

The future

* Imagine a system that integrates data from health plans, physicians and hospital systems to produce realtime customer information. With this information, service representatives respond to inquiries, initiate transactions and correspond with patients to provide a complete range of member and patient services.

* Imagine comprehensive patient information across the continuum of care that is accessible to caregivers when and where they need it. With flexible graphical user interfaces, medical professionals receive information the form each prefers.

* Imagine a decision-support application that accesses and relates multidimensional data - members, patients, health plans, demographics, clinical activities, outcomes - accessed from divergent databases.

* Imagine work-flow applications that control work flows through the healthcare enterprise, streamlining the way caregivers and administrators perform daily tasks.

Although widespread implementation of these applications is still in the future, business and technology foundations are being laid today.

The client/server

technology foundation

In reengineering projects, healthcare players are transforming stand-alone administrative and clinical activities into integrated processes. To aid this transition, client/server technology and applications are expected to rejuvenate, replace and integrate dozens of disparate and redundant databases and applications. In one example, a managed-care organization is scheduled to replace 30 mainframe-based applications with a new administrative client/server system.

How does client/server

make tomorrow possible?

1. With front-end intelligent workstations and back-end integration servers (e.g., HL7), client/server can integrate health plan, hospital, physician and medical-services systems into enterprise applications.

2. Robust desktop computing environments can enable more advanced knowledge-worker applications.

3. The modular nature of client/server architecture allows for incremental approaches to development and

How does this work? First, it is important to define two concepts: client/server and distributed computing Because vendors broadly apply these terms, the role and benefits of each are often confused and incorrectly applied. The following defines their proper roles an benefits.

Client/server

Client/server is an application design concept. An application is broken into two components. One part of the application, the server, provides data or services when asked. The receiving component of the application, the client, receives data or services for its own local use.

Applications can change roles, sometimes acting as a server and at other times acting as a client. For example, a database application may provide data to a PC spreadsheet (the database application is the server, the spreadsheet is the client). A few minutes later, the database application may extract data from a mainframe-based application (the database is the client, the mainframe application is the server).

Client/server designs are often referred to as two-tier or three-tier designs. Our earlier example illustrates each. When the database application serves data to the spreadsheet, it is a two-tier design (spreadsheet/database). If the database also retrieves data from a mainframe application, it is a three-tier design (spreadsheet/database/mainframe application).