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

The following strategies are currently being implemented by MIS departments in major healthcare organizations. Strategy choices are not necessarily made for technical reasons. Many decisions are based on an organization's ability and willingness to absorb risk. Decision factors include organization size, MIS skills, available time and financial resources.

One: application packages

Client/server application packages provide a safe starting point for MIS organizations and users. MIS can get its feet wet with the basics, such as network management, PC-configuration management and distributed-systems management. Users can discover the power of new graphical designs before custom development projects are attempted.

Vendor packages can be rich with features that users need and want. If vendor designs are proven in high-volume environments, architectural performance risks are significantly reduced. The drawback is that until standards mature vendors will depend heavily on proprietary solutions for middleware. Because middleware is the means by which clients connect to servers and servers connect to legacy systems, a flexible and enduring strategy is critical. When selecting packages, make sure to understand what lies between the tiers of the proposed client/server architecture.

Two: custom development

Custom development of mission-critical applications is a strategy pursued by large healthcare organizations that are willing and able to accept the inherent risk. These organizations cite competitive advantage as the primary benefit of developing custom solutions. These players have relatively few choices, due to their size, their enterprisewide architecture objectives and limited offerings from leading software providers.

Systems integrators are included in these multimillion dollar projects to reduce risk and time frames. Projects are managed jointly so that expertise can be transferred to MIS. Fully outsourced developments are rare because expertise transfer is critical to long-term success.

In a few cases, ownership and marketing arrangements have been struck between the organization and integrator. These arrangements can offset the organization's cost. In exchange, the integrator is allowed to resell basic application components. In other cases, customers resist these arrangements because they view their application design and architecture as a strategic advantage in the marketplace.

The risk is designing custom applications and distributed computing architectures that perform on the first try.

Three: surround and layer

Many organizations are layering client/server applications on top of existing systems. This sandwich approach is popular when results are required within limited time frames. It is used when there is immediate demand for:

* an integrating architecture to support a newly integrated administrative or clinical process, and

* a common presentation and sign-on for all applications.

On the front end, workflow applications facilitate work processes spanning many applications. On the back end, data warehousing and data-navigation applications are commonly used to collect, cleanse and convert data from disparate databases.