I just responded to a comment posted to Linked-In at this link. The comment began:
Health care IT is moving from desktop application to complex multi-faceted Enterprise systems. The OS, wireless devices, and databases are much more sophisticated than even a few years ago. Enterprise security takes a skill set that is not readily available in much of the health care industry. Staff HIT most likely will not have the expertise to harden these systems. The needed skills very with system(s) and network. As the HIE rolls out, security will become more complex. But in saying that, many non technical requirement can be covered today with written policies and enforcement.I replied:
Better yet ... Stick with desktop applications that exchange patient data via secure email using innovative decentralized peer-to-peer cyberarchitectures. See, for example, http://curinghealthcare.blogspot.com/2009/09/novel-way-to-exchange-patient-health.htmlTo which the commenter responded:
Stephen, Interesting but I see desktop apps such as Microsoft Excel are giving way to Cloud computing. Desktops app no longer make financial sense from a maintenance standpoint.I then replied with the following:
A federated system is a great way to exchange data but we will have to see what HITSP, (for one) comes up with.
While desktop apps are becoming Cloud enabled (which can be a good thing in certain circumstance), I do not see desktop apps ever being replaced by the Cloud for many reasons. There are distinct pros and cons of each depending on the situation and use case. For example, accessing and processing data from local storage using local computer resources (as opposed to the cloud) has many benefits, including the following:
Also see, for example: http://www.slate.com/id/2188015/, http://www.itbusinessedge.com/cm/blogs/byron/in-cloud-computing-vs-desktop-its-the-data-stupid/?cs=31286, http://www.filterjoe.com/2009/05/29/the-desktop-or-the-cloud/, and http://www.inquisitr.com/26717/the-cloud-vs-the-desktop-an-irrelevant-argument/
- Since there are concerns about the security of data stored in the Internet cloud [Reference1, Reference2, Reference3], people may feel more secure if they have complete control over their private information (such as personal health information), which is stored in encrypted data files in their own computers and other computerized devices.
- Total cost of ownership is minimized since there is no need to rely on expensive central servers, databases, and server administrators. Also, there are times when the cloud is more expensive than alternatives (Reference1, Reference2, Reference3).
- Performance is greatly increased when performing complex, intensive computations since all data processing is done quickly and easily using local computer resources, rather than waiting for a strained central server, or paying for an expensive racks of servers. However, when massive computations from hugh centralized databases must be done, for which a local PC is inadequate, cloud and grid-cloud computing may serve an important function (although grid computing alone may surfice). [Reference]
- All the information can be accessed anywhere/anytime, even if there is no Internet or other network connections.
- Unlike communications requiring continuous connectivity, there is no loss of data when a network connection drops out (i.e., unexpected disconnection) [Reference]
- A node-to-node network [e.g., a mesh node network] is more robust. In web-based networks, a central server breakdown may cause the entire network to shut down and prevent anyone from exchanging data. In the node network, however, a malfunction in one or even many individual computers may have little or no effect on the network as a whole since functioning nodes can still communicate with each other. In other words, there is no single point of failure to disrupt and entire network when a central server develops problems.
- Since copies of the encrypted data files can be stored in many different locations (i.e., widely distributed), information survivability is enhanced in the face of terrorism and natural disasters.
- And following are key advantages and disadvantages of web versus standalone applications:
- Web applications are easily accessibility because they can be easily accessed from any computer or location that has Internet access. With a standalone, the computer must have the application installed. On the other hand, once the standalone application is installed, it is accessible anywhere/anytime, even when there is no adequate Internet connection; Web applications, however, typically rely on persistent and unmanaged Internet connections, or else the data are inaccessible.
- Maintenance and forced upgrades are lower because with web applications when a company must manage hundreds or thousands of desktop computers, although this has become less of a problem with improvement in automated desktop updates. On hosted systems, furthermore, users are at the mercy of the host; so, if an upgrade does not go well, or the individual user doesn't want or need the new features, the upgrade will still go forward.
- Over the life of the software use, web applications are typically significantly more expensive over time because desktop applications are purchased outright and there are rarely recurring fees for the software use (except for possible maintenance fees or fee based upgrades associated with them). Many corporate web applications, however, charge users monthly service fees (i.e., "subscription fees") to operate the software. [Reference]
- Web applications relying on the Internet to transfer data, rather than a using a computer's local hard drive, may operate slower. The speed may also vary depending on number of users accessing the application (i.e., network traffic). Standalone applications have no such constraints; the application will operate as fast as the person's computer power allows.
- When using a web application that is hosted by a third party, privacy policies should be in place to prevent that data from being used by the web host. This is not an issue with standalone applications.[Reference]
- Multiple desktop applications can be integrate and used, enabling a model's functionality to be enhanced by other software programs. This cannot be done securely using a web-browser.[Reference]
- "Because all computation is done on the computer that the application is running [offline], the amount of data transmitted over the internet is reduced…In the case of web based application the data is passed back and forth between the client and the server each time a new calculation is to be done. If many clients are connected to the server at the same time this leads to allot of processing on the server and the power of the clients is not used."[Reference]
- While standalone applications may be the platform dependent (e.g., can only operate on Windows computers), it is possible to build platform neutral applications that avoid this constraint.
And I don't understand your claim that "desktops app no longer make financial sense from a maintenance standpoint." After all, as mentioned above, with the automated update methods now built into many desktop apps (including MS Office), maintenance is easy, reliable and free, so I don't understand your claim that "desktops app no longer make financial sense from a maintenance standpoint."The debate continues as this link.
We do agree, however, that a federated system is a great way to exchange data within and between healthcare organizations, as well as between them and between individual clinician and small practices. It would be foolish for HITSP or other standards bodies to eliminate email (SMTP) transport as a viable means of health data exchange, because it is a simple, low-cost and secure method everyone understands.
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