This is the second guest post by Bill Horvath II describing the pros and cons of thin clients with an EMR. Also, take a look at his first entry discussing the pros and cons of laptops with an EMR.
An office which chooses this approach will typically have one thin client terminal in each exam room, as well as in each physician’s office, and at stations occupied by non-mobile staff who need access to computerized records. The terminals are typically managed or ‘driven’ by a server, which provides applications, data storage, and administrative control over the whole system. Remote access to charts is usually provided via application server software.
- Easy To Use – Thin clients don’t have to be carried or pushed from room to room, and don’t require recharging. Some manufacturers also use smartcards or other technologies to offer location-independent desktop sessions, whereby the desktop session virtually ‘follows’ the doctor from room to room, eliminating the hassle of logging out and logging in at each station, or of figuring out how the last person to use the computer left it. Many thin clients can go from off to fully ready to use in 15 seconds or less, and because they have no moving parts, they are silent when operating. And because data storage is centralized, a complete backup strategy is straightforward.
- Inexpensive – A fully-furnished thin client (with monitor, mouse, keyboard, and cabling) can be purchased at a price starting around $650, depending on the makes and models of the components. Spare parts are inexpensive to keep in inventory, and individual parts can be replaced in the event of failure. Because they are highly reliable (and their capabilities are usually determined by the central server which administers the network), they can remain functional for 7 years or longer.
- Reliable – Modern thin clients have no moving parts, making them exceptionally resistant to normal wear-and-tear. Since they aren’t typically moved by the doctor, they’re less likely to be broken through an accidental drop or collision.
- Trivial to Replace – Since thin clients are usually controlled and configured by am administrative server, it’s trivially easy to replace one in the unlikely event of a failure. In such cases, replacement of the device is simply a matter of unplugging cables from the old unit and plugging them into the new one.
- Energy Efficient – Because they have no moving parts, thin clients use very little electrical power. Around 5-15 watts or less is common, even when operating at full capacity.
- Highly Secure – Thin clients, by definition, have no local data storage, meaning it’s impossible to lose data by way of theft or equipment failure, and a bad actor can’t use a stolen device to extort money or expose private or embarrassing information. Some thin client manufacturers also provide two-factor authentication built into their products, which precludes access to the system entirely without an alternate means of identification, such as a smart card. Under these circumstances, the thin client won’t even present a password request (or other user interface) without the required token. It is also easy to physically lock a thin client in place to prevent theft.
- Unlimited Scalability and Upgrade Capabilities – The capabilities of some manufacturers’ thin clients are completely determined by the managing servers, which means the maximum number and processing power of the thin clients in any particular installation are limited only by the capabilities of the controlling server. To allow for more simultaneous users or more complex applications, only the servers need to be upgraded or replaced; the thin clients can remain unchanged.
- Automatic Firmware Updates – Many thin client manufacturers provide software in their thin client server package which automatically keeps the firmware of the thin clients up-to-date.
- Expensive Back End – A thin client installation with an administrative server will almost always be more expensive at the point of purchase than a set of laptops, especially if the laptops are deployed without an administrative server.
- Single Point of Failure – If the server which provides administrative control to the thin clients fails, all of the thin clients may be down until the server is brought back up. Exposure to this risk can be mitigated by using redundant servers, which themselves feature redundant systems (power supplies, memory, processors, etc.), however it can’t be entirely eliminated.
- Everyone is Subject to Each Others’ Usage Patterns – The performance of thin client’s desktop sessions can be adversely affected by what other users on the system are doing. Someone watching online videos, for example, may occupy significant processing power and bandwidth, which can drag down the performance of other user’s sessions. This problem can be alleviated by upgrading the administrative server, but doing so engenders additional costs.
- Limited Peripheral Support – Thin clients may have limited support for attachable peripherals, such as USB storage or printers. (This will mostly depend on the operating system of the administrative server.)
- Geographically Grounded – Because they aren’t mobile, a thin client terminal is needed for each location in the office at which a computer is desirable. Power and network access are needed at each such location, which may require the installation of additional wiring.
- Limited OS Options – Most thin clients come with a Linux desktop as a default option, as this doesn’t force any additional licensing costs. Presenting a Windows-based desktop to thin client users currently requires Windows Server, Windows Client Access Licenses, and Windows Terminal Services licenses, each of which costs extra. Furthermore, Apple does not currently offer a suitably efficient protocol for serving an OSX desktop to a thin client.
- Server Requires Physical Security – The administrative server must be physically secured from theft, accidental damage, and power loss. In addition, such servers are typically noisy, meaning placement in a closet, mechanical room, or soundproof rack is usually highly desirable, but may require additional wiring or other expenses.
Bill Horvath II is the CXO of DoX Systems, a company which offers medical office productivity solutions to physicians in private practice. Their flagship product is DoxCIS, an electronic medical records system.