Types of EHRs: Desktop vs Web


Previous posts have discussed advantages of EHRs made specifically for behavioral health vs generic EHRs made for the entire medical profession and also, the differences between EHRs with a shared chart model vs those without. This post addresses another important issue to consider when choosing an EHR: whether to choose a desktop app or a web app.

Definitions

A desktop app “lives” on your computer. This means that you either purchased a CD or downloaded the program from the web. Either way, at some point you had to actually install the program on your computer. If you installed it on your office computer, you won’t be able to use it on your tablet or your home computer. You’d have to install separate applications on each device you plan to use.

In contrast, web apps “live” on the web. You access them with your web browser which means you can use them on any computer. Web applications are sometimes referred to as “on-demand” software or “SaaS” (Software as a Service). These terms imply that the software is a “service” on the web that you can access when you need it. Typically with these types of apps, you sign up via your web browser and start using them right away.

Pros & Cons

There is a growing trend away from desktop apps toward web apps. Many well-known applications that used to be available only as desktop apps are now on the web – some of them, exclusively so. Examples are Microsoft Office, Quicken, and the Adobe products. There are numerous reasons for this:

  • With desktop apps, there may be compatibility issues with your computer. For example, the program may have been written only for Windows or only for Mac. Or perhaps it only works on a version of Windows that is not what you’re running on your computer.
  • When an application lives on your computer, if your computer crashes, you’ve not only lost your computer, you’ve lost all of your client data unless you’ve been diligent about backing it up. Even if you’ve made daily back-ups on another device, if the computer with your program crashes, you no longer have a way to open the backups.
  • If your computer is stolen, you have the above issues and also a potential HIPAA breech because confidential client data is now in the hands of unauthorized individuals.
  • When there are bug fixes and/or upgrades to a desktop app, you have to download patches or, in some cases, buy an entirely new version of the product. Since making and releasing patches is sort of a big deal, developers of desktop apps tend to let fixes accumulate until they have enough to warrant releasing a patch. This means that bugs can go unfixed for weeks or months until the next patch is released. In contrast, web developers are able to constantly make improvements and fixes in their products because it all takes place behind the scenes. There’s never anything for you to download and install.

But What About . . .

When I talk to colleagues about the desktop vs web issue, there are two reservations I sometimes hear about web apps:

  • Some people feel that desktop apps are cheaper, i.e., a big one-time purchase as opposed to monthly subscription fees.
  • Many people have concerns about the safety of the web – they’re more comfortable with the thought of keeping client data on their own machines instead of “out there” somewhere that they can’t physically touch or see.

For the “desktop apps are cheaper” question, my answer would be “possibly”. It’s unrealistic to assume that your desktop app will be a one-time purchase because as the field changes, applications need to change. Over the course of your career, even if you stay with one company, you’ll more than likely have to buy a new version of the software at least every few years. Also, many companies are now requiring fairly lengthy and expensive service contracts for you to receive any type of support at all. This tends to be true more with desktop apps, whereas most web applications offer free support. When you add the price of the service contract with the price of the application, the price of desktop apps is probably in the same ballpark as a subscription to a web application.

The second issue – safety concerns about the web – requires a thorough explanation so will be covered in a separate post.