Thick client vs Thin client

HIS/EMR applications have evolved from modular systems existing at departmental levels. Integrated HIS/EMR applications came up when the thought process evolved to entrprise level. Integrated HIS/EMR may have a single database at the backend or extreme modular design where each modulae has a separate database.

Obviously the front-end UI has also evolved in the same way. Mostly its an extreme modular design where each module has a separate UI. Some HIS/EMR offer an integrated UI and others even allow integrating thrid party applications under their portals. We have very few examples of Monolithic design with single database at backend and single front-end UI and shared services in the business layer.

All these systems were designed for client-server environment to work within an enterprise. The need for looking at the healthcare data from outside the enterprise wasnt felt till internet became prevalent and healthcare professionals started using mobile platforms too.
Thick clients do a wonderful job in Client-server environment, Where the front-end is rich in personalisation features and offers extra security in terms of allowing a user to login only from his/her desktop. The response time for data intensive applications is very good since its located within the enterprise and bandwidth isnt an issue unless concurrent users exceed the planned load.

However Thin client concept came with the internet paradigm where people wanted to look at everything through the 'Single Window' browser. Thin client within the enterprise works in the same way as a Thick client. Personalisation, CRM, security feautures etc have been pushed to the middle business layers of the application.

Now due to the eveolution of thought, healthcare professionals started demanding the availability of Thin client over a browser from anywhere outside the enterprise as well. This raises some pertinent issues such as security, turn-around time, data throughput. Large data intensive work slows down the response time e.g. hitting the database often for CPOE or getting the medical images. This is a challenge outside the enterprise, due to limited bandwidth. Some solutions are available, but there isnt a perfect solution yet.

Thin client thought process gets even more difficult to put in reality when you want to put it onto the small screen of mobiles and PDAs. Again there is some success but lot is left to achieve.

An extreme case of Thin client is to host the entire HIS/EMR on a central server and offer it as a service to clinicians and hospitals. However this model requires a lot of bandwidth and good security to be built into the system. Also the clinicians and hospitals have to trust the system for safe keeping of their data. From a business stand point this reduces to capex of the hospital or clinicians and they pay only as per use. The capex burden is shifted to the application service provider.

Revenue Cycle Management - Hype

As per me Revenue cycle management is another hype created by general purpose MBA consultants who have no idea about Healthcare. Its another hype just like HIPAA.

Healthcare system is focused on clinical, lab, rad operational issues. The IT and Consulting budget of a hospital cant be more than 10% of the total outlay; this mostly falls short for the core IT issues such as HIS/EMR/EHRS and clinical, lab, rad operational issues. Who has the budget for Revenue cycle management? Besides RCM doesn't make sense in Healthcare at all, because of the nature of the business.

How can you control the number of consumables used by the surgeon? Should he be counting the consumables or counting the minutes he has to get the patient back? Even the most experienced cardiac surgeon can't accurately predict the length of stent required in stent angioplasty. Even the most experienced orthopedic surgeon cant accurately predict the number of holes plate required for surgical reduction of bone fracture. So who pays for the stents or plates that were opened but not used/wasted in the surgery? Till date there is no way to exactly predict Disease outbreaks, then how can you ever predict the required medications? When you cant predict the variables, then how can you strictly monitor the cost and manage the revenue cycle?

How can you make surgeons use the most economical material and not allow him to decide his best way of doing surgery? Innovation in healthcare happens in the doctors office and surgeons theatre, and not in a lab environment like other industries.

I can go on with examples of why RCM doesn't make any sense in healthcare. But I feel its high time the generalist MBA consultants realize that Healthcare is different. Its time for Healthcare professionals to stop listening to generalist MBA consultants who bring ideas from other industries and then blindly try to force it on Healthcare.

Bottom line, you cant control something that you cant predict. Therefore dont apply the revenue cycle management techniques blindly taken from services, FMCG or manufacturing business.