The Flaws of SaaS in Medical Practices

Software as a Service, or what is known as SaaS, has come on strong over the past few years. The concept of SaaS is that a company hosts their software application on a computer server that is attached to the Internet. The application is accessed by the customer from any other computer connected to the Internet. Many software companies focus their entire business on SaaS. Google’s Gmail is a perfect example of SaaS where a user can access their email from any computer, not knowing or caring the physical location of where their email is stored.

So how will SaaS function in the healthcare industry, specifically medical practices?

As we know, the medical industry will be moving to electronic medical records (EMR) over the next five years due to the adoption of the Stimulus Plan earlier this year which provides physicians with up to $44,000 in reimbursements over a five year period for implementing and using an EMR system. Patient records will be easily accessible by the physicians from within their medical practices, instead of having to find the patient file in the sea of manila folders.

Patient Record Size

A patient record stores a wide variety of information such as correspondence, x-rays, lab results, EKG readings, and examinations. A single visit to the doctor can generate over 10 to 15 pieces of paper (Blau, 2004). More information will be added to these files as the industry moves to EMR. The amount of information going into a patient record is not slowing down anytime soon.

In addition, much of the existing data that is stored in the patient’s file will need to scanned and attached to the patient’s electronic record. X-rays, for example, will be scanned and stored as an image, increasing the size of the patient record considerably. Any new x-rays that are taken will be received as an image and also stored int he patient’s record. Dermatologists, cosmetic surgeons, reconstructive surgeons, and plastic surgeons all use photography as part of their medical practice. Before and after photos are taken from multiple angles and distances, and are then stored within a the patient record.

Dr. Blau (2004) points out that “one patient can easily have 500 pieces of paper added to her medical chart every year.” Retrieving a patient’s record that contains hundreds of pages needs to accessed quickly in order for the doctor to find the needed information.

Medical Practice Network

Another variable is the the network capacity and reliable that is used when accessing these records. A patient’s record being accessed by a doctor in central Kansas that is stored on a SaaS server in southern California will flow through many networks and take a large number of turns before being displayed on the physician’s computer. The biggest concern here is SPEED for both the physician and the patient.

Today’s physicians are seeing more patients in a less amount of time in order to make-up revenue that has been lost due to insurance companies determining the cost of each procedure. The days of physician sitting down with the patient and understanding a complete health history are gone. The physician only has a few moments to review the next patient’s chart before entering the exam room. Physicians demand access to patient information to be quick and reliable.

Over the past few weeks, we have see Google Mail, one of the most visible SaaS systems, have a number of outages resulting in users unable to access their email for hours (Fox News, 2009). How would a medical practice handle such an outage that would result in physicians unable to access any patient information? In addition, how will patients react to sitting in the waiting room for a few minutes, then being moved to the exam room where they wait again. Then hearing that the doctor can not see them since their patient information is inaccessible.

The result for the practice will be lost revenue and the potential for lost patients.

SaaS is a very good technology for situations where a small amount of information is needed from almost anywhere. However, the client / server architecture is a much faster and more reliable design when it comes to getting access to large amounts of information, quickly. The client / server design is where a computer server that contains the medial data, is located on the premises. Users would access the information by using desktop computers, tablets, or other devices from within the medical practice.

Since patient’s medical records will continue to grow with information from from a variety of sources, physicians and medical practices need to evaluate whether a SaaS or Client / Server architected software would function better based on their situation.

Race Proffitt has a software engineering background, has been involved with a number of start-ups, and associated with various product launches. He is currently the VP of Sales & Marketing with PatientNOW, an electronic medical records and practice management software firm. He can be reached at


Blau, R. H. (2004). “One physicians journey into automation”. “ehrcentral”. Retrieved Sept. 9, 2009 from

Fox News. (2009). “Gmail outage caused by server overload, google says”. Retrieved Sept. 9, 2009 from,2933,545571,00.html?test=latestnews.

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