Interesting discussion.
But seems to me it is all a matter of scale.
When I started with computers in medicine it was with one machine running Applesoft (1979).
Later, in a different office, it was 2 machines running Win95.
Now, it is about 8 or 9 running on SBS-Essentials.
Always small scale, always works with relatively inexpensive equipment
Now, these enterprise-level setups that Sandeep is talking about are for practices of several doctors in multiple locations, I think. I can't see what the extra investment in all that IT infrastructure would gain me in my simple setup. And I really can't understand what seems to be a dyseconomyof scale with big clinics -- the doctors can only see so many patients, and no one else is making any money (except maybe lab and x-ray) -- so all that IT overhead, along with all the administrative overhead is just more chunks taken out of the aready over-subscribed "reimbursement" -- scheduled to drop another 30% after January.
As for the cloud -- what a headache. If something stops working, it becomes a scramble to figure out whether it is your router, your internet gateway, the phone service or the cloud server. And no one will admit they are the problem.
At least for a small practice, far from a big city, dependent on DSL which is fairly reliable, the only sensible thing is in-house AC with an in-house billing program (some day, perhaps, AC will be that billing program) and UpDox for fax access.
I could wish for tighter integration with UpDox, for the "clearinghouses" to be part of AC, for the hospital to communicate directly with my office -- but it runs ok as it is.
