Application Service Providers
Application Service Providers |
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With the advent of the internet over the past decade, many new and exciting technologies, have been spawned including application service providers, or ASPs.
As defined by the ASP Industry Consortium an application service provider "manages and delivers application capabilities to multiple entities from data centers across a wide area network, giving customers a viable alternative to procuring and implementing complex systems themselves. In some cases, ASPs provide customers with a comprehensive alternative to building and managing internal information technology operations. ASP customers can control the total cost of technology ownership more precisely through scheduled payment schemes."
Usually the ASP charges a fee for the use of the applications that they host on their servers. They in turn provide access to their programs and applications, which can be available either on a per-transaction basis or by subscription fee. The user can then access the software service or application remotely through a browser on their own computer. The actual software program or application itself is housed remotely and is physically stored on the server or host computer remote from the user.
Examples of photographic ASPs are Ofoto, Shutterfly, Snapfish, and Yahoo Photos. These internet based image storage and processing services allow the user to upload their personal photographs to a database on the host server which can function as a virtual photo album. The user can then touch-up and photographically manipulate the images on the host’s computer through their browser, without the need for any additional photo manipulating software. The user can then direct the ASP to print hardcopies of their favorite photos and mailed then back to the user or any other recipient or alternatively, images can forwarded to others by email.
ASPs in Radiology can be found as a component of the electronic medical record (EMR), health information and management systems (HIMS), radiology information systems (RIS), picture archiving and communication systems (PACS), and in teleradiology systems. In fact, there continues to be a convergence of all of these technologies into an enterprise-wide information system whereby the ASP provides remote storage of all types of hospital-wide data including radiologic images. Market consolidation in the healthcare information technology industry reflects these trends as well. Banking on the future of electronic medical records, Siemens for example has invested $2.1 billion to purchase Shared Medical Systems (SMS), a provider of healthcare information systems and networking services. By combining Siemens’ strong market presence in PACS with the SMS installed base of clinical and administrative information systems and ASP services, Seimens expects healthcare services to grow to 50% of its revenues.
POTENTIAL BENEFITS OF AN ASP
The ASP delivery model is appealing for a variety of reasons, including theoretical cost savings. The argument in favor of ASPs focuses on the outsourcing of these applications which lower upfront capital necessary compared to locally administered PACS. There are also other cost savings associated to software and hardware upgrades which can be attributed to economies of scale. Since the software and hardware are shared remotely, all upgrades are the responsibility of the ASP, not that of the individual department. There are additional benefits to ASP customers as well. For example, for example, while purchasing, configuring, and installing an information system could take days to weeks, ASP customers can be up and running in a matter of hours. In addition, some departments are too small, or would prefer not to invest heavily into information technology or IT personnel. An ASP solution, relying on simple browser technologies would require only a broadband internet connections and PC’s and can function like a virtual PACS. ASPs are a relatively new phenomenon. The maturation of this technology can largely be attributed to progressive browser technology and the capacity of the Internet to handle large volumes of data with larger networks.
There are specific scenarios which might favor of considering an ASP solution to PACS including:
The ASP Industry Consortium publishes a list of things one should look for in an ASP of any kind (Figure 1). In general it is important to know the history, reputation and the size of the company. One should ensuring that the ASP's architecture is open, accessible, and scalable which will allow the addition of new applications when the need arises easily and without major costs. Since many ASP vendors require their clients to sign multiyear contracts, it is therefore essential to ensure that longevity, scalability, and growth are part of the company's future.
Figure 1: What to look for in an ASP (ASP Industry Consortium)
- How long has the company been operating as an ASP?
- Did the company operate in another area of the technology industry before becoming an ASP? If so, in what area? Why did it become an ASP?
- What types of technology or business partnerships has the ASP formed, if any?
- What is the technology experience and expertise of the ASP senior management team? What is the team's business experience?
- Is the ASP a global provider? Can it support the department/company's applications in multiple languages?
- How many customers does the ASP serve?
- What applications do they use?
- How long is the typical contract between the ASP and its customers?
If an ASP doesn't deliver as promised, clients can be left stranded, perhaps necessitating a switch to a different ASP. To make matters worse, it can be difficult to migrate databases from one vendor to another.
Since a major part of the ASP is service, if a healthcare facility is planning to outsource part or even all of its IT component, it is critical that it know what the provider can and cannot provide in terms of upgrades and technical support. Appropriate penalties should be built into the contract in case requirements established in the agreement are not met.
The risks clients assume in an ASP relationship make it worthwhile to construct worse-case scenarios, and include in appropriate to guarantee they'll always be protected.
While protection from technology obsolescence is a universal industry concern, it is perhaps even more pronounced in an ASP environment, where the service provider's motivation to keep equipment current through upgrades may be questionable.† Along these lines it is important to ensure that the database is in a nonproprietary format so it can be transferred from one vendor to another if necessary.
Additional concerns of the ASP client should include what safeguards the ASP offers to ensure data security and disaster recovery. The ASP must also ensure that data transmission, storage, and access of data are in compliance with HIPAA regulations.
As this industry quickly evolves, new applications emerge daily. Likewise, costs and models for pricing continue to develop. Currently, the general structure in radiology revolves around charging a set fee per study. Costs for Internet-based image management using the ASP model have a wide range depending on service and vendor:
Five-year costs for an installed PACS acquisition and distribution network, by comparison, go from $2 million for a relatively small hospital to up to $4 million for a large one. ASPs create new access points to image management for smaller imaging centers and hospitals that can't cost-justify full-fledged PACS. Costs are likely to improve however as storage costs and network infrastructure improves and most importantly when competition among ASPs drive prices down.
The ASP can be though of as a cyber-form of a PACS system, delivering the highest quality of medical imaging on a pay-as-you-go basis. One of the hottest topics among PACS climatologists is the emergence of ASPs as an alternative for hospitals hesitating to purchase PACS because of economic concerns. Under this financial umbrella, ASP vendors maintain most of the PACS hardware and software at central locations, relieving customers of the bother and expense of supporting a PACS themselves.
The forecast is mostly clear. Many see ASPs as the answer to the challenges facing healthcare in a cost-constrained environment, where facilities are expected to accomplish more while spending less. It is generally conceded that by eliminating film and switching to PACS, radiology departments can reduce operating budgets by 20% or more.
FREQUENTLY ASKED QUESTIONS
ABOUT APPLICATION SERVICE PROVIDERS (ASPs)
(Diagnostic Imaging, Virtual Symposium on ASPs in Radiology, Oct 16-20
2000)
What are ASPs?
Application service providers are companies that rent software
functionality over the Internet or a private network.
In radiology, ASP models based on Web technology are being used to support image storage (temporary or long-term) and distribution (either local or wide area), among diagnostic facilities, or between radiologists and referring physicians.
What are some of the benefits of
ASPs?
For radiologists, the key benefit of Web-based ASP
models is the ability to focus on the core business (diagnostic image
generation and interpretation) while outsourcing nonclinical work such
as image storage, retrieval, and distribution.
ASPs bring the power of PACS technology to hospitals and practices that might not otherwise be able to afford it, while providing the same image storage and management capability as hardware-installed PACS. Costs are usually levied on a monthly or transaction basis, or a combination of the two.
Who maintains and supports the ASP
network?
The vendor assumes responsibility for integration,
network maintenance, upgrades, and support. With an ASP setup, vendors
are motivated to help users upgrade to the latest version of software
and hardware on a regular basis. This is one of the biggest benefits of
ASP models, since it places the burden of avoiding equipment
obsolescence on vendors instead of end users.
What are some other benefits of
ASPs?
Cost shifting is one benefit. Cost for an Internet-based
image management system such as an ASP can be shifted to the operations
budget of the imaging center or department, freeing up funds from the
equipment budget. ASPs can make the decision between buying a new MRI
machine or installing an onsite PACS-ASP solution easier.
Which vendors offer ASP capability?
Nearly every major modality and PACS vendor now offers some sort of
ASP model for image distribution, storage, and backup. It should be
noted that relatively few vendors have the technology installed at user
sites, however. A partial list of ASP vendors includes:
How are radiology practices using ASP
applications?
The most common ASP application in use today in
radiology is off-site storage of noncritical images, accessible by the
practice as needed. Some practices are also using ASPs for local
distribution of images among diagnostic imaging facilities. Depending on
the vendor, radiologists can also provide access to images for viewing
by referring physicians, who log on to the vendor's central server.
What are the primary drawbacks of
ASPs?
The biggest drawback at this time is wide-area
distribution of images among radiology departments and facilities.
Existing barriers to wide-area distribution include lack of affordable
high-bandwidth connections, the impact of high compression ratios on
image quality, and the ability of offsite data management facilities
with multiple applications and customers to handle high-volume
traffic.
For example, a typical radiology department with a PACS generates between 2 and 4 GB of image data daily; the figure increases if access to reports is also required.
In addition, if film-based operations within a hospital or practice continue, the cost of image management only doubles when radiologists add an ASP solution. Yet it's not clear whether ASP systems will be reliable enough or fast enough to replace film in all circumstances.
As a result, many imaging facilities are initially considering ASPs not for image management or distribution, but as the best way to securely store noncritical data offsite.
What kinds of questions should I ask a
vendor about ASP services?
Radiology practices and departments
need to determine exactly which services are covered under the ASP
contract (image storage, distribution, management) and how per-use costs
are tabulated. Requests for proposals should include inspection of
operations at a live site.
Make sure the contract is flexible and can be adjusted if the pricing scheme proves to be too much for the value of the application. Many agreements are based on the percentage of desired uptime. In addition, make sure the contract includes an exit plan in the case the application is discontinued or the company folds. Establish a single point of contact at the company to confirm the ASP application's performance on a regular basis.
What are some futuristic applications for
ASPs?
The ability to create large image repositories,
representing millions of images from academic sites around the world,
and accessible by any radiologist with a question about a disease state
or image representation, is just one of the many future applications of
ASP technology.
Such a reference tool could provide powerful data mining capability, and revolutionize practice by bringing true interactivity to the radiologist's desktop. Works in progress include the ability to link online content with just-in-time tools to enhance image interpretation.
Other projects based on ASP models could revolutionize education and research, such as electronic teaching files featuring multimedia technology that emulate real-world radiology case presentations.
Where else can I go for information about ASPs?
ASP Industry Consortium http://www.aspindustry.org/
The ASP Industry News http://www.aspindustry.com/
Diagnostic Imaging has carried a number of articles on ASPs and are accessable online:
Copyright © 2004 American Society of Neuroradiology, www.asnr.org