**A. Hosting Options**

+------------+-------------+---------------------+--------------------+
| **Hosting  | **De        | **Pros**            | **Cons**           |
| Options**  | scription** |                     |                    |
+------------+-------------+---------------------+--------------------+
| **A        | Practice    | -   Lower start-up  | -   Continuous     |
| pplication | leases      |     costs for       |     "lease" costs  |
| Service    | software,   |     physicians      |                    |
| Provider   | hardware,   |                     | -   Less direct    |
| (ASP) --   | related     | -   Shortened       |     control        |
| Hosted by  | network,    |     implementations |                    |
| the        | and         |                     | -   Less control   |
| Vendor**   | maintenance | -   Shared          |     of network     |
|            | services    |     personnel costs |                    |
|            | from the    |                     | -   Locked in to   |
|            | software    | -   Less upkeep     |     multi-year     |
|            | vendor.     |     burdens         |     service        |
|            | Vendor in   |                     |     contract       |
|            | turn takes  | -   Better clinical |                    |
|            | full        |     integration     | -   Could result   |
|            | res         |     amongst         |     in loss of     |
|            | ponsibility |     practices       |     connection to  |
|            | for support |                     |     remote         |
|            | of the      | -   Centralized     |     services       |
|            | server,     |     management of   |                    |
|            | backup of   |     upgrades and    | -   One of         |
|            | data,       |     enhancements    |     thousands in   |
|            | security,   |                     |     priority cues  |
|            | etc.        | -   Improved        |                    |
|            |             |     security        | -   Less security  |
|            |             |                     |     between        |
|            |             | -   Ensures         |     individual     |
|            |             |     regular, secure |     clinical data  |
|            |             |     backups         |     sets           |
|            |             |                     |                    |
|            |             | -   Less HIPAA      | > The software     |
|            |             |     compliance      | > vendor may be in |
|            |             |     burden          | > another state    |
|            |             |                     | > far away.        |
|            |             | -   Monthly fee has | >                  |
|            |             |     positive tax    | > The stability of |
|            |             |     effect          | > the vendor and   |
|            |             |                     | > ability to get a |
|            |             | -   Provides update | > copy of your     |
|            |             |     of local        | > data may be more |
|            |             |     hardware        | > difficult.       |
|            |             |     dependant upon  |                    |
|            |             |     lease structure |                    |
|            |             |                     |                    |
|            |             | > The software      |                    |
|            |             | > vendor tends to   |                    |
|            |             | > have a greater    |                    |
|            |             | > degree of         |                    |
|            |             | > redundancy and    |                    |
|            |             | > disaster recovery |                    |
|            |             | > options.          |                    |
+------------+-------------+---------------------+--------------------+
| **A        | Practice    | -   Lower start-up  | -   Continuous     |
| pplication | leases      |     costs           |     "lease" costs  |
| Service    | software,   |                     |                    |
| Provider   | hardware,   | -   Short           | -   Less direct    |
| (ASP) --   | related     |     implementations |     control        |
| Hosted by  | network,    |                     |                    |
| a Local    | and         | -   Reduced         | -   Less control   |
| Hospital   | maintenance |     personnel costs |     of network     |
| or         | services    |                     |                    |
| orga       | from a      | -   Less upkeep     | -   Locked in to   |
| nization** | local       |     burdens         |     multi-year     |
|            | hospital or |                     |                    |
|            | sponsor     | -   Improved        | -   service        |
|            | or          |     security        |     contract       |
|            | ganization. |                     |                    |
|            | The local   | -   Less HIPAA      | -   Could result   |
|            | sponsor in  |     compliance      |     in loss of     |
|            | turn takes  |     burden          |     connection to  |
|            | full        |                     |     remote         |
|            | res         | -   Ensures         |     services       |
|            | ponsibility |     regular, secure |                    |
|            | for support |     backups         | -   Less security  |
|            | of the      |                     |     between        |
|            | server,     | -   Better clinical |     individual     |
|            | backup of   |     integration     |     clinical data  |
|            | data,       |     amongst         |     sets           |
|            | security,   |     practices       |                    |
|            | etc.        |                     | -   The hospital   |
|            |             | -   Centralized     |     or local       |
|            |             |     management of   |     organization   |
|            |             |     upgrades and    |     may not have   |
|            |             |     services        |     the right      |
|            |             |                     |     resources to   |
|            |             | -   Local oversight |     adequately     |
|            |             |     and 1^st^ level |     provide the    |
|            |             |     support         |     necessary data |
|            |             |                     |     protection,    |
|            |             | -   Monthly fees    |     security,      |
|            |             |     have positive   |     backup, and    |
|            |             |     tax effect      |     disaster       |
|            |             |                     |     recovery       |
|            |             | -   Provides update |     environment    |
|            |             |     of hardware     |     needed to      |
|            |             |     dependant upon  |     protect the    |
|            |             |     lease structure |     data.          |
|            |             |                     |                    |
|            |             | -   Less            | -   Local host     |
|            |             |     integration and |     responsible    |
|            |             |     interfacing     |     for a 7x24     |
|            |             |     needed          |     help desk.     |
|            |             |                     |                    |
|            |             | > The hospital or   |                    |
|            |             | > organization can  |                    |
|            |             | > provide better    |                    |
|            |             | > local service and |                    |
|            |             | > support through   |                    |
|            |             | > its relationship  |                    |
|            |             | > and integration   |                    |
|            |             | > with the hospital |                    |
|            |             | > information       |                    |
|            |             | > system.           |                    |
|            |             | >                   |                    |
|            |             | > Physicians' data  |                    |
|            |             | > is stored         |                    |
|            |             | > locally, and each |                    |
|            |             | > physician can see |                    |
|            |             | > and physically go |                    |
|            |             | > to the local data |                    |
|            |             | > center to verify  |                    |
|            |             | > the data center   |                    |
|            |             | > environment.      |                    |
+------------+-------------+---------------------+--------------------+
| **On-site  | Practice    | -   Direct control  | -   Higher         |
| Hosting at | purchases   |     of systems      |     start-up costs |
| P          | hardware,   |                     |                    |
| hysician's | software    | -   Lower on-going  | -   Higher IT      |
| office.**  | and         |     maintenance     |     support costs  |
|            | licensing   |     fees            |                    |
|            | rights.     |                     | -   Greater HIPAA  |
|            | Hires IT    | -   Reduce reliance |     burden         |
|            | employees   |     on external     |                    |
|            | or          |     sources         | -   Longer         |
|            | contractors |                     |     implementation |
|            | to          | -   No downtime due |     timeline       |
|            | configure   |     to connectivity |                    |
|            | and         |                     | -   More IT        |
|            | maintain    | -   Better          |     support needed |
|            | EMR system. |     individual      |     at local       |
|            |             |     security        |     facilities     |
|            |             |                     |                    |
|            |             | > The physician has | -   Less clinical  |
|            |             | > full autonomy of  |     integration    |
|            |             | > the data, access, |                    |
|            |             | > security, and can | -   More           |
|            |             | > set standards for |     maintenance of |
|            |             | > the data.         |     individual     |
|            |             |                     |     system         |
|            |             |                     |     components     |
|            |             |                     |                    |
|            |             |                     | -   Less           |
|            |             |                     |                    |
|            |             |                     |    standardization |
|            |             |                     |                    |
|            |             |                     | -   More           |
|            |             |                     |     connection,    |
|            |             |                     |     interface and  |
|            |             |                     |     integration    |
|            |             |                     |     points of      |
|            |             |                     |     failure        |
|            |             |                     |                    |
|            |             |                     | The physician is   |
|            |             |                     | responsible for    |
|            |             |                     | obtaining services |
|            |             |                     | for ongoing        |
|            |             |                     | hardware support,  |
|            |             |                     | security           |
|            |             |                     | standards, remote  |
|            |             |                     | access solutions,  |
|            |             |                     | backup, and        |
|            |             |                     | disaster recovery  |
|            |             |                     | solutions. This    |
|            |             |                     | creates additional |
|            |             |                     | risk and           |
|            |             |                     | management         |
|            |             |                     | responsibilities   |
|            |             |                     | for the physician. |
+------------+-------------+---------------------+--------------------+

B. LAN Options Table

+------------+--------------------+------------------+----------------+
| **LAN      | **Description**    | **Pros**         | **Cons**       |
| office     |                    |                  |                |
| Wiring     |                    |                  |                |
| Options**  |                    |                  |                |
+------------+--------------------+------------------+----------------+
| **Mobile   | Radio frequency to | -   Portability  | -   Speed can  |
| Wireless   | transmit data      |     of wireless  |     be slower  |
| Network**  | through a          |     equipment    |                |
|            | centrally located  |     when         | -   Speed can  |
|            | wireless server    |     relocating   |     be         |
|            |                    |                  |     affected   |
|            |                    | ```{=html}       |     by poor    |
|            |                    | <!-- -->         |     signal     |
|            |                    | ```              |     quality    |
|            |                    | -   Computers    |     and data   |
|            |                    |     can be       |     encryption |
|            |                    |     located      |                |
|            |                    |     almost       | ```{=html}     |
|            |                    |     anywhere     | <!-- -->       |
|            |                    |                  | ```            |
|            |                    | -   Can be a low | -   Upgrading  |
|            |                    |     cost         |     to faster  |
|            |                    |     alternative  |     speeds can |
|            |                    |     to running   |     be costly  |
|            |                    |     wire         |                |
|            |                    |                  | -   Less       |
|            |                    | -   Can be       |     secure     |
|            |                    |     deployed     |     than a     |
|            |                    |     quickly      |     wired      |
|            |                    |                  |     network    |
|            |                    | -   Add to       |                |
|            |                    |     existing     |                |
|            |                    |     wired        |                |
|            |                    |     network      |                |
|            |                    |                  |                |
|            |                    | ```{=html}       |                |
|            |                    | <!-- -->         |                |
|            |                    | ```              |                |
|            |                    | -   Ideal for    |                |
|            |                    |     home use     |                |
+------------+--------------------+------------------+----------------+
| **WiMAX**  | Longer range and   | -   Fewer        | Untested       |
|            | higher speed       |     connections  | technology     |
|            | wireless network   |     and access   |                |
|            | for metropolitan   |     points for   |                |
|            | deployment         |     remote sites |                |
|            |                    |                  |                |
|            |                    | -   Quick        |                |
|            |                    |     deployment   |                |
|            |                    |     of remote    |                |
|            |                    |     sites        |                |
|            |                    |                  |                |
|            |                    | -   Security     |                |
|            |                    |     built into   |                |
|            |                    |     technology   |                |
+------------+--------------------+------------------+----------------+
| **T        | Requires a         | -   More secure  | Remote         |
| raditional | physical           |                  | networks       |
| wiring**   | connection to the  | -   Supports     | require        |
|            | wall jack for      |     higher       | dedicated      |
|            | every device to    |     speeds with  | telecom lines  |
|            | connect to the     |     central      |                |
|            | s                  |     equipment    |                |
|            | erver/application. |     upgrades     |                |
+------------+--------------------+------------------+----------------+

Hardware Components

-   Personal Computer (PC)

-   Thin Client

-   Laptops

-   Pen Tablets

-   PDAs (personal digital assistants)

-   Printers

-   Scanners

System Access & Locations

-   Data Entry Methods

-   Exam Room Access

-   Global Office Access

-   Orders Management

-   Reception

-   Treatment Rooms

-   Conference Rooms

-   Waiting room kiosk

-   On site labs/blood draw

-   On site testing equipment -- ultrasound, spirometry, cuffs