In my opinion, many EMR and LIS systems have become outdated in terms of their architecture (see: Possible Adverse Consequences of Increased Federal Investment in HIT). I have attributed this in the past to the fact that hospital and lab executives keep purchasing them so there is no rush by the vendors to convert them to a more modern design. A recent note by Mr. HIStalk on the use of Citrix in the healthcare industry provides another view of this problem. Here is his note:
...[S]omeone lists the five companies Dell should take over, all of them in healthcare IT. They are Allscripts, Quality Systems (NextGen), CSC, Cognizant, and Citrix Systems. Citrix isn’t technically a healthcare IT vendor, but [healthcare is] probably [the company's] biggest vertical since the industry is dominated by 1970s time capsule applications that won’t run efficiently and securely without it....Actually I use Citrix a fair amount at work and it’s pretty cool – poorly architected fat client apps run a heck of a lot better over wireless or VPN when you’re only painting screens and not slinging massive data packets back and forth.
His observation is very interesting and hits the mark. I am reminded of a LIS vendor many years ago which was reluctant to admit that the use of Citrix was absolutely essential in order for its product to function adequately. The company did not want current clients to understand its fat-client problem nor potential clients to add the cost of the Citrix software to the total cost of ownership (TCO). This need for Citrix as companion software for many LISs and EMRs also places an additional work burden on the lab and hospital IT support staff. As noted above by Mr HIStalk, the success of Citrix in the vertical healthcare market is a function of the inadequate design of the EMRs and LISs that we continue to buy and operate. Citrix is cool but there is a big price to be paid in order to see it work on a daily basis.