The primary goal of this article is to explore the solutions available to Amazing Charts users with multiple locations. As such, the advantages and disadvantages will be focused around multi-site capability as opposed to the issues with general remote access. We have an article that covers types of remote access here. The first thing you need to do is determine if you need concurrent remote access or simple remote access. Concurrent remote access meaning you need both offices to be operational at the same time.  This is common with large multi-site clinics and group practices who keep multiple fully-staffed locations. This article primarily concerns concurrent remote access.

Remote Desktop Services/RDS 

Remote Desktop Services is a server role in Windows Server that provides technologies that enable users to access session-based desktops, virtual machine-based desktops, or applications in the data center from both within a corporate network and from the Internet. (Microsoft)

With Amazing Charts, RDS is typically deployed in two formats: Remote Desktop Apps or Remote Desktop Sessions or both. I will mainly focus on RD Sessions since Amazing Charts in the cloud uses the same architecture as RD Apps. With RD Sessions, a user arrives at a full desktop after logging on to the RD Server. From here, the user can launch any number of programs including Amazing Charts. This is great if you have separate scheduling, billing, or other software that you need to share. Most users also have files such as scans and faxes that they need to share outside of Amazing Charts. Users can logon from virtually any device including desktops, laptops, phones, or tablets. This flexibility makes a popular solution enabling users to use cheaper laptops and desktops. RDS was also designed to run on slow dial-up connections so you can expect great performance even in less than stellar conditions. However, the terminal server needs resources to accommodate the number of users logging into the server. There are management benefits such as only needing to maintain, update, and secure one machine for multiple users and locations. Remote Desktop Apps (Amazing Charts in the Cloud) is quite similar to RD Sessions except the end user gets a single application window as if it were installer on his or her computer. These mainly work on Windows based computers that can interact with the Windows.

Cloud/Software as a Service (SaaS) Solutions

Software as a service is a software licensing and delivery model in which software is licensed on a subscription basis and is centrally hosted. (Wikipedia)

Amazing Charts now provides a fully hosted EHR solution to its clients. Most SaaS providers will use a similar platform to Remote Desktop Services unless they were the original developers of the application. For instance, Microsoft Office 365 would be considered SaaS, but it has its own proprietary platform through the web. Whereas, Amazing Charts uses Remote Desktop Services (in the form of an RD App) to provide its application. Amazing Charts Hosted EHR uses the exact same technology as Remote Desktop Apps but they manage and implement it. As such, the same advantages of disadvantages of RD Servers apply here. One major difference is that with RD Servers, you have the option to use a session-based implementation, meaning you can have a full desktop as opposed to a single app. As mentioned earlier, this can be an issue if you have separate scheduling, billing, or other software/files that you need to share. There's also less flexibility as you will not have control over the server. However, all security, patches, and updates are handled by the provider.
Most SaaS solutions cater to smaller practices as they are priced by number of users/seats. As the demands of a practice grows (users, bandwidth, storage, etc.), the less attractive the SaaS solution becomes. However, many providers also provide bulk/volume discounts to make their offers more competitive. SaaS is great solution for a provider who sees patients at one office half the week and the rest at another location for the remainder of the week. However, having two fully-staffed locations for the whole week would require twice as many seats/licenses.

Virtual Private Networks (VPN)

A virtual private network (VPN) is a network that uses a public telecommunication infrastructure, such as the Internet, to provide remote offices or individual users with secure access to their organization's network. (SearchEnterpriseWAN)

Basically a VPN allows you to access your local/in-office network over the Internet. There are numerous ways to setup a VPN. The simplest involves using an application such as Hamachi to establish a VPN. A lot of Windows Servers also have built-in VPN functionality. Business-grade routers/firewalls also have VPN options. So if you were to have a multiple offices. You could keep your database server at one location and use a VPN to connect your branch locations to the main office. The primary disadvantage associated with this method is that speed is limited by your Internet connection. So if you have a DSL Connection or even cable, you are likely to experience poor performance. For example, if you were trying to view a 20 MegaByte PDF on a 3 MegaBit DSL Connection, it would take nearly a minute (53.3s assuming max speed) just to load that single PDF file! A lot of users have tried the VPN method and have found it too slow even when avoiding large files. This is typically due to latency. Your typical wired network will have a latency that is less than 1 millisecond. On the other hand, your latency over the Internet is likely over 30-40 ms in optimal conditions. However, different users have different expectations of latency. Here's my take on it for SQL (smaller is better):

• Excellent: < 1ms
• Very good: < 5ms
• Good: 5 – 10ms
• Poor: 10 – 20ms
• Very Poor: 20 – 100ms

Point-to-Point Bridging (PtP)

In a Wi-Fi network, Bridge mode allows two or more wireless access points (APs) to communicate with each for the purpose of joining multiple LANs. Some wireless bridges support only a single point-to-point connection to another AP. (TP-Link)

PtP wasn't listed as a main choice since it only applies in certain conditions. Wireless PtP bridges serve as an alternative to leased lines (also not listed). With leased lines, you pay an ISP to run direct lines often in the form of a T1/T3 line between locations. Due to the cost of leased lines and much better alternatives, they weren't listed. Wireless PtP bridging provides an effective alternative to leased lines. The latency is much more acceptable and is capable of achieving near gigabit speeds. PtP bridges eliminate the need for a VPN and/or Terminal services because it appears as if the devices are directly attached to your switch. You will need to consult a professional to see if it's a viable option for your offices. Many offices not only share local resources but also Internet connections via PtP resulting in fewer ongoing costs. These PtP bridges are often capable of achieving latencies in the very good to good ranges and are also quite economical.