Yes, unless reliable and adequate telecommunications links to the data centre are not available. Local installations are exception-based and require evidence of network connectivity issues.

If your clinic meets one of the following exceptions, a local server installation will be allowed:

• Application service provider (ASP) connectivity is not available at a reasonable cost. Reasonable cost is assessed on an individual basis. Cost of ASP connectivity must be substantially higher than the cost to provide a local installation (including infrastructure costs such as the server room).
• Sufficient or reliable telecommunications are not technically available for a clinic to support an ASP solution.

Your clinic will realize the following implications, if you choose to pursue a local install:

• Your clinic's privacy impact assessment (PIA) will still be a streamlined PIA but it will be more detailed than the PIA that is used for an application service provider (ASP) hosted solution.
• Day-to-day ongoing security will be the responsibility of your clinic, however, your electronic medical record (EMR) provider will be responsible for setup of appropriate security.
• If your clinic will be connecting to provincial assets like Netcare and PIN, it will require a provincial Organizational Readiness Assessment (pORA) that will review security steps.
• A disaster recovery plan for the local install would be required as well as a business continuity plan for when the server is down. Your EMR provider will be responsible for the portions of the backups to be done from the local install.
• Many service levels will need to be measured locally. Availability, response time, schedule downtimes, and backup and restore will have to be measured within the local applications. Service levels related to the help desk will remain the same as those for ASP.
• A site visit will be required to determine if the server and other hardware meet the physical, technical and administrative security requirements and all risks are adequately addressed.