Local EMR vs Hosted EMR

by Brian Tuttle 

If you are reading this article you are no doubt a little confused about which type of EMR solution is best for your practice, local vs. hosted.    This is a very heated subject matter that EMR vendors battle over constantly.  However both have distinct advantages and disadvantages.

 First let’s be clear on how the two are defined:

  • “Local” EMR (also called in-house) is a system that is physically housed within your practice.
  • “Hosted” EMR (also called web-based) is a system that is housed elsewhere and it typically accessed via a web browser. 

What are the benefits of having your own “local” in house EMR system?

  • Speed – The datacom speed of the locally hosted system will always be faster.  You are accessing data from a server down the hall, not perhaps thousands of miles away.  This is especially true when scanning large files into the system.
  • Internet Independent –   If the internet goes down (and we all know that is does) you are not dead in the water.  For the most part you can continue to work as usual while your colleagues with the hosted system can do nothing but get angry at the internet.
  • More control over timing of software updates – When you have your system locally housed you (not the vendor) control when the updates and patches are applied.  This can be a nice perk especially considering updates can be very time consuming and completely take down a system for a period of time.
  • Ownership of data – With a locally hosted system you have complete control over your medical data.
  • Customizable – Typically a locally hosted system is more customizable specific to your practice than the hosted option.
  • You own the system – Although you pay more upfront, in the end you actually own the system and are not obligated to the revolving monthly costs that can be incurred with hosted EMR systems.

What are the drawbacks to “local” in house EMR systems?

  • Higher upfront cost – You must purchase server(s) to host the system and have IT expertise to get everything up and running correctly.
  • You are responsible for backups – Clinic/physicians are liable for data integrity, security and privacy per the HIPAA Security Rule.
  • Dependency on competent local IT support – There will be a higher need for local support in the “local” EMR model.
  • Server Crash – Nobody likes these words “the server has crashed!”  If this happens you are dead in the water and may be down for an extended period of time.

What are the benefits of using the hosted (web based) EMR model?

  • Lower initial cost – The upfront costs for hosted EMR systems are typically much cheaper, you don’t usually need to buy any equipment (unless you have VERY old PC’s or a specific type scanner is needed).
  • More accessibility – You can access your system usually from any PC that has an internet connection.  Of course there usually is some initial install of Java script and Active X controls that can be annoying.
  • Easier to upgrade – You really have no responsibility on keeping the system current and upgraded.  This is all controlled on the vendor’s end where the hosting server is located.
  • Backups – This is perhaps the best part of the hosted model.  You are not responsible for keeping the system backed up.  However it is a good idea from time to time to ask the vendor to prove that your data can be retrieved and restored in a “disaster recovery test”.
  • Less need for local IT support – Although local IT support would be needed from time to time, the need would be lessened as most of the nuts and bolts of the system are housed elsewhere.

 What are the drawbacks of using the hosted (web based) EMR model?

  • Speed – You are completely dependent on your ISP (internet service provider) for speed.  This can be a major issue especially when trying to upload images into the system via DSL or cable internet access.   This is due to the slow upload speeds of these two types of internet access.
  • Costlier Internet – Due to the upload speeds it may be necessary to purchase a higher grade internet (perhaps a T1 or T3) which will provide more consistent speeds, especially on the upload side.
  • Higher costs over time – Overtime the high recurring monthly charge to lease the system will exceed the original cost of the server and software purchase.
  • Unannounced updates – Nothing is more annoying than an update that crashes the hosted system that was not announced.
  • Bad IT support – Many times the IT support from the vendor can be poor at best.  Many are overseas which can be difficult to understand and get in touch with.
  • Big Brother – Many physicians have concerns with their patient data being housed elsewhere which can be accessed by staff members of the hosting vendor.  Although the vendor is held liable under the HITECH Act of the HIPAA Security Rule and through the Business Associate Agreement with your practice, this is still a concern as some feel it may lead to monitoring of performance, privacy breaches, etc.

What is my opinion?  I have implemented over 100 different EMR systems, both local and hosted and interviewed over 200 different MD’s and practice managers regarding how they feel about their system.  This opinion is not scientific nor is it all encompassing……but…..in my experience I’ve found those with the “local” based EMR are much happier with their EMR.  The reasons they tend to site are speed, good local IT support, long term cost and the comfort of having a system they can touch and feel.    Of course there are a lot of factors that you need to weigh before choosing which system to go with but the feedback I receive overwhelmingly supports the locally based solution.

If you have any questions or would like to get my non-biased opinion with multiple EMR systems (both local and hosted) email me at: brian.tuttle@ingaugehsi.com


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