The Path to Paperless

EMR in the Clouds — New or Better?

By Peter J. Polack, MD, FACS

As if medical practices don't have enough to worry about with EMR implementation, now they have to decide what kind of EMR system to get: a client/server-based system or a Web-based system. The former is the kind that most of us are familiar with. You purchase a computer server, buy a license for the EMR software, install said software on your server and you're ready to go.

But recently there has been a lot of buzz about “new” Web-based EMR systems that allow the user to pay a monthly subscription fee to access their EMR rather than having to purchase it. And since any computer can use the Internet to “run” the EMR, there isn't the need to purchase more expensive servers and their associated hardware and software.

What's New and What's Not

So, is Web-based EMR really a new thing — and is it really better?

In fact, running software across the Internet is nothing new. Also known as an Application Service Provider (ASP) or Software as a Service (SaaS), some major software companies have been offering this service to their clients for over a decade. Depending on the nature of the business, these can run across the World Wide Web using a simple Web browser or a secure internet connection. Since this information is often stored across a redundant network of data storage centers, it is considered to be hosted in the “cloud” and in no one particular place at any time.

Many of you are already (unknowingly) running your EMR systems as cloud computing if you have a centralized data center and use it across multiple office locations. If you are seeing patients in a satellite office and entering information into your EMR system, this process is actually happening back at your central office across your wide-area network. The main difference between this and true cloud computing is that many (if not most) of your devices have a more direct connection to your network than a truly Web-based system, which always must store and recall data across the Internet.

Choosing between the two options is not an either/or proposition. Jim Messier of MedFlow says that its EMR solution works as either a client-server or a Web-based system, as do many EMR systems out there today. “Client-server systems are not passe and are often preferred by larger practices or those with multiple offices,” he says. “But smaller groups with fewer sources can run the same software as an ASP or SaaS, and the user experience is essentially the same.”

Tera Roy, ophthalmology specialty director at NextGen, says that, “With or without stimulus dollars, healthcare is headed to the cloud. Our newest releases are all based in the cloud, like NextGen Mobile, Patient Portal and Health Information Exchange, and we plan to keep introducing more of these Web-driven alternatives. They will play a critical role in breaking down barriers for small practices to achieve the full benefits of automation.”

If cloud-based systems are cheaper to set up, why doesn't everyone go this route? Mr. Messier points out that, similar to deciding between leasing or purchasing a car, it helps to crunch the numbers. And for many practices that commit to a long-term relationship with their EMR system, there is usually a better return on investment for most practices to buy the EMR system rather than pay a monthly access fee, with a typical break-even time of about five years. OM

Peter J. Polack, MD, FACS, is co-managing partner for Ocala Eye, a multisubspecialty ophthalmology practice located in Ocala, Fla. He is also founder of Emedikon, an online practice management resource for physicians and administrators.