Cloud vs. Server: Which EHR Option Is Best?

Tera Roy, vice president of business development, Nextech
SEPTEMBER 06, 2019
server room

In-house or in the cloud—what’s the right move when it comes to choosing an EHR? As the share of value-based payments steadily increases, 30% of medical groups with more than 11 clinicians plan to replace their EHR, according to a Black Book survey. Ninety-three percent of these groups are seeking cloud-based functionality to support on-demand data access.

But the transition from server to cloud can be daunting. First, there’s the cost of switching from server-based to cloud-based EHR software, including data transfer from one system to another, which can total thousands of dollars. Then there are the strains on operational efficiency that accompany any change in EHR software, such as the time required for staff to get up to speed on a new system. Further, simply understanding what is meant by cloud-based takes diligence.

How can healthcare leaders most effectively weigh cloud-vs.-server options? Here are four questions leaders should consider.


What’s the difference between “web-based” and “web-enabled” cloud solutions?

These are two distinct offerings. When leaders don’t understand the difference, they risk getting a solution that is less advanced than what they were seeking.

A web-based solution is housed in the cloud. Access to patient records requires only a web browser and a secure password, which means physicians can access patient information on demand from a mobile device. Updates to software, including security updates, are applied automatically. Web-enabled solutions still require the organization to house at least one application server. Users can view aspects of patient records outside the organization with a secure password, but they must also maintain their server.

Ultimately, the cost of ownership for a cloud-based solution is less than that of a server-based or web-enabled solution because there is no need to install EHR software on each PC.


How will a move to the cloud impact staff workflows?

Minutes count in delivering patient care. Healthcare organizations need to know their staff will be able to access EHR data at any time. When EHR data is stored on the cloud, organizations don’t have to stress about hardware malfunctions, natural disasters, or weather patterns that can crash an onsite server in minutes. However, in investigating a cloud-based solution, it’s important to understand the company’s approach to data backup, disaster prevention and recovery. Make sure data is regularly backed up in a server at a separate location.

Server-based EHRs, on the other hand, don’t require a Wi-Fi connection to support EHR access internally. However, Wi-Fi access is needed for external interfaces, such as within laboratories or pharmacies.

It’s also important to consider the ease with which the EHR solution supports care collaboration. For every one hour spent with patients, physicians typically spend two hours on the EHR, an American Medical Association survey found. Cloud-based solutions enable physicians and staff to seamlessly exchange data among themselves and with other providers. Additionally, leading cloud-based solutions increase charting speed and simplify documentation, boosting efficiency while elevating in-person care.


What IT support is available for maintenance and updates?

One of the primary differentiators between server-based and cloud-based EHRs is that updates to cloud-based solutions are automatically performed via the SaaS provider. These updates include security patches that can be pushed out immediately when new threats to data security are identified—critical to maintaining HIPAA compliance and protecting the continuity of service. Server-based EHRs, on the other hand, require an organization to invest in IT staff or service providers for maintenance and security updates—an expensive proposition, particularly for small practices.

Cloud solutions also are easily scalable. With cloud-based EHRs, organizations can expand their storage capabilities with a change to their subscription. On-premise EHR servers, meanwhile, can be costly to expand.


What is the impact on revenue?

The right solution—whether cloud-based or server-based—should be easy to use, with streamlined workflows and easy access to customer service support when challenges arise. Consider forming a team to explore cloud-based and server-based offerings, gaining their insight on the amount of training required to implement the solution. Be sure to gain physician feedback as well as feedback from clinicians and staff. The right solution can reduce staffing costs and expand care capabilities, strengthening the organization’s bottom line.


Making the Right Investment

The demand for cloud-based EHRs that support on-demand access to actionable data is increasing, but the choice between a server-based and cloud-based solution is highly individual, dependent on an organization’s size, needs, the comfort level of physicians and staff in changing their software platform, and cost concerns. Taking the time to carefully investigate your organization’s options will ensure the solution you choose best supports high-quality care, improved efficiency, longer IT lifelines, and reduced expense.

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