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Web Based EHRs vs. Client Server EHRs

Currently, there are two broad methods of using Electronic Health Records (EHRs). The first is the web based method and the second is the client server model. Both have advantages and disadvantages and we will outline both here for your consideration.

Definitions -

Web Based EHR - there are generally two types of web based EHR products. The first is a true hosted application that requires only a web browser such as Internet Explorer to access. The second requires some form of remote access program such as Citrix or Microsoft Terminal Services. However, both achieve the same end result. The program is hosted on a secure server at the EHR company's office. The data is stored on these servers. Practices connect to the server using the Internet. This allows the data to be accessible from anywhere that has an Internet connection.

Client Server - In this model, the EHR data is stored on a server in the practice's office. The computers in the office connect directly to the server to see the EHR data.

Advantages of a web based EHR -
Lower initial cost - a server is not required for a web based EHR product. Also, the requirements for workstations are not as strict. This lowers the initial cost of implementing an EHR product.

Server maintenance - since there isn't a server, the IT costs are lower. This lowers the initial cost as well as the yearly operating costs of the EHR.

Data security - the data should be being backed up daily at the EHR company. This way, practices don't have to deal with this issue.

Accessible from anywhere - with the software being accessed via the Internet, this allows the flexibility of the data to be accessed anywhere an Internet connection can be found.

No upgrades - the EHR company should maintain all updates and keep the product current. This lowers IT costs and keeps the product always current.

Disadvantages of web based -

Dependence on Internet access - as the data is hosted at an offsite location, practices are dependent on their Internet access to gain access to their data. If the Internet goes down, the practice is not able to access their data.

Slow responsiveness - when data is accessed via the Internet rather than on a local network, the responsiveness will always be considerably slower. This affects charting speed.

Limited customizations - when the program isn't in the direct control of the clinic, it makes customizations difficult.

Total investment - while the initial outlay of capital may be low, over time with monthly access fees, license fees, and the increase in Internet connectivity costs, the overall costs are considerable.

No control over access to data - when the data is outside of your direct control, there is always an issue of access. Even if it is clearly spelled out in a contract, you do not have direct access to your data when it is hosted on an offsite server.

Advantages of client server -

Control of data - when the server is installed in the practice, the practice has total control and ownership of the data. If your EHR vendor goes out of business, your practice is still up and running.

Not limited by internet access - if Internet access goes down throughout the day, practices retain access to their data. The Client Server model is not affected by whether the Internet goes up or down.

Still up if company goes out of business - if the EHR software company goes out of business, practices are still able to function as their software and data are not dependent on the survivability of the EHR software company.

Responsive - when the software is installed on a local network, it will be extremely fast and responsive because the network is significantly faster than the Internet. Charting times will be near instantaneous.

Total flexibility - having the program and data in the office allows a practice total flexibility in customizing the EHR for their needs.

Disadvantages of client server -

Higher upfront cost - due to the purchasing of a server and stricter hardware requirements, the client server model is more expensive up front.

Higher hardware requirements - the hardware necessary to run a client server EHR install is more demanding than that of a web based EHR. This increases up front costs of the client server EHR.

Server Maintenance - as the practice now has a server, there are maintenance items that must be performed on the server periodically. This increases the overall practice IT costs.

Backups - the practice must manage the backups at their location. If the practice forgets to perform a backup, then the data isn't backed up.

Items to consider -

As we have indicated, both options have positive and negative items. The main things to keep in mind when choosing any EHR system are:

The total cost to your practice of implementing an EMR - this includes the initial costs but also the long term costs.

The reliability of your internet access - is your Internet access reliable enough to allow your practice to make use of a web based EHR should you choose to go that route?

Possession of data - where is your data going to reside and do you have control over it?

Support - is your practice going to get reliable support from the EHR vendor?