Electronic Health Records

Adoption & Implementation News

Cloud-based EHR considerations for small providers

By Patrick Ouellette

- Small practices, more so than most healthcare providers, are constantly looking at the bottom line. So when it comes to EHR adoption, thinking about cloud-based EHR is a natural progression. While cloud-based EHR does have its advantages over client-server EHR, there are items that smaller providers need to take into account before going all-in on cloud.


Because cloud-based EHR software is run through the Web, you won’t have to worry about server, hardware and software installation. This may mean a quicker return on investment (ROI) than if you were bringing in a big, server-based system. And for small offices with limited space, installing all that hardware may not be the best use of your surroundings. But don’t let the ease of implementation be the definitive reason you use cloud-based EHR. Quality, security and cost of the software should be the three main areas of focus when selecting EHR software.

Short term vs. long-term savings

Some client-server systems can cost $40,00-$60,000 to bring in and then you need to consider licensing fees, maintenance costs, updates and patches. Implementing cloud-based EHR is much less, as you pay a monthly fee, called software as a service (SaaS), which can cost about $10,000-$13,000 up front and then about $500 per month in service fees. And you get automatic updates, instead of having to pay separate fees with a server-based EHR.

While using Web-based software may make an instant impact on your bottom line right now, how confident are you in this company’s longevity? It’s great if you’re paying a certain amount per month for services and getting everything you need from the software, but what happens if the company goes bottom-up down the line? For small practices, this is an area in which they need to remain cautious during the decision process.


Security is a big concern among physicians when it comes to EHR – but it shouldn’t be as worrisome as some perceive it to be. According to poweryourpractice.com, Web-based EHR systems achieve HIPAA compliance through data centers with bank-level security and high-level encryption methods that render data unreadable even in the event of a data breach. Furthermore, client-server systems are often left unencrypted and only as secure as the room where they are stored. The key here is having an encrypted high-speed Internet connection, which provides your practice with access to data and applications without having to manage software changes or invest in server hardware. And if you’re comfortable with personal Gmail or online banking accounts, both of which are cloud-based, you shouldn’t have too much concern with cloud EHR when it comes to security.

Scalability and accessibility

The ability to be agile and grow out or scale back an EHR system is a necessary requirement for small providers, because it’s hard to future predict staff or financial changes. You can’t increase the capacity of a client-server system without paying through the nose, while expanding your cloud EHR software’s capabilities shouldn’t be too cumbersome.


This is another area where there’s a difference between perception and reality. A natural disaster or fire will give you no chance of recovering your backed-up server data, whereas cloud data is backed up securely in multiple locations. But providers also need to know what type of redundancy the cloud-based EHR company is offering – what happens if the Internet goes down? You need to be prepared for these situations, and have paper charts ready if need-be.

Data theft may also be easier from a central location, but if a hacker really wanted to steal Web-based medical data, unless you have high-level encryption, it wouldn’t be all that hard either. This is an area where if you’re already comfortable with communicating sensitive data via the Internet, the transition to cloud-based EHR wouldn’t be too bad.

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