What are the Types of EHR Technology?

What is Client Server?  What is Hosting?  Is all ASP (Application Service Provider) or Internet-based the same?

Client-Sever – The server that runs the EMR software is physically located in your office.
1. You purchase the server and supporting hardware and other network gear.
2. Server replacement recommended every three to five years.
3. Nightly backups are completed by your staff.
4. You complete scheduled updates and upgrades.
5. Access from remote locations varies.

Hosted Client-Sever Model – A variation of the above Server-Client Model. These are the same systems that are sold as Client-Server but the server that runs the EMR software is located in the EMR company’s office or in a third-party data center and is typically accessed using the Internet.  Systems may be sold as ASP or Internet-based so you should ask to be sure.
1. Because the software was not designed for the Internet data transfer speeds may vary from system to system and depending upon the functions being performed in the EHR.
2. The responsibility for nightly backups and upgrades is on the hosting company instead of the practice.  Check out the hosting company’s processes and facillities.
3. Access from remote locations varies.

ASP (Application Service Provider) – The EMR software has been designed in a manner that allows it to be deployed over the internet. There is no server to buy or separate hosting fees to pay.
1. The system should be consistently fast over the Internet – but get a demo on the production system to be sure.
2. Usually accessable from anywhere you can get Internet or a cell connection. Security and data safety are built into the system. Expensive firewalls at every location are not required.
3. Connectivity requires an always on internet service like DSL or cable service.
4. Backups and system updates/upgrades are done by the vendor.

In addition to the way these various system types work, the costs can vary widely and comparing costs can seem like comparing apples to oranges (more like apples to steak!).  For that reason, its a good idea to get 100% complete pricing from the vendors for at least 3 years.  Ask at least two questions:

1) Tell me every possible hardware and software cost/purchase I may have to make to get this system up and keep it running well for 3 years.

2) Can I get your price list – a list of every service and item you sell/charge any customer for?

The second question is very important because your sales rep may not be presenting you all the options and services in an effort to be “price competitive”.  Even if you don’t want all the options and services now its good to know what they cost and especially needed if one of the other systems you are comparing to includes that option or service in its regular pricing.

Catherine Huddle, VP Market Development