Weighing the benefits of client server and cloud-based EMRs

There has been no shortage of buzz surrounding cloud computing. And some would have you believe that moving your EMR data needs to the cloud is the only viable – and cost effective – solution for medical practices, versus keeping records in house via a client server. That’s the equivalent of saying people should never purchase an automobile, they should only lease. It’s a notion that doesn’t take into account the vast differences in personal finances or the life circumstances of everyone who needs the use of a car.

Well, the same can be said about the current client server versus cloud debate. Is a client server based EMR – where a practice owns the hardware and software to run the EMR – the best solution? It depends. How about a cloud-based solution where the software and hardware are off site? That, too, depends.

Perhaps the biggest reason cloud computing has received so much attention is that it makes the use of sophisticated practice management and EMR software accessible without the upfront costs to the client of deploying a locally hosted server and software. This alone has made cloud computing an attractive option for smaller medical practices or those that have a number of different low-volume locations. In these instances, it makes sense for the practice to opt for a de-centralized model that offers a monthly fee for the Software as a Service (SaaS) and remote data storage fees.

But there are limitations. Since a cloud solution relies on an internet connection, practices need high-speed internet service that offers fast download speeds. Even then, the speed of pulling up medical records, while adequate, is slower than via a locally hosted server. Also, if multiple users are working in a cloud solution simultaneously, they are competing for the same bandwidth, further slowing response time. Finally, if internet service goes down, users won’t be able to access patients’ medical records during the outage – a real operational headache.

With a locally hosted server, medical practices need not worry about the reliability of their internet provider, since it is a dedicated, client-owned, in-house system. Granted, opting for a client server-based solution has upfront costs, including the server itself, software and building the network, but total costs over four to five years using a client server model are about equal to those of a cloud solution and lower as time goes on.

A locally hosted solution is also very fast at delivering information to users’ desktops. With speeds of 1 GB per second, data can be moved about five to six times more quickly than with a cloud solution using the very top tier of internet service. This makes a client server a sensible solution for high volume practices where many users will be connected at the same time. It also means practices control their patients’ data: how it is handled, stored, backed up and even whether some of it is resold – important considerations in this age of HIPAA regulations.

When it comes to making the choice between a local server and a cloud-based system, don’t be steered automatically in one direction. Practices should perform their own analysis detailing the costs of one solution versus the other, taking into account the length of time they intend to utilize the system. If this is a longer-term investment, a client server can grow with the practice over time and can have a low long-term cost of ownership. Another factor to consider is how the practice would be affected if access to data was lost one, two or five or more days a year due to internet outages? This has costs, too.

At Nextech we believe that clients should conduct their own in-depth due diligence about the specific costs and needs of their business. Only then will they be able to make the best choice between owning the hardware to host their EMR or outsourcing to a SaaS vendor with a cloud solution.