Small practices find cloud based EHRs better than client-based EHRs – Here’s why?

 Erika Regulsky Billing & Collections, Medical Billing, Most Popular, Most Recent


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There are two kinds of EHR modules, one which is cloud based and the other which is client-based. The end use of both modules is to store clinical data.

In a cloud based system, the data is stored on external servers, and the access to the data is only through a computer with an internet connection. 

The client based servers are located within the premises of the practice; requiring hardware and EHR software to facilitate data storage and access.

Most practices conventionally have been using in-house software, but many are considering switching to a cloud based EHR, notably because there are few complexities associated with it, and implementation is much simpler.

  • Being web-based, there is no need for installing expensive hardware and software. There are no interruptions to the cash flow of a practice, with a minimal implementation downtime, the ROI is much faster than a conventional in-house systems.
  • One of the barriers small medical practices face is the initial cost of installing EHR systems. The minimal installation cost can be anywhere in the range of $40,000 or more, besides license fees, maintenance costs, and software updates escalate the cost even further.
  • Comparatively, there is no initial cost associated with cloud based EHR, neither any license fees have to be paid, or any hardware needs to be installed. The implementation cost is the barest minimum, with only a monthly fee paid to a provider that leases it on ‘Software as a Service’ (SaaS) basis.
  • Migrating clinical records to the cloud requires minimum IT support. In contrast, an in-house IT team has to be dedicated to install, configure, test, secure and run the EHR software. All of these technical tasks are overseen by the SaaS provider, at no extra cost. Besides, the versions of cloud based systems are regularly updated; allowing practices an advantage of using the most current version of the software.
  • Practices that migrate to web based EHRs can access clinical records from any location with internet connectivity and a secure log-in. The out-of-office secure collaboration between different entities working in the clinic has a positive impact on continuity of care.
  • Flexibility of adding new users, doctors and even locations is very convenient on web based EHR platforms. The network expansion is possible without any in-house IT intervention. It gives practices a leverage to grow without hurting their finances.

Is clinical data safe on cloud based EHR systems?

A common misconception most physicians have is about the security aspects of cloud-based EHR systems. Their concerns are imaginable, but security features of cloud-based EHR systems are HIPAA compliant, and measure at the same degree of bank-level security. The high-level encryption renders data unreadable, in the event of any data breach. 

In comparison, despite security tools being available on client-based EHR systems, they are barely used, and data is often unencrypted.

As for the safety of paper and client-based electronic records, they are safe as long as natural disasters or fire accidents haven’t happened. The cloud based data on the other hand, is backed up securely at multiple locations.

The stored data seldom becomes vulnerable to mishaps, natural or man-made.

Some of the most popular utilities that are cloud-based, and are a part of our daily lives, including Gmail, Yahoo and Facebook. If the vulnerabilities of data breach would have been a concern, they most certainly wouldn’t have setup data storage platforms on cloud.

Eventually, costs saving cloud based systems are going to be the backbone of our industries, big or small.

Transitioning to the Cloud EHR

Small and medium health organizations may consider cloud EHR as an attractive option in comparison to the high up-front cost associated with on premise EHR implementation. There are no upfront capital investments associated with Cloud EHR, either buying new hardware or deploying in-house storage systems.

Flexible payment options are provided by a few health IT companies that provide cloud-based EHR solutions. These options facilitate health organizations to pay the health IT companies a monthly subscription based on their collections instead of a down payment. 

Smaller organizations that do not have IT teams for implementation of an on premise EHR system consider the cloud EHR solution a bonus because of the simple technicalities involved in its deployment, besides all system updates too are provided by them.

The popularity of cloud-based EHR systems has been bolstered among small and solo providers because of lower costs and ease of implementation. 

In a 2015 survey of 5,700 small and solo providers, the Black Book study found that the cloud-based EHR adoption had escalated from 60 percent in 2013 to 82 percent in 2015, primarily because of lower upfront costs and an improved clinical productivity. The survey noted that participating solo practitioners agreed that cloud-based EHR offered better clinical productivity than on premise EHR systems.

Large Organization Prefer On Premise EHR Solutions

On premise EHR systems is a preferred choice of many large healthcare organizations, which consider them as a reliable option, despite having to pay upfront cost and maintain servers.

Epic, Cerner, MEDITECH, and few other companies offer on premise EHR systems. These systems give health organizations complete control on infrastructure configurations and data storage. It leverages them to customise their health IT systems, with the level of control enabled by the systems.

No internet connection is needed to access patient health data, enabling health organizations to maintain the continuity of operations even when the internet is down. Unlike cloud based EHR, which are internet dependent, access to clinical information can be disrupted when the services are down.

However, organizations have to spend over $100 million as upfront cost for an on premise EHR system. In order to go live, more hardware, software and personal are needed than a cloud EHR launch, besides implementing on premise EHR projects can take 18 months to complete.

Despite customised deployments that are built to suit the needs of health organization’s specific workflow, the implementation of on premise EHRs  has also resulted in financial losses to an organization. The Tennessee based Erlanger Health Systems suffered $4 million losses, after the Epic EHR system deployed at its inpatient services went live, and billing problems surfaced soon after, resulting in that loss.


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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.


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