The previous section of our buyer's guide listed common features of electronic health record (EHR) software and helped health care providers pinpoint the particular features most relevant to their users. This section examines one particular type of software -- Web-based EHR -- that may be worth a close look by providers worried about the implementation, maintenance and infrastructure costs of client-based systems.
For a majority of solo physicians and small group practices, the first big decision on the technology front is whether to go with a Web-based EHR system, which can also be referred to as a cloud computing system or a Software as a Service system. In this case, an EHR vendor will host and maintain the system, manage access for the provider and staff via the Internet, and store the records.
For the provider, the pros of a Web-based EHR system include less on-site maintenance and all the data storage issues that come with it, robust backup systems run by the vendor, and no upgrade fees. In addition, those who sell Web-based EHR encourage users to join community forums to share their expertise or suggest new or improved features for future product releases. Finally, some Web-based EHR systems support smartphones -- or, in the case of Epocrates, will be solely available on smartphones; this feature lets physicians view medical records when they are not at their desks.
The cons typically include monthly subscription fees that may vary depending on the scale of a practice, reduced control over the customization of the EHR system, and service outages if the Internet service provider (ISP) goes down. The latter concern can be addressed by installing a T1 line or contracting with a trusted ISP.
Larger facilities probably will host their own EHR systems, although in some instances -- for instance, an affiliated provider located at a satellite facility -- they might also use a Web-based EHR when the provider's local network doesn't stretch that far. Some providers within a hospital system might choose to run their own Web-based EHR system for other reasons, including better support for their particular specialty or convenience for a practitioner who might juggle work in multiple locations. Hosting your own system, many facilities are finding, requires upgrading or rebuilding the network infrastructure and storage architecture to make way for an influx of applications, documents and communications systems.
The next section of this buyer's guide helps providers decide whom to talk to outside the organization when they're seeking advice on EHR technology.