Physicians in the market for EHR may wonder about the comparative benefits and drawbacks of web-based versus client-server systems. Each system has positive and negative characteristics. Which is right for you depends upon several factors, but chief among them would be budget and how long you hope to use the system. Practices with little or no budget, or providers that expect to retire within the next five years may want to go with a web-based system like Practice Fusion. Otherwise, we feel like client-server systems, like XLEMR, offer the best value over the long term.
Web-based EHRs require little or no up-front costs. They are usually priced on a per-provider per month basis. Prices range from free, like practice fusion, to $600 per month for a combined practice management and EHR system. This is also known as the “Software as a Service” model.
Client-server systems, by contrast, require purchase instead of monthly rental. Although prices fluctuate, most client-server systems range between $10 and $20,000 for a single provider. Most vendors offer financing, which makes the price comparable with web-based systems. Client-server systems are normally licensed per provider, so expect the price to scale accordingly.
Which is right for you? Have you ever wondered whether you should buy a car or lease it? The decision between client-server and web-based systems is the same. Client-server systems offer the best value over the long run. Once you pay off the software, it is yours forever, and your monthly costs go down. Web-based could be the right choice for you if you have poor credit, a very limited budget, or expect to retire or sell your practice within five years.
Proponents of web-based software claim you will not need to invest heavily in IT. There is some truth to this, as you will not need servers for web-based software. However, you will still need computers for each staff member. If your office doesn’t currently have computers, or has outdated computers, you may still face a heavy investment.
Client-server systems do require a server. However, this doesn’t necessarily mean you must spend tens of thousands. A server in the $1000 - $2000 price range should be sufficient for most small practices. So while you may save a little with web-based systems, it’s more important to pick the system that best meets your needs.
Web-based systems require constant high-speed internet access. If your internet fails, you loose access to your system. This may not be a major concern if you practice in an urban area. Otherwise, you may want to consider a client-server system. You will still need some internet access for electronic prescribing, billing, and other features. However, client-server systems do not rely on the internet to access your data.
Which is right for you? If you live in an urban area and already have current computers, web-based software may work well for you. However, if you live in an area where high-speed internet is not available, or not reliable, you should definitely consider client-server software.
Web-based systems store your data in secure centers, which could be located anywhere around the world. Most vendors invest heavily in securing their data centers, much like your bank or credit card company. However, data centers located overseas are not subject to HIPAA law and may have lax security. Ultimately, data security is your responsibility.
Client-server systems usually house all the data in servers at your office. This gives you more control over your data, since you can put your hands on it at any time. However, you will need to take steps to backup your data and invest in appropriate security technology, such as anti-virus software and firewalls.
Which is right for you? We feel like it is better to have total control over your data, even though it will require more work on your part. Current HIPAA law requires business associates (BA) agreements with any third party that has ongoing access to your data. Ask if your web-based vendor where their data centers are located and if they will sign a BA agreement. Keep in mind that web-based systems can be easily compromised by poor password management policies.
Usability and Customization
Usability of an EHR system depends on several factors, and does not necessarily depend much on whether the system is web-based or client-server. Web-based and client-server systems both usually offer some degree of customization. However, the customization these systems support may be limited to text-based templates. Overall, most EHR systems are fairly static and use a “one size fits most” approach.
Static, cookie-cutter systems may not be a problem if your practice is primary care. However, specialists or other practices with unique needs may find them extremely limiting. Trying to twist your workflows to fit one of these EHR systems may slow you down, causing you to lose revenue and otherwise lead to frustration and headache.
Which is right for you? Again, web-based systems are great if you have a very limited budget. We designed XLEMR based on Microsoft Office, which lets us easily customize your EHR. This gives you a dynamic system that can change to meet your evolving needs. Although XLEMR may require more up-front investment than a web-based system, you won’t be stuck with a cookie-cutter system.