Pros and cons of cloud based or web based EMR systems


As if medical practices don’t have enough to worry about with EMR implementation, now they have to decide what kind of EMR system to get: a client-server-based system or a web-based system. The former is the kind that most of us are familiar with. You purchase a computer server, buy a license for the EMR software, install said software on your server, and you’re ready to go.

But recently there has been a lot of buzz about “new” web-based EMR systems, also known as cloud-based EMR, that allow the user to pay a monthly subscription fee to access their EMR rather than having to purchase it. And since any computer can use the internet to ‘run’ the EMR, there isn’t the need to purchase more expensive servers and their associated hardware and software.

So, is cloud-based electronic medical records really a new thing, and is it really better?

In fact, running software across the internet is nothing new. Also known as Application Service Provider (ASP) or Software as a Service (SaaS), some major software companies have been offering this service to their clients for over a decade.

Depending on the nature of the business, these can run across the web using a simple web browser or a secure internet connection. Since this information is often stored across a network of data storage centers, it is considered to be hosted in the ‘cloud’ and in no one particular place at any time (sort of like the ambiguous nature of an electron cloud).

And many of you are already (unknowingly) running your EMR systems as cloud computing if you have a centralized data center and use it across multiple office locations. If you are seeing patients in a satellite office and entering information into your EMR system, this process is actually happening back at your central office across your wide-area network (WAN). The main difference between this and true cloud computing is that many (if not most) of your devices have a more direct connection to your network than a truly web-based system, which always must store and recall data across the internet.

Choosing a particular vendor does not necessarily limit your choices. Jim Messier, of MedFlow Inc., says that their EMR solution works as either a client-server system or a web-based system, as do many of the EMR systems out there today. “Client-server systems are not passe and are often preferred by larger practices or those with multiple offices. But for smaller groups with fewer sources, the same software can be run as an ASP or SaaS, and the user experience is essentially the same.”

Tera Roy, Specialty Director, Ophthalmology at NextGen Healthcare, says that, “With or without stimulus dollars, healthcare is headed to the cloud. Our newest releases are all based in the cloud, like NextGen Mobile, Patient Portal and Health Information Exchange, and we plan to keep introducing more of these Web-driven alternatives. They will play a critical role in breaking down barriers for small practices to achieve the full benefits of automation.”

If cloud-based systems are cheaper to set up, why doesn’t everyone go this route? Mr. Messier points out that, similar to deciding between leasing or purchasing a car, it helps to crunch the numbers. And for many practices that commit to a long-term relationship with their EMR system, there is usually a better return on their investment if they buy the EMR system rather than pay a monthly access fee, with a typical break-even time of about five years.

Here are some pros and cons of cloud-based or web-based EMR systems.



  • Less up-front costs for licensing
  • No server hardware or software to purchase/house/maintain
  • Possibly easier to transition to a different system
  • More cost effective for solo/small group practices
  • Better support
  • Easy to set up hot-site in case of disaster
  • Host companies typically have more sophisticated security measures/data protection
  • Vendor more likely to meet HIPAA regulations than the practice can
  • Onus more on vendor to meet Meaningful Use
  • Good for physicians who are not office-based or travel a lot


  • Customizability limited
  • Latency or lag time accessing information across web/ slower response time
  • Patient information may be compromised if co-mingled with other clients
  • At the mercy of the vendor regarding backups, security
  • More expensive over the long haul
  • Captive client – host controls your data
  • Practice is dead in the water with internet outage
  • May not be viable for rural practices with limited internet options
  • Practice can lose data if vendor goes out of business
  • May be impractical for uploading larger imaging files
  • Bandwidth limited by practice’s internet connection

Peter J Polack is an ophthalmologist who blogs on medical practice management and electronic medical records implementation on Medical Practice Trends.

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