EHR best practices: Choosing cloud or web-based EHR

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In short, cloud and web-based services are so ubiquitous as to become the norm.


Nowadays, few resist putting a portion of their data in cloud and accessing their files through a web-based interface. Google Drive is the latest to the scene, but the number of cloud storage services continues to grow: Amazon Cloud Drive, Microsoft SkyDrive, Apple iCloud, Dropbox, Box — the list keeps going and going.


Coupled with the number of cloud storage providers is the increased security made possible by modern browsers harnessing the power of encryption to protect your information over the wire. Welcome the https:// which indicates that a site is using a secure connection, such as transport layer security (TLS), secure sockets layer (SSL). You’ve all seen them in your online banking, and it’s the reason why you always have to log in each time you sign on.


A general survey of healthcare providers about the top concern they have when choosing an EHR is the amount of time and resources they will need to come up with to go live with a solution. As Patient Management Officer for Hello Health Stephen Ferguson explains, there’s not only the cost of the EHR but loss of revenue from the time spent implementing the system:

The problem is cost — even though it’s not that high, it’s high enough — and then the other aspect is the amount of help that small practices really need in getting where they need to be with the technology. They can’t take efficiency hits to their workload, which is the way new technology has been introduced.

The cost factor is especially high for small practices struggling to afford either expensive monthly fees for the larger online services or the hefty upfront cost for a client-hosted enterprise system.


Two companies in the EHR web-based space have developed solutions that are not only technological but also financial. Practice Fusion, whose name and product has been bandied about for the last several months, offers a free browser-based EHR that connects ambulatory settings with labs and pharmacies by using highly-target ads and marketing which providers can pay to remove (though many choose not to).


The return on investment (ROI) is much improved, but what about the time spent implementing the system. Depending on your goal, the amount of time can vary. Practice Fusion and Hello Health both average two weeks to get a practice up and running. “There’s very little downtime at all because we do put people right on site to help in whatever way we can,” observes Ferguson.


At the same time that you move your EHR on to the web or into the cloud, you’ve also offloaded the responsibilities of maintaining those systems from an information technology (IT) standpoint.

First, subscription models for these vendors make them responsible for maintaining the systems and updating their platforms. For Ferguson, it leads to a partnership rather than a business agreement: “We come in with a partner approach with the practices. It’s not a vendor relationship where they sign on the dotted line, and then we say, ‘Good luck.’ We partner with them to help with the technology, workflow, implementation, training, and so on.” There are no servers to monitor, no patches or installation packages to deploy, and no hiring of dedicated IT staff.

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