In 2001 the majority of physicians (82%) still used paper files and color-coded charts to document patient encounters and maintain individual health records. By 2013, according to the Centers for Disease Control and Prevention (CDC), almost 80% of office-based physicians used at least basic electronic health record (EHR) systems. Adoption continues to increase as physicians strive to meet federal mandates requiring more extensive outcome reporting and reimbursement schedules shift toward a value-based payment system.
Practice administrators who have not already converted paper-based records to digital files must decide whether to add a cloud-based EHR system or invest in traditional EHR technology. While both record systems have pros and cons associated with the conversion, there are a few key differences.
Financial Investment and Physical Footprint
Both systems reduce the necessity for extensive physical storage space. Storing digital files compared to paper records storage is minimal. However, traditional EHR, which involves maintaining an in-house computer system and peripheral devices, requires purchasing or leasing hardware and software. Dedicated space to house servers and backup batteries demands a larger physical footprint than cloud-based systems.
Purchasing the necessary equipment and software to initiate a digital recordkeeping system can be financially burdensome, especially for small to mid-sized practices. When practice administrators opt to switch to a cloud-based platform supported by 24/7 technical support teams and trainers, they can avoid costs associated with hiring and training in-house personnel to assume those roles.
Compliance and Liability
Some providers fear sharing control of their data may expose the practice to co-mingling of client accounts if they implement web-based EHR systems. Administrators have full control over who accesses system information and what devices are used in a closed-network environment. They also assume full liability for HIPPA compliance and data security.
Architecting a secure network to protect against cyber attacks and unintentional internal exposure is very expensive and requires continuous monitoring to upgrade codes, patches and updates. Web-based EHR vendors are responsible for meeting HIPPA and other federal privacy mandates and updating code-sets, security patches and software updates. Vendors also tend to have stronger disaster recovery plans that include backup protocol and redundancy capabilities to reduce or eliminate down-time and data loss during an outage or emergency event.
Upgrading Cloud-based EHR vs Traditional EHR
Self-managed, in-house systems are owned and operated by medical organizations, whereas cloud-based EHR are subscription-based. Although traditional EHRs afford desirable benefits, such as maintaining total control over data management and security, updating legacy systems may involve purchasing new software and hardware as technology evolves every few years.
Especially for small to mid-sized practices, it may be more cost-effective to pass the financial burden of upgrading along to service providers who leverage economies of scale to reduce per client costs and human resources to facilitate the process efficiently.
Customization and Cost Control
Early electronic health records enabled full customization, but required highly-skilled programmers and IT professionals to develop custom solutions tailored to the individual practice or medical organization. Today's cloud-based solutions have built-in features, such as templates and care plans, that are easier to customize without extensive coding or programming skills.
Conclusion:
In-house EHR systems give administrators full control over data management and records maintenance. Practices and medical facilities assume all legal and ethical responsibility to protect patient information and meet federal compliance mandates. Initiating cloud-based EHR solutions may reduce operating expense, legal liability and time-demands on medical and administrative personnel.
Key Comparisons:
- Upgrading a web-based solution may be more efficient and cost-effective than updating traditional EHR.
- Administrators have total control over both in-house and subscription-based EHR data, but it may be more burdensome to self-manage than to switch to a web-based EHR.
- Web-based EHRs may reduce data loss potential and compliance challenges.
- Traditional EHRs cost more initially to implement and require a larger physical footprint compared to vendor-supported EHR solutions.
