Both models have advantages and disadvantages. Lets explore the advantages and disadvantages of each model so that you’ll be able to make an educated decision when choosing the right system for your practice.

The Cloud Based Electronic Medical Records/Electronic Health Records is server software remotely hosted on secure server hardware that you access via the internet.  In the case of VistA EHR, the client software that you use on a day-to-day basis is installed on the local computer(s) in your office.   This is the same case if the server is brought in-house..

Cloud-based applications are usually accessed by paying a rental or service fee. As the server is not located in your office your initial setup costs are almost negligible with the added advantage that all technical aspects of the server are managed by EHR Doctors, it is secure and HIPAA compliant. It also allows you to access all of your information at any time, from any place with internet access. Physicians feel secure that all information is backed up, and some also have it backed up in their office.  We use the highly reliable eC2 cloud, the same network of servers used to run Amazon.com, the largest online retailer, so service reliability is 99%.

The disadvantage of Cloud EMR/EHR is that you are relying on your office internet connection to access your data. In a weather emergency or interruption from your ISP can cause service outages. The same risk applies to so-called “Web Based EMRs” offered by some companies (EClinicalWorks for example).

With VistA, because you own your data on the cloud and you have 100% secure access to all data and other source code, you can always keep backup electronic copies of the records that are suitable to view for contiuity of care in the event the internet goes down.  Many Web based EMR’s actually retian ownership of the records and try to “lock you in”.  With our Cloud based solution, there are no barriers.  All of your data can be exported easily to standard CCR formats One option for mitigating the risk is to install two internet connection at your office from two separate ISPs.  Not only is this faster, it is redudant/fault tolerant, and will provide better service.

The In house Client/server EMR/EHR model on the other hand generally faster becasue it runs inside your local area network.  Security issues are the same becasue local networks are sometimes less safe than the internet becasue of the lack of encryption in transit.  We solve these issues using VPN connections on the LAN as well. Depending on the number of patients and the size of the practice you might want to verify whether you can justify the vital seconds that are spent everyday waiting for data to transfer over the internet in a web based model especially during the peak traffic hours of internet usage. EHR Doctors can still help you with server management and support services to minimize your vulnerablity to the risk of theft, fire, and hard drive failure.

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