Cost to Update to Meaningful Use Certified EHR Software

In my previous post about the EHR certification costs, a reader emailed me that I’d missed an important downstream cost. It’s not as much a cost for the EHR company as it is for the current user of an EHR system. It’s the cost for a current EHR user to upgrade their software to the latest and greatest version of the EHR software. You know, the one that is certified and allows you to show meaningful use of that EHR.

All EHR Will Need to Update
Lest you don’t think this is going to happen, I can pretty much guarantee that EVERY EHR company will need to upgrade their software to become a certified EHR and meet all the meaningful use requirements. The good thing is that most EHR users have a contract that provides them with all the upgrades free. Although, there might be some users that will incur a cost to upgrade.

Less Visible Update Costs
Beyond the potential cost to get the upgraded software, there’s also the cost to physically update your EHR software. There’s the very apparent cost of having to run a software install on all the computers in your clinic. This is pretty negligible for a small clinic with only a couple computers. However, in one clinic I supported we had 100+ computers and so the update process did take time.

However, more important than the actual software update is the process of preparing for the update. Certainly you could just update the software and go forward with it. Although, this is far from recommended and can be really problematic. I should cover this topic in a future blog post, but suffice it to say that the upgrade process goes much better when you 1. Look over the new features/changes to the EHR softare 2. Test the changes to see how they work 3. Train your staff on the new changes and how it will affect their workflow. These are all pretty academic steps, but they do take time.

SaaS EHR Vendors
Of course, the SaaS-hosted EHR vendors will all really enjoy this part of the process. They can easily update their EHR software to meet the guidelines with little interaction or work from the customer end. They still could cause the headache of an update to their EHR software affecting a clinic’s workflow. However, most SaaS EHR software companies are doing many regularly scheduled smaller updates as opposed to the large traditional client server EHR updates. These smaller changes generally cause fewer issues or at least spreads those issues out over time.

Even More Hidden Update Costs
I recently was aghast to learn of the EHR update requirements for a certain very popular EHR vendor. They’d told a clinic (or at least given them the impression) that in order to update their clinic to the latest EHR software that met the meaningful use and certified EHR guidelines (which is kind of silly since there still aren’t any officially recognized Certified EHR, but I digress) that the clinic would need to have computers that ran the Windows 7 Operating System. The sad news for this clinic was their current Windows XP machines weren’t powerful enough to run the Windows 7 operating system.

Let me translate what this means for the less tech savvy readership. The clinic would need to buy all new computers and the Windows 7 operating system (which should come on the new computers) in order to upgrade their EHR software to the latest meaningful use-certified EHR software. One could certainly argue that the clinic might need to upgrade these older computers anyway, but something doesn’t feel right about this being “forced” on a clinic. I personally still use Windows XP and don’t see much benefit to pay for a new computer with Windows 7. I will at some point, but there’s no compelling reason for me to move now. Why should clinics be forced into this expense by an EHR vendor?

Certainly Windows 7 and Windows XP are not ALL that different, but be sure that the change will cause some heartache in a clinic. Some mundane task that a user use to do easily in Windows XP will require a change to make it work in Windows 7. It’s easy to quantify the cost of new computers with Windows 7. It’s much harder to quantify the cost of this heartache.

Ongoing Update Costs
Many of these costs aren’t generally meaningful use specific. These costs or some variation are going to be part of the EMR update costs going forward. Unless your EMR vendor stops updating. Although, if your EMR vendor stops putting out updates, then you have a much different problem to deal with.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • No reason to upgrade that I can see, especially since I don’t see you as an IE user; although I will say, I have found several features in Win7 that I feel are pretty nifty, to the point that I miss them when I switch back down to XP (in a word, the toolbar is a great improvement).

    I think the most important cost, as with implementation, is the training. That’s time and money you’ll have to spend to “relearn” a system. Hopefully the vendor would simplify this process, but of course it’s still going to take time.

  • I’m definitely not an IE user. Chrome is the best browser out their by far. Although, I do use IE to test for browser compliance and sometimes when I need another cookie session.

    I agree that Windows 7 has some “nifty” features, but nifty isn’t what motivates me to spend money on the new thing. Plus, getting used to the new toolbar/start button and the way it handles document storage and retrieval are simple examples of things that people will have to learn when they make the switch. Minor things like that can really annoy users if they don’t expect them and have a good way to learn the new feature.

    I agree that EMR vendors should be better at this, but it’s a hard thing to do. Plus, even at their very best it does indeed take time to learn and evaluate what needs to be learned. Each clinic implements different EMR processes and so it’s hard for an EMR vendor to know how it might affect yours and not another one.

  • Instead of replacing all the XP computers, the provider might be able to migrate to remote desktop sessions (Terminal Services or Citrix) on a Windows Server 2008, which would probably be compatible with the EMR software that requires Win7. In addition, it provides the benefit of a single upgrade to provide new software for all the users who run the software in sessions on the Terminal Server. The TS sessions can run on the existing XP client computers.

  • SaaS is the way to go and is the future. I don’t know why any EHR software out there is not. On top of that, why doctors are still going for the server based system. Great blog post!

  • “… why doctors are still going for the server based system…” Here are a few reasons right off the top of my head:

    1. Richer user experience than web-based products.
    2. Unreliable internet service or limited bandwidth.
    3. Security concerns.
    4. Not available from the provider’s preferred vendor.

  • Seth has it spot-on. If your EMR uses the “fat client” approach, whereby every client box requires an update, you’re obviously using the wrong EMR software. EMR updates need to be confined to a central server, with minimal demands made of the clients. Any client software should of course work with either Window XP or Window 7 (and ideally Mac OS or Linux).

  • Seth,
    Sure, you could go with some sort of remote desktop application, but you still have to pay for the server, the RDP software, the support to set it up, the thin client, etc etc etc. Might be cheaper than buying all new computers with Windows 7, but it’s still a crazy cost to have to incur if you have working machines that just aren’t Windows 7.

  • P.S. The SaaS EMR vs. Client Server EMR is one of my favorite discussions. There’s such passion on each side. It’s one of those things that’s not easily changed once you’ve gone down that road, so each party has to defend their placement vigorously.

    I’ve been thinking about finding a couple proponents of each side and having them do guest blog posts defending each. We’ll see what I can find.

  • Security patches and hotfixes for WinXP SP2 ended this past July and will end for all versions of XP in April 2014. It might be reasonable for an EHR vendor to get ahead of the curve related to the switch from XP to 7 to take advantage of the superior security feature set of 7 given the strenghening of the security and privacy standards contained wihin HITECH.

    But all things considered, I stand with the SaaS crowd. The usability delta between SaaS and Client Server applications has been shrinking considerably in the last several years. My favorite EHR on the market today is a SaaS solution with an extremely well designed interface that was just given a 5 star rating for usability by CCHIT. IMHO, the only significant downside of a SaaS solution is business continuity in the event of a lost internet connection. So I do not recommend SaaS solutions for rural practices with spotty internet. On the plus for SaaS solutions are lower cost of adoption, lower hardware costs, lower hardware maintanance costs, easier updating process, and world class security infrastructure maintained by the vendor. I require all my clients, for example, to encrypt their endpoint devices running client server solutions. I do not for those utilizing a SaaS solution (although I still recommend encryption for other reasons).

Click here to post a comment