SaaS EHR Down Time vs. In House EHR Down Time

As part of my continuing series of posts about EHR Down time (see my previous Cost of EHR Down Time and Reasons Your EHR Will Go Down posts), I thought it would be interesting to look at how a SaaS EHR down time is different from an in house EHR down time.

I’ll use the list of reasons your EHR go down as my discussion points for how it’s different with a SaaS EHR versus an in house EHR. On each point, I’ll see if either approach has an advantage over the other.

Power Outage – Certainly a power outage will impact both types of EHR implementations. If your computer or router doesn’t have power, then it doesn’t matter where your EHR is hosted. However, many clinics use laptops which can run for quite a while without being plugged in. Plus, a small UPS for your network equipment is pretty cheap and easy to implement.

However, a good UPS for your own server will cost a bit more to implement. Plus, the UPS won’t likely last very long. Most UPS are there to give you enough time to power down your system properly or to handle a short power outage. Of course, in this case we’re talking about a small clinic implementation. I have done an EMR implementation where we had some nice UPS and even a backup generator. However, this is the exception.

Conclusion: Slight Advantage for the SaaS EHR

Hard Drive Failure – Certainly the failure of a hard drive in your desktop machine will affect both types of EHR install equally. So, that part is a wash. However, the hard drive failure on your local server is much more of an issue than a SaaS EHR vendor. At least, I’ve never heard of a hard drive failure causing an issue for any SaaS software vendor of any type. Both in house and SaaS EHR implementations can implement redundant hard drives, but SaaS EHR vendors have to implement redundant servers.

Conclusion: Advantage SaaS EHR

Power Supply Failure – This one is similar to the Hard Drive failure. I know a lot of EHR vendors that have their clinics buy an in house server that doesn’t have redundant power supplies. I can’t imagine a SaaS EHR vendor buying a server without redundant power supplies even if the redundancy is across servers.

Conclusion: Advantage SaaS EHR

Network Cable – Cables can get pulled out of switches just as easily as servers. So, I conclude that it will affect SaaS EHR and in house EHR the same.

Conclusion: Tie

Switch/Router – Loss of a switch/router will cause either a SaaS EHR or in house EHR to go down.

Conclusion: Tie

Motherboard Failure – An in house server only has one motherboard. If that motherboard fails, you better hope you have a great tech support contract to get a motherboard to you quickly (For example, Dell has a 4 hour support contract which is amazing, but pricey). Certainly a motherboard can fail for a SaaS EHR as well, but since they likely have multiple servers, they can just roll the users over to another server while they replace the motherboard.

Conclusion: Advantage SaaS EHR

EHR Software Issue – This is a hard one to analyze since a software issue like this could happen on either type of EHR install. It really has more to do with the EHR vendor’s development and testing process than it has to do with the way the EHR software is delivered.

You could argue that because the SaaS EHR is all hosted by he company, they will be able to see the issues you’re having first hand and will have tested on the hardware they have in place. A client server/in house EHR install could be on a variety of EHR systems that the EHR vendor didn’t know about and couldn’t test as they developed and deployed the system. So, I could see a slight benefit for the SaaS EHR system.

However, one disadvantage to the SaaS EHR system is that they are hosting it across dozens of servers and so when something goes wrong on a server it’s sometimes hard to figure out what’s going wrong since all the servers are the same. Maybe that’s a bit of a stretch, but we’ve all seen times when certain users of a service are down, but not others.

Conclusion: Maybe a slight advantage to SaaS EHR

Internet Outage – This one is the most clear cut benefit to an in house server. When your internet connection goes down, the in house server keeps plugging along no problem. Loss of your internet connection with a SaaS EHR is terrible. No doubt that’s often the greatest weakness of a SaaS EHR. Although, it can be partially mitigated with multiple internet connections (ie. wired internet and wireless broadband internet).

Conclusion: Advantage In House EHR

I have to admit that I didn’t realize going into this analysis that it was going to be a landslide for the SaaS EHR. Although, that’s quite clear from this analysis. When it comes to EHR down time, the SaaS EHR is much better. Unless, you live in an area where the internet connection is unreliable and slow. Then, you don’t really have much choice since SaaS EHR needs a reliable internet connection.

It’s also worth noting that this article only talks about how EHR down time relates to SaaS EHR versus in house EHR. There are certainly plenty of other arguments that could be made for and against either implementation method such as: speed, privacy, security, cost, etc.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, 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, EXPO.health, 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.

7 Comments

  • I would say that the hard drive failure is a wash, or maybe not as one-sided, as well. It is modern practice for any server to have a raid array to prevent that problem. Of course, replacing that hard drive would require some sort of (potentially expensive) technical experience, but is not impossible. So maybe the cost is greater with in-house, but the risk of hard drive failure should not be as dire.

  • Nick,
    You make a good point. It is definitely closer than what I described. Although, I would also offer the concern that a small office might or might not have implemented the RAID correctly. So, that could be a real issue too and would be less likely for a SaaS EHR.

    Good point on the cost of fixing the failed hard drive. Those other costs are all part of the rest of the analysis of SaaS EHR versus in house EHR server.

  • I am an IT provider in Melbourne, FL and I install a client / server EMR system and feel that this is a better solution for my clients. I’d like to offer my insight for the points you pose:

    POWER OUTAGE – Many SaaS EMR’s require a cache server onsite. If you want to continue working, this server will need to be on a battery backup device just as a regular server. I contend that ALL devices on the networks I install are on a battery backup. I am in Florida so there are many spikes and surges that we contend with. Do you really want to risk a databse corruption because one of your computers was not on a $40 battery backup? In the event of a major outage, you will not have lights in your office so whether your system is up or not is inconsequential.

    HARDDRIVE FAILURE – A reputable IT provider will insist in redundant drives in your server that will tolerate a failure. The right server will have drives that can be removed while the server is running without opening the chassis itself. As an added safety net, we provide a backup device that can 1) allow the restoration of a lost file / folder 2) be “virtualized” and run as the server if that unit fails 3) push the server data securely off-site in the event of major catastrophy to ensure business continuity. You cannot work without your charts – we make certain that you will always have them.

    MOTHERBOARD FAILURE – As I mention above, it is imperative to have an onsite backup appliance that can be “virtualized” in the event of a catastrophe such as a motherboard failure. With the proper IT provider, you will have little to no downdime.

    EHR SOFTWARE ISSUE – We have seen many companies change hands over the years. When your data is outside your office, who owns it? How do you know that the Saas provider is paying their bills? How solvent is the company?

    POINTS NOT ADDRESSED:
    Bandwidth – With a Saas, you only get a certain amount of bandwidth over the Internet. If you are on a slow DSL connection, your upload speed could be cripplingly slow. A client / server install should operate at 1Gbps. Physicians have a tough job – picking a solution that does not keep pace with the doc will be bound to fail.

    Interfaces – How will you connect your EMR to a medical device / patient portal / patient checkin device / phone dialer for patient reminders, etc.?

    There is added cost to a client / server installation. But this leads to added control and customization so that you can match your process flow to a system. Your charts are your livelyhood. Make certain that you can always get to them and that they are always safe and secure.

  • While not as technical, I have a couple of other issues that I’ve seen impact our clients:

    inter-connectivity- We’ve found it much harder to get a SaaS option to integrate with other service providers (such as local hospitals, smaller labs, etc). The connection often either doesn’t work at all or is buggy and hard to support since we’re stuck between two vendors.

    contract problems- Believe it or not, we’ve had a client who had a billing issue with their SaaS provider. The provider shut down the system until the problem was resolved (the error was on the SaaS provider’s side!). This doesn’t happen with a system the practice owns. It caused a serious downtime issue (they migrated to self hosted shortly afterwards).

    Everyone will tell you that healthcare is about ten years behind the rest of the tech world. As the rest of the world begins to move into the cloud more and more, I’m hopeful that SaaS or web based versions of EMR will someday replace heavy in house systems. But until then, the benefits of each system aren’t always clear.

  • Donnie,
    Good reminder about the lights when the power goes out. Although, a number of practices could continue on without lights if they have the high windows that bring in light.

    Much of what you describe has the really big IF of if you have a reputable IT provider. The problem in far too many small practices is that they don’t have a quality IT provider. Plus, many that do have a good IT provider try to take shortcuts and don’t understand the consequences of these choices.

    So, I think my post and your comments will really help to educate these offices in the choices they have to make.

    Jason,
    Some nice additions in the choice between SaaS EHR and in house. It’s definitely not a clear cut decision. Down time is definitely only one small part of the overall equation.

    Thanks everyone for expanding the conversation. There’s much to learn.

  • John

    As a SaaS provider, you are hosting your solution in Tier 3/4 data centers ( make sure your SaaS EHR vendor is not hosting it from his garage.. there are lot of them) with N+1 if not N+N redundancy on most critical infrastructure layer i.e server, network gears, ISP providers, bandwidth providers etc. Now try to built this in a locally hosted solution, your practice will go out of business. For practices which are not larger , SaaS provides a vast superior platform.

    BTW, our platform stayed up during Sandy, however the providers facility had no power to connect but some of the providers were able to complete their charts from home ( who had the power).

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