Conflicting Indications of the Move to SaaS Based EHR

One of the really interesting things I noted while attending the NextGen user group meeting had to do with the move to SaaS based EHR and other SaaS based EHR software. I partially mentioned this in the write up I did at the conference, including a tweet where I talk about how Scott Decker really pushed the idea of NextGen making the move into the SaaS based software world.

I think there’s little doubt that NextGen sees the value of SaaS based software. I think they see the convenience to doctors of not having to manage a server. Most importantly, I think they see the value of not having the healthcare data stored in EHR in silos.

One thing that Scott Decker mentioned in his keynote was improving their coding rules engine based on the feedback and experience across all of their SaaS based EHR users. I found this really intriguing since it highlighted some of the challenges and limitations of the client server EHR model that’s so prevalent in healthcare.

After hearing these comments about NextGen’s move towards more and more SaaS based software, I wondered what users at the meeting thought about the move by NextGen to SaaS EHR. The nice part of a user group meeting is I had a chance to talk to a number of them.

One company I talked to said basically, “We have 30 Citrix servers in our NextGen EHR installation. That’s a huge investment we’ve made and I don’t see us changing that any time soon.” They’ve got an interesting point. There’s a lot of money invested in training, equipment, software, and general understanding of the current client server EHR installs that NextGen employs (or is it employed?) for its large EHR customers.

It’s quite a stark contrast to consider this entrenched client server user base that is unlikely to change even if NextGen’s direction is headed towards SaaS EHR software. To be completely honest, I’m not exactly sure how this “conflict” is going to play out.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, 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.


  • SaaS EHR Pros:
    – Reduced IT costs

    SaaS EHR Cons:
    – Speed
    – “I want my data in my office”
    – Speed

    It seems like a web based EHR makes a lot of sense.
    It seems like, if Facebook & Yahoo can serve up huge amounts of info instantly, then a web based EHR can to. Is the amount of data stored by an EHR really that different than the amount of data stored by Facebook?

    I haven’t met a SaaS based EHR that doesn’t drive the office nuts a month down the road in poor speed.

    There will always be folks who don’t want their data in the cloud – heck I created my own cloud in my office so I don’t have to store it somewhere else.

    BUT – as Facebook serves up loads of data almost instantly, using Google Docs drives me crazy. It is slow and clunky…compared to Office.

    This may be part of the issue.

    Either way, SaaS EHRs make a lot of sense for small offices…beyond that it gets fuzzy.

  • A really simplistic look at the pros and cons of SaaS vs. client server EHR software. Lots of them missing from your list. However, it’s very true that many offices will continue to use client server EHR software. Particularly in rural areas where internet speeds are terrible.

    Personally I’ve seen the issue of slowness with client server EHR as much as cloud based EHR. Yes, that probably does say something about many of the client server EHR software out there.

  • I think the lower IT costs of a SaaS solution are more mythical than reality.

    First, the practices still have to maintain a local network and that, often, is the biggest long-term problem and expense. You still have local clients, you still have viruses, you still have printers. Worse, the practices will be paying a lot more to their local telephone/Internet solution than they otherwise would. Sometimes, a LOT more…I have plenty of non-urban clients for whom reasonable commercial bandwidth is more expensive than the software.

    Second, server costs aren’t at all what they used to be. Every vendor I’ve spoken to simply amortizes their server costs and pushes it back onto the practice somehow. It’s not like a vendor is going to voluntarily take less money or even a loss.

    Third, every SaaS solution I’ve ever seen effectively guarantees a greater amount of downtime. Period. Whether it’s the vendor or the local Internet connection, you will not have access to your data and tools more often. What’s the cost?

    Years ago, there used to be an “ASP EHR vendor” mailing list. We were considering the jump to ASP/SaaS at the time and I asked the vendors on the list who among them actually passed their savings – because they can be considerable for a vendor – back to the customers. I even publicly shared our potential agreements for feedback.

    I got radio silence.

    In the end, the balance of the SaaS advantage is in the vendors’ favor.

  • What is lost in any discussion is the ultimate cost to the patient. Keeping up compliance with HIPAA, for instance, requires systems costs, software costs and increased paperwork (or should we say ‘computer work’) for office staff, not to mention legal advice. Sometimes what is initially seen as an enhancement to the practice of medicine is actually in impediment.

  • According to a paper from Carnegie Mellon University, compliance with the HIPPA requirements for 2003 cost $10,000 for a small medical practice to $14 million for larger organizations. It will be interesting to see the financials for compliance with the 2013 directives.

  • @ John: overly simplistic, sure, but reality.
    We tech nerds have to remember that non-techies don’t give a damn about a computer.
    This morning I installed a new graphics card on my wife’s computer so she could go dual monitor…I find that fun…many others don’t.

    @Chip: I agree. As I help offices to meaningful use risk assessments, those on a SaaS don’t really have any less costs. Some less pain-in-the-behind, but in the big picture, no huge savings.

    @loinc: hmm, is that cost per year, over the lifetime? I get small practices HIPAA compliant daily. To go from zero to fully compliant is not $10,000.

  • In the UK, where physicians and other health professionals are relatively new (and slow) to adopt electronic EMR solutions, SaaS EMRs provide a cheaper and reliable entry into the arena. ClinicYou ( is UK’s premier web based physician practice management and EMR software that helps clinicians to get EMR out of practice based silos. Patients retain control of their health records created by practices, even if the practices that created them delete their accounts.

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