The Move to Cloud EHR

I’m pretty sure that many people missed the announcement that Amazing Charts now offers a Cloud EHR. For those who don’t eat, sleep and breathe EHR like me, you probably don’t realize that this is a pretty significant announcement on Amazing Charts part and I think represents a larger shift in the EHR industry.

I know the SaaS EHR purists will say that not all “Cloud EHR” are created equal. This is highlighted in the Amazing Charts press release where it says “without a web browser.” It’s an ironic statement when you consider that most SaaS EHR happily say, “with only a web browser.” (Although, the web browser only EHR software companies should read this post by Dr. West) However, my goal here isn’t to highlight the various nuances of hosted or cloud EHR software.

Instead, I wish to highlight how one of the popular, established, client server EHR software vendors was getting enough requests from doctors for a hosted EHR solution that they now offer a cloud based EHR. The reality is that many physician practices want to have to deal with as little IT support as possible. This is the major reason I’ve heard over and over again that many practices want to have a hosted EHR.

It’s worth pointing out that Amazing Charts focuses on the small physician practice market. It’s always been clear that the larger physician practices or hospital owned practices have better capabilities and a greater interest in hosting their EHR in house. While there are strengths and weaknesses to a hosted EHR vs an in house EHR, the hosted EHR is the compelling choice for the IT averse clinic.

Very soon we’re going to see almost all new EHR installs in small ambulatory practices using some sort of hosted EHR software. This doesn’t necessarily spell the death of client server EHR software. Many large practices will continue using and implementing client server EHR software. Not to mention many long time EHR users will continue with their existing client server installs. However, the shift to hosted EHR is happening and will start to really pick up pace in the next couple years.

Full Disclosure: Amazing Charts is an advertiser on this site, but they didn’t know I was doing this post.

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.


  • I just had a discussion with a medical IT firm yesterday about this. About 200 doc offices, their average size is 5 providers.

    He said daily gets questions about the “cloud”.

    According to him, there are no two ways around it:
    The cloud costs the client more, and makes him more money.

    This doesn’t mean a SaaS based EHR is a bad thing.
    My experience is, it generally makes sense in a small practice (1 provider, ~5 total staff).

    BUT watch out for the sales pitch where cloud is mentioned more times than EHR.

    I’ve seen too many SaaS implementations move at ludicrous speed.

    The argument as to whether a SaaS based EHR is developed properly for the web can also be made about a client/server based EHR.
    That is: if a client/server based EHR is designed correctly, and maybe more importantly IMPLEMENTED correctly, then there wouldn’t be much to-do about the two different types.

  • John,
    That’s really the key challenge. Implementing the client server correctly is harder for a physician practice.

    I’d be interested to know what services the medical IT firm provides with a cloud based EHR that makes it more expensive than an in house EHR.

  • I’ve made no secret of my preference for many practices of a cloud / SaaS / ASP based system. But I’m just as adamant that such a system needs to be as robust. It must have proper internal redundancy, effective failover to DR / COB sites – in REALTIME, and full ability of the provider to have an up to date copy of their own data. Not that I know that this all exists today!

    Consider this; in the financial world, there was once a firm that pumped out financial market data (interest rates, equity prices, news, etc.) to tens of thousands of terminals. It did have a robust data center with all sorts of backup power, well secured. It NEVER got around to building a 2nd ‘plant’ in case something happened to the first. One day, during a major blackout, the plant was doing fine, on generator, when a rent-a-cop heard an alarm going off (alarm caused by the blackout). The guy got a brilliant idea; he could silence the alarm by pushing the proverbial big red button under the label “Press only in case of emergency’. Push he did, and by so doing, shut down the emergency generators!

    The users were down for more then a week! The basic lesson is simple – how does the cloud provider make sure that there are never unscheduled outages – and that backup equipment has all the current data? Consider what happened to Amazon’s cloud service. So 1. the provider has to have 2 or more truly independent data centers not near each other on different grids with different comm vendors plus having full emergency power capability, and the local user needs to have a dual connection at minimum set up in a way that one way or another he connects to his data SOMEWHERE continuously.

    Unfortunately, my guess is that few if any EHR vendors do it the way I think it should be done! Maybe if they thought of EHR’s as being important as say, live feeds from the financial markets they’d take this a bit more seriously. And maybe the Fed’s should have some standards!

  • The challenge of meeting the opportunity that cloud/web technologies can bring to healthcare is to get beyond thinking in terms of web browsers and understand the true implications of connecting APIs.

  • @John
    It is not more expensive up front, but basically from about year 2 on, you could have bought the in house system…and you’d actually own something.

    I’ve dealt with both. Even the same EHR SaaS version with one office, client/server at another.
    Each has its issues – the biggest issue on the C/S side is the vendor upping hardware requirements with new versions.

    Ah yes, APIs.

    On mobile devices, APIs driving a custom app is great, and basically required due to the limitations of a mobile device.

    Write a custom desktop app and you quickly step away from one of the sales pitch reasons for the cloud.

    There is an EHR out there that installs “neat” add-ons to IE.

    The problem with the two above examples is they add complexity, which in-turn reduces much of the simplicity of a web based EHR.

    In the end, though, speed is the SaaS EHR issue.

  • can you explain to your knowledge what most of these Hosted application are using to present the app the the user? Is is RDS, Citrix, or something else?

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