Server vs. Web-based electronic health records

Q. We are a 3-doctor primary care practice in Kansas and we're wrestling with the decision to either purchase a client-server based electronic health record (EHR) or a Web-based Application Service Provider (ASP)-hosted solution. Which is better for us?

A: If cost is a significant consideration and you can tolerate the hospital's primary care EHR templates, you should research any offers by local hospitals to subsidize your EHR purchase if you choose their system. They may offer to subsidize up to 85% of the software cost, thanks to a Stark exception, and they will provide the hardware infrastructure by hosting your software. Smaller-sized practices, 5 doctors or fewer, are gravitating toward hospital and nonhospital hosted solutions, since they eliminate the need to purchase and maintain hardware within the practice. Several larger EHR vendors recommend practices with 5 or fewer physicians consider ASP-hosted solutions because of the overall cost savings. With the uncertainty of physician reimbursement, it may be wise in your situation to take a more cost-conscious approach to your EHR purchase and be more willing to sacrifice the heightened functionality and features of the higher-priced systems.