"There's no portability to [a SaaS-based EHR system]," said Bell. "If a company goes out of business, or if you decide to move your records from one EHR and go to another, there most likely will be issues with getting the data out of where it's residing and moving it to somewhere else."
Bell also points out that there are hidden upfront costs many users forget to consider with a SaaS EHR setup. They include, for example, the costs of installing the proper networks and ensuring that the new software will work with your existing practice management system.
"These are all things that have to be considered," she said.
For Columbia Memorial Hospital in Hudson, N.Y., unexpected costs came from the need to upgrade remote physician practices from Windows 2000 to Windows XP servers, and from the need to get wireless and broadband networks installed. The hospital is located in a rural area, so getting adequate bandwidth is difficult. Most of the remote clinics were running fractional T1 lines or DSL virtual private networks with 1.5KB/sec. download and 512KB/sec. upload speeds. The hospital needed 768KB/sec. bidirectional capacity to handle the additional data traffic that came with an EHR system.
At one clinic with four physician practices, the hospital was forced to run a 10Gbit/sec. fiber optic line. The project required the use of "several carriers," said Michael LaForge, Columbia Memorial's network administrator .
LaForge said his hospital considered using a SaaS offering for itself, but the board decided it wanted control over the information, hardware and software. Having control can be costly, though. Without putting an exact price on the project, LaForge said it cost millions of dollars.
"I think in the end, we were a little surprised what the costs were. Not only was it expensive to get in, but then you have the ongoing costs. You figure in 26 practices and remote sites, and it adds up fast," he said.
LaForge said hospitals not only have to figure in monthly license fees, but also have to pay for maintenance and support for things like tablet PCs, laptops, smartphones, scanners and even fax lines, which some physicians insisted on even though they could fax documents electronically.
Columbia Memorial's CIO, Cathy Crowley, was able to secure a significant amount of state grant money to help defray the cost of the EHR rollout by offering to share the hospital's data center with physician practices that aren't affiliated with Columbia Memorial.
Under the state's HEAL New York grant program, the 190-bed hospital was able to afford a virtualized cloud computing network that serves 200 clinicians at 26 clinics, laboratories and group practices in the Hudson River Valley.