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SaaS EHR Down Time vs. In House EHR Down Time

Posted on August 9, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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.

Reasons Your EHR Will Go Down

Posted on July 26, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My previous post about the cost of EHR down time prompted me to think of all the ways that your EHR can go down. This might not be an exhaustive list, but hopefully it gives you an idea of the many many ways that your EMR can go down. With that knowledge hopefully you’ll be inspired to plan for EMR down time.

Reasons Your EMR Could Go Down:
Power Outage – Very few EMRs are setup to be able to handle a power outage. Sure, maybe you have a UPS attached to your server and some battery life in your laptop, but that’s only going to last so long. Plus, I bet your router/network switch isn’t on a UPS. What about your printer? You get the idea. EMR and power are friends.

Hard Drive Failure – At some point I asked someone why it was so common for hard drives to crash. They then described that hard drives are moving parts and anytime something is moving, there’s a higher chance that something will go wrong. Of course, now they have solid state hard drives that you can get. Either way, I’ve seen a lot of hard drives fail in my time. Of course, if you have a nice RAID setup for your hard drives, then you often won’t notice. Until they have to replace the failed hard drive with a new one. This could be the hard drive of your server or your computer. Most computers don’t have a RAID configuration.

Power Supply Failure – Most servers have redundant power supply. Why? Because they’ve been known to fail. If your server doesn’t have a redundant power supply, then be ready for down time. Most desktops don’t have redundant power supply and so they could easily fail too.

Network Cable – I don’t think I’ve ever seen a network cable go bad. However, I’ve certainly seen plenty of cables to servers bumped, moved, ripped out of the server. Everyone wonders why the server went down. Takes far too long to see that the network cable just got pulled out a little too much.

Switch/Router – Switches and Routers are what’s used in most offices to connect all your computers to the internet. Certainly these can go down if the power goes out. However, they can have other issues too. It’s not that common, but can sometimes cause down time for your office. Of course, wirelesss routers in particular can cause clinics lots of headaches when they go down.

Motherboard Failure – Might as well cover another common hardware failure: the motherboard. No motherboard and you can’t use your EMR.

EHR Software Issue – I’ve seen where a poorly tested and implemented EMR system would slowly use up all the memory on a server. Once it used up all the memory on the server, the EMR would take forever to do the simplest task. While not technically down since the server is up, it’s still a form of down time since users start refusing to use it in this state.

Internet Outage – This is particularly applicable to a SaaS EHR. Unless you have spent a lot of money to get redundant internet lines to your office (which in some locations is impossible), your internet will go down sooner or later. I don’t know how many times I’ve heard of some construction guy digging up the internet lines and causing outages for doctors offices. Happens all the time.

Much of the above can be applied to servers, desktops or laptops. Sometimes it causes a partial outage (ie. one laptop dies). Other times it takes down your whole EMR system (server dies). Either way, you should consider all these possibilities. Then, you see how you can minimize them (likely with the help of your IT support). Then, you think about what you’re going to do when the EMR down time happens.

Speaking from first hand experience, having a plan for EMR down time made all the difference when the event occurred.