SaaS EHR Down Time vs. In House EHR Down Time

Posted on August 9, 2011 I Written By

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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.