Choosing deployment for your software is like choosing a new car. Options vary in price and what they can offer you, but the end goal is the same. Choosing between cloud-based EHR vs. on-premise systems can feel like comparing a Mazda to a Lexus, but we’re here to tell you about the pros and cons of both types of EHR software that may surprise you.

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What This Article Covers

• Overview
• What Is Deployment?
• Impacts of Software Deployment
• Software Deployment Process
• Cloud-Based vs. On-Premise
• How to Find the Right Deployment for Your Business
• How to Choose Between Cloud and On-Premise

Overview

As a practitioner looking to purchase an EHR system, you may be feeling overwhelmed. Do you need medical practice management software or an EHR?What’s the difference between electronic medical records (EMR) and electronic health records (EHR)? What are deployment options? Which is right for me? Do not let these questions haunt you when we are here to help. This article will provide a quick rundown of what deployment means and how to make the right choice for your field-specific requirements.

What is Deployment?

The deployment environment is basically a habitat for software to live in. It is a collection of clusters, servers and middleware that work together to host that software. These environments can be simple, where a program is developed and executed on the same machine — but they can also be as intricate as a biological ecosystem where software is hosted over a range of steps and locations.

Software deployment has evolved over the years, creating better paradigms for meeting the ever-changing needs of health care organizations. In a connected world like today, requiring frequent software upgrades enables medical practices and enterprises to access newer technology and features for an efficient and swift production environment.

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Impacts of Software Deployment

Analyzing the impacts of cloud-based and on-premise deployments is essential for users to know how they can expand their enterprise based on the application’s features and updating capabilities. Take a look at the below-mentioned points to ascertain the impacts both types of deployment have:

Updates

Deployment impacts updates in the sense that it determines how, when and who implements updates. With cloud-based deployment, vendors install updates and make them live for users. They typically come without additional charges as well.

On the other hand, with on-premise deployment, updating a system is often left to individual organizations that use the software, which means they need IT support to implement it. In addition, they may have to purchase individual updates from the vendor before they can add them to their on-premise system.

Functionalities

As far as the application’s features and functionalities are concerned, they are typically left up to the vendors. Customization in cloud deployment often comes with extra charges depending upon the unique requirements of the buyer. Whereas on-premise offers more flexibility for customization as long as you have the IT support and know how to do it.

Software Deployment Process

The method of deployment you choose matters almost as much as the choice of which software you use. Every method for deploying software comes with unique benefits and drawbacks. Pricing, accessibility, convenience and security are some of the main features to look at when choosing between EHR systems.

Each organization has to develop a deployment process on its own depending on its unique business requirements. While most like to customize a new process each time they wish to buy an application, others might just use their existing framework to meet their organization’s objectives. In either case, it all narrows down to three general stages. Read ahead to know what these phases are:

Preparation

In the first stage of the process, the vendors have to prepare for software deployment by gathering all the necessary information, including coding, configuration files and data libraries for the new system to function efficiently.

Testing

Before making the new update live, it is necessary to test it on a server for quality assurance and bug fixing, if any. The developers create a set of automatic tests to check the upgrade prior to deploying it to the live environment.

Deployment

After system testing and error fixing, this is the final stage where vendors change the databases for the update to go live. This phase is where the final alterations take place for users to have an enriching experience with the new update.

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Cloud-based vs On-premise

While there are other deployment options (like hybrid or hosted), the two most popular deployment environments are on-premise and cloud.

On-premise deployment involves hosting the EHR software on in-house servers, maintained and implemented by an organization’s IT team. Cloud-based is an online Software-as-a-Service (SaaS) implementation that hosts the software in the cloud where users access it via the internet. Both come with unique pros and cons that can impact your decision-making, and we’ve done some research on those, so you don’t have to.

Pros of Cloud

Cloud EHR systems are becoming ubiquitously more popular regardless of the software field, and it’s not hard to see why. Web-based EHRs don’t require complex installation processes where technicians come to your practice and set up intense infrastructure to host your data. It can all be done via the internet, with no need for a large IT presence to support you if you have trouble.

Speaking of it all being done on the net, cloud-based EHR systems give you anytime, anywhere access. Need to take your EHR on a tablet to patients’ rooms? Cloud has you covered. Want to access patient notes via a smartphone? Cloud can do that too.

Although there is a general consensus that cloud-based data storage is less secure than on-premise, it’s not as significant a liability as some sources make it out to be. Because the vendor is responsible for security measures, you know they’ll utilize robust security services to keep sensitive patient data safe that you potentially couldn’t afford on your own.

As cloud becomes more popular, the security discrepancy is also shrinking. Plus, because your information isn’t stored physically within your premises, it is protected in the event of a natural disaster or other unforeseen incidents that could destroy an on-premise system that has no backup.

Cloud-based EHR systems will also typically be more cost-effective. Cost is determined mainly by the number of users and usage of features, and many vendors will only charge you for the features you want access to. Most vendors offer extensive customization abilities. If your practice operates across multiple locations, the cloud allows you to all collaborate within the same system regardless of distance.

The cloud-computing market size is anticipated to reach $947.3 billion in 2026, growing from $445.3 billion in 2021 at a 16.3% Compound Annual Growth Rate (CAGR) over the forecast period.

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Some primary advantages of cloud-based systems are:

Reduced Staff Burden

As cloud storage management is in the hands of another company, you will not require your IT department to install a new application with its patches and updates, thereby enabling them to focus on other crucial tasks.

Minimized Capital Expenditure

Cloud-based systems fall under the category of operational expenses. Since external parties handle the entire storage requirements for these systems, there’s no need for you to buy and install extra equipment for your organization.

Budget-friendly Price

Organizations in their initial stage benefit extensively from cloud-based systems as they do not require significant investments for these applications upfront. Since storage is taken care of externally, you will never find yourself locked into making payments for extra storage or features you don’t require.

Scalable Framework

Cloud-based applications have a scalable nature, due to which users can also upgrade their storage plans as and when required. Since these systems are great for helping you expand based on your current company requirements, you never have to worry about your system slowing down or purchasing a new one with changing business needs.

Cons of Cloud

Just because on-premise is often more expensive than cloud, at least upfront, it doesn’t apply to every situation. Costs can quickly accumulate when utilizing cloud-based software. A monthly subscription fee could end up costing you more in the long term than a one-time licensing fee, depending on how long you end up using the software.

Because patient data is transferred back and forth across internet connections, it is vulnerable to attack at more points than data secured onsite. Maintaining HIPAA compliance is crucial for a practice to continue delivering patient care, so make sure you read in detail about vendors’ reputations and work ethics before you join hands with them.

Because you are purchasing a software platform that another organization controls, there will also be less extensive customization features than an on-premise software you implement to your specifications.

Deploying your online EHR in the cloud can also establish a relationship of dependence between you and the vendor. You rely on them for updates, support and access, which may be something you don’t want to risk depending on the vendor’s reliability. That’s one reason it’s essential to do your research beforehand!

Take a look at the points mentioned below to determine some disadvantages associated with cloud-based systems:

Internet Outage Downtime

Keep in mind that cloud-based EHR software is, well, cloud-based. This implies that if your facility has connectivity problems, you could be without your system. Cloud-based software will also go through automatic updates, sometimes happening at inopportune times resulting in business interruption.

These problems aren’t limited to unexpected internet outages. If your practice has limited bandwidth or a generally underperforming internet connection, you could experience severe concerns with a cloud-based system, which is difficult to fix even through customer support assistance.

Ballooning Costs

The scalability advantage of cloud-based applications can be a disadvantage if not taken care of properly. Since these applications run on consumption models, the higher your requirement for storage and other features, the bigger your monthly subscription will be. In such cases, health care organizations must always adopt policies and processes to circumvent last-minute invoice surprises.

At-risk Data Security

With cloud applications, you have to entrust your data security and storage to an external party for them to handle it with safety and protection. When you join hands with a vendor for information management, you risk giving an unauthorized party access to your personal data. To avoid this, always ask cloud application vendors to brief you about their security procedures and data encryptions while files are in transit.

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Pros of On-premise

We get it — storing sensitive patient data in the cloud can be nerve-wracking. What if the internet goes down and you can’t access your data? What if it gets lost? What if it gets hacked? These are the primary user concerns of those who swear by on-premise solutions.

Because your data isn’t traveling anywhere, it is typically safer and more secure from hacking. Keeping your patients’ electronic medical record data safe from prying eyes is a high priority, so when considering software solutions, security features should be at the top of your list.

On-premise deployments can be convenient for some specific needs. It allows users to work without an internet connection. If the internet goes down, that doesn’t mean you have to.

This option is very customizable during implementation. Since users are basically building the hosting environment from scratch, they can request the vendor customize various aspects to their specifications. And if you need support with on-premise, you’ll most likely already have a robust IT team supporting your practice and won’t have to wait for customer support to react to your needs.

Here are some key advantages of on-premise systems:

Offline Operation

Since on-premise software deployment occurs via internal servers, you’ll never have to worry about slow connectivity because of unreliable internet. If your internal server connection is strong, your software will run at its best.

Better Security

Since cloud-based applications are vulnerable to prying parties, a solution to this problem is on-premise deployment. In this case, you can restrict your data from anyone that does not have authorized access to your storage.

Enhanced Control

In lieu of asking cloud application vendors to upgrade their feature stack or introduce new functionalities, you can upgrade your system yourself by using an on-premise system. This software type enables you to modify your product with great flexibility, customization and storage options.

Cons of On-premise

Being in control of your own security is both a pro and a con. While you may be less likely to be hacked, you are also responsible for managing your security measures. Your practice’s IT department will be busy when you choose on-premise — they will have to work on everything from implementation to support to repairs.

Some disadvantages of on-premise deployment are:

Pricey Upfront Costs

From maintaining that IT department to the original installation and upfront software license fee, on-premise will usually be more expensive than cloud-based deployment. This may not be a problem for a multi-physician practice or hospital, but a small practice may find it cost-prohibitive. Software updates not included in your original contract can cost extra and may also need implementation from users instead of vendors.

While large hospitals could definitely benefit from on-premise EHR software, family practices may find it challenging to come up with the space for servers as well as the money for the initial implementation.

Data-loss risk

With backup services so prevalent and affordable these days, it’s unlikely that you would store your data only in your on-premise server. But in the event of an incident like a fire or flood, on-premise software has the disadvantage of being stored in your physical location. Other issues, including system malpractice and ransomware attacks, can also lead to information loss.

Limited Scalability

When your company decides to expand, your system scalability is what you primarily require to execute this plan. With on-premise servers, scalability is challenging as additional features and storage requirements demand new hardware installation with labor for software implementation.

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How to Find the Right Deployment for Your Business

Each company’s IT department has its own set of unique needs. And while these requirements could also sometimes look like challenges, setting up a structured procedure for your IT team can help keep all your employees on the same page.

For choosing the right deployment for your current business needs, you’ll need to consider the following:

• Make a list of goals you wish your organization to achieve in the next 5–10 years. Since application purchase isn’t something you’re going to go for every year, it’s crucial that you factor in each important aspect of your objectives to be directed towards goal achievement.
• Choose a deployment plan by considering your employees’ feedback and current company goals.
• Create a deployment checklist to ensure you’re not missing anything of paramount significance.
• Use a trial version to ensure zero bugs or errors in the system you want to purchase.
• Get in touch with the application vendors to know their products better and communicate your requirements and expectations from the purchase in a detailed manner.

How to Choose Between Cloud and On-Premise

To reach a decision that fits your organizational requirements, you need to consider the following points:

Data Storage

This aspect of your purchase decision decides whether your data will be stored on a third-party server or your own in-house system. Since cloud computing offers you an external system to run your codes rather than managing each and every piece of information on company premises, base your decision on how you’d like to store and run your data.

Statista’s report states that 49% of data will be stored in cloud centers by 2025, leading the global creation to grow more than 180ZB (zettabytes).

Control

Since cloud computing comes with its own terms and conditions, you may not always be able to use the system if there’s downtime on the cloud. On the other hand, on-premise systems let your company’s IT team take responsibility for uptime and downtime troubleshooting.

Security

Even though the cloud offers better convenience than on-premise deployment, one area where you may have to sacrifice a tad bit is information privacy and safety. Since on-premise systems allow you to take complete charge of your data security, you will have instant access to everything stored on your premises.

Compliance

Users looking to purchase cloud-based deployment need to ensure that the vendor they choose for their application requirement complies with regulations. On-premise, in contrast to this, makes compliance way easier and direct irrespective of whether or not the system is subject to HIPAA.

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The Final Verdict

We can’t decide for you, but hopefully, we gave you the knowledge you need to make an informed decision. On-premise is a valid option for security-conscious, technology-savvy practices. Cloud-based EHR is an equally valid solution for those who want the convenience and accessibility that comes with the age of the internet. Check out our EHR comparison report to compare some of the most popular EHR solutions for both deployments.

Which deployment do you use, an on-premise or a cloud-based EHR system? What made you make that choice? Have you had good or bad experiences of your own with EHR deployment? Leave us a comment and tell us about it, and help others determine which deployment is best for them!