By Lawrence Gordon, MD, CEO of Waiting Room Solutions


Are you thinking of taking the plunge and instituting an Electronic Health Record in your practice?  Before you do, consider web-based software as an alternative to the traditional on premises software.  Many other industries have accepted Software as a Service (SaaS) as a viable alternative to on premises software with leading software applications like and Oracle Small Business.  With some new introductions to the market, there are now systems that will certainly pique your interest.  All that is required to get up and get going is a broadband Internet connection, a workstation or tablet and  a web browser.

Why Go Web-Native.   Generally web native software can be delivered more affordably in a subscription model, rather than a one time license purchase.  Because you are essentially “turning the software on” that is already running, vendors can price their software at a reduced costs.  Implementation costs can also be reduced as there is no on-site software or data sets to install.

Centralization of computer system functions also offers a big advantage to the end-user.  Updates, maintenance, network security, and backups all happen centrally.  These are all functions that are hidden costs for on-premises software.  Moreover, it is difficult for the small practice to maintain and afford an infrastructure to perform these functions professionally.   This centralization of computer services also enables centralization of other functions such as billing, scheduling and transcription services.

Your data is also always available to you wherever you have an Internet connection.  So if you are in the hospital, home at night, or away on vacation, all you need is an Internet connection to view or monitor what is going on in your office.  Having your records always available also can save on the cost of chart-pulls and the expense of faxing records between offices.

Finally, connectivity is another advantage to using a web-based platform.  If the platform you select is connected to reference labs, clearinghouses, pharmacies and hospitals – these are connections that you do not need to individually maintain yourself.  The cost and work associated with maintaining these connections is centralized and relieves the practice of establishing and then maintaining all these connections.  As connectivity becomes more important in Health IT, this becomes a big differentiator.

What are the Risks.  There is a natural concern about not having your data sit on your own servers in your own office.  Although your data remains yours, you are relying upon your service provider to perform reliable backup and continuous service.  Most software providers can do a better job of maintaining your data better than the small practice, but physically having on site servers may be an issue for some practices.  Also, many of these software services are relatively new to the market.  This leaves some room for uncertainty about the quality of the products.  Independent certifications such as CCHIT (Certification Commission for Health Information Technology) can help relieve physician concerns about the levels of functionality and security contained within a product.  CCHIT certified web-native products include Waiting Room Solutions 3.0 (, WebChart 4.23 (, CureMD 9.0 (, athenaClinical 0.15 (, and OfficeEMR 2007. You can use CCHIT certification as a starting point, however there are other non-CCHIT certified products that also may suit your needs.

Other risks associated with a web-based platform include system speed.  Most systems, if optimized should perform with the same speed and functionality as on-premises software.  However, you will need adequate bandwidth at your office and workstations that have sufficient chip-speed and RAM. With new technologies such as AJAX, web native software can do everything and respond as quickly as on-premises client-server software. 

Is the Software as a Service better for some practices than others?  The software as a service model may hold particular appeal for the small practice of 1-5 physicians.  Most small practices do not have the financial resources to afford expensive license fees of on-premises software.  Moreover, the cost of updates and service for on-premises software may be in the same range as the subscription cost for SaaS web-based software.  Also practices that are just starting up and looking for a complete solution, but do not want to spend a lot of money would fit well with a SaaS vendor.

Is now the right time?  With the low barrier to entry in terms of cost and features, there could not be a better time to try a web-based solution.  Most of these systems are compatible with multiple forms of data entry such as templates, voice recognition, key board and handwriting recognition.  Some will also offer a limited free trial.  With the advantages growing it might just be the right time to get connected.

Dr. Gordon’s article is published in EHR Scope Fall 2007 Volume 4 publication.  To view his article please visit