Three EHRs can all be sold as "in the cloud" and still work in very different ways. The difference shows up in your bills, your backups and how your staff log in.

Here's what each term means, and four questions that tell you which one you have.

Server-based

The software is installed on a server in your office. Your PCs connect to it over the office network.

• You own the server. You replace it when it wears out, often every five to seven years.
• You look after it. You or your IT person install updates, run backups and fix it when it breaks.
• If it stops, you stop. A dead server or a power cut can close the front desk.

Cloud-hosted

This is the same server software, moved to a server in a hosting company's building. Your staff reach it through a remote desktop app that streams the screen to your PCs.

• The host looks after the hardware. It often runs backups too.
• The software hasn't changed. It's the same program, with the same upgrades to schedule.
• You pay twice. The host charges for the server. Your EHR vendor still charges for the software licence.
• Everything goes through the remote connection. Printers, scanners and signature pads have to work across it.

Cloud-based

The software is built to run on the vendor's own servers. You use it in a web browser. Some vendors call this "cloud-native."

• No server anywhere you pay for. There's nothing in your office and nothing rented from a host.
• The vendor does the upkeep. It ships updates to everyone, runs the backups and handles security.
• One bill. Hosting and software come in a single subscription.
• Log in from any computer. All you need is a browser and an internet connection.

Four questions that tell you which one you have

1. Do you open a remote desktop app before your EHR? If yes, your EHR is server-based or cloud-hosted.
2. Who installs Windows updates on the computer your EHR runs on? If it's you or your IT person, it's server-based. If it's a hosting company, it's cloud-hosted.
3. Can you open your charts in a normal web browser, with nothing to install? Only cloud-based software works that way.
4. Who pays when the server wears out? You pay directly for server-based and through your hosting fee for cloud-hosted. For cloud-based, the vendor pays.

How they compare

Cost - Server-based: the server, the software licence and IT help. - Cloud-hosted: the hosting fee and the software licence. - Cloud-based: one subscription.

Backups - Server-based: yours to set up and test. - Cloud-hosted: usually the host's. Ask what's covered and how fast they can restore it. - Cloud-based: the vendor's. Ask how often they run and how long they're kept.

Access - Server-based: office PCs, or remote desktop into the office. - Cloud-hosted: remote desktop from any PC set up for it. - Cloud-based: a web browser on any computer.

Why it matters now

Many practices moved to a hosting company when their office server died. That fixed the hardware problem. It also kept the old software and added a second bill.

If your EHR vendor is already steering customers toward a newer product, a move is coming either way. Compare all your options before you sign another hosting term.

Where IrisMed fits

IrisMed is cloud-based. You open it in a web browser, and there's no server to buy, rent or patch. Hosting, backups and security are part of it.

Your data is encrypted in transit and at rest. Our HIPAA compliance is independently audited by Thoropass.

When you switch, we help you move your data and we train your team. Ask us what we can bring over from your current system.

FAQs

Is cloud-hosted less secure than cloud-based? Not by definition. Either one can be run well or badly. The real differences are who does the work and how many bills you pay.

Does a cloud EHR work if the internet goes down? No. Cloud-hosted and cloud-based systems both need an internet connection. A backup internet line keeps you working if your main one fails.

Is a hosted server really "the cloud"? It's in a data center, so some companies call it that. But it's still server software, reached through remote desktop.

Which is cheapest? It depends on your practice. Add up every bill, including IT help and staff time, before you compare. Our article on EHR hosting cost includes a worksheet.