Your EHR hosting cost may be only half the bill. Many eye care practices pay a monthly bill they think is for "HIPAA storage" or "IT." Look closer, and it's often rent on a server that runs their old EHR.

That's only one of the two bills.

How the two bills start

Older EHRs were built to run on a server in your back office. When that server got old, many practices didn't buy a new one. They paid a hosting company to run the same software on a server in its building instead.

Your staff now log in through a remote desktop app. The screen streams to your office PCs, but the software runs somewhere else.

That move changed where the server lives. It didn't change who owns the software. You still pay your EHR vendor for the licence, usually through a yearly maintenance and support agreement.

So you pay two companies for one job:

• The hosting company rents you the computer.
• Your EHR vendor rents you the right to use the software on it.

Why practices don't notice

• Two companies, two schedules. The hosting fee is often monthly. The software agreement is often yearly. They rarely sit side by side.
• Vague names in the books. The hosting fee gets filed as "IT services" or "data service."
• No one chose it. A hosting company was the quickest fix when the old server died, so it stuck.

We met one practice that thought its monthly bill was for file storage. It was paying to host its whole EHR, with a separate software agreement on top.

Add up your own numbers

Pull the last 12 months from your accounting software. Search for your EHR vendor, your hosting company, and anything labelled IT, hosting, cloud, backup or support. Then fill in these lines:

1. Hosting fee. The monthly charge times 12, plus any yearly extras.
2. Software maintenance and support. The yearly agreement with your EHR vendor, for each location. Add any separate charge for the exam or charting module.
3. Remote access. Licences for the remote desktop app, if they're billed separately.
4. Outside IT help. Anyone you pay to keep office PCs, printers and scanners working with the hosted server.
5. Backup. Any backup service billed on its own.
6. Downtime. Hours your front desk couldn't work because the connection dropped, times their hourly wage.

Lines 1 and 2 are the double bill. Lines 3 to 6 are what it costs to keep that setup running.

What the total can look like

These are estimates, not quotes. Hosting fees of a few hundred dollars a month are common, which adds up to several thousand a year. Yearly software agreements for older systems can pass $1,000 per location.

Put together, a one-location practice can spend $5,000 to $7,000 a year on hosting and software alone. That's before any IT help or lost staff time.

Before you cancel anything

Many older EHRs go read-only when the maintenance agreement lapses. You can view your records, but you can't add to them.

So don't stop paying either bill until your data is safely out. Ask your vendor and your hosting company what export they'll give you, in what format, and what it costs. Get the answer in writing.

What a cloud EHR changes

A cloud EHR is software you open in a web browser. The vendor runs the servers, the backups and the security as part of one subscription. There's no server to rent and no separate licence on top.

On the worksheet above, lines 1, 2 and 5 become one bill. Lines 3 and 4 usually get smaller, because there's no remote desktop to keep working.

Watch the word "cloud," though. A hosted server that you reach through remote desktop is sometimes sold as a cloud EHR. It's the same software in a different building. Our guide to cloud-hosted vs cloud-based EHRs explains the difference.

Where IrisMed fits

IrisMed is an all-in-one EHR and practice management system that runs in your web browser. Hosting, backups and security are part of it. There's no server to buy, rent or patch.

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

How do I know if my EHR is hosted? If you open a remote desktop app before you open your EHR, it's almost certainly hosted. Check your books for a monthly payment to a company that isn't your EHR vendor.

Can I stop paying the maintenance agreement? Only after your data is out. Many older systems go read-only when the agreement lapses.

How long does a switch take? It depends on how much data you have and what your current system can export. Our EHR migration timeline guide walks through each phase.

Will I lose my old records? Not if you plan the export first. Ask for a full copy of your data before you give notice to anyone.