When selecting an Electronic Health Record (EHR) system for your medical business, you will encounter the following two models offered by vendors: Software-as-a-Service (SaaS) and On-Premise. Each model has its advantages and challenges, so making the right choice is crucial since transitioning between them are extremely complex, especially when migrating historical data to new EHR.

SaaS EHR

SaaS EHR is hosted in the provider’s data center or a rented cloud-based environment. With this model, you pay a subscription fee based on the number of user accounts. Typically, payments are made monthly, with potential discounts for annual prepayment.

On-Premise EHR

With an On-Premise EHR, you purchase the software (software license for a limited or unlimited number of users) and deploy it on your own infrastructure. Servers can be located in your office, a data center, or hosted on a rented cloud infrastructure such as Virtual Private Servers (VPS) or collocated hardware nodes.

A. Cost-benefit analysis – Saas vs On-Premises EHR

SaaS EHR: Lower initial costs, but higher long-term expenses
SaaS EHR is typically less expensive at the beginning, making it best choice for small practices with limited staff. Usually the monthly subscription fee covers software usage, server administration, preventive and corrective maintenance. However, as your business grows, subscription costs increase, making SaaS more expensive in the long time perspective.

Cost breakdown example for SaaS EHR

• For the first year: you have 10 users at $200/month each – you pay $24,000 per year.
• For the second year: you have 20 users – you pay $48,000 per year.
• For the third year: you have 30 users – you pay $72,000 per year.
• After 3-4 years of operations, your cumulative costs will exceed $100,000.

While SaaS offers convenience, it may become financially burdensome as your practice expands. Additionally, customization is limited, meaning the software may not fully align with your specific needs.

On-Premise EHR: Higher initial investment, lower long-term expenses

On-premise EHR requires a larger upfront investment but offers significant savings over time. Although you will incur costs for server administration and hosting, these become relatively lower as your business scales.

To ease the financial burden, some EHR vendors may accept gradual payments and offer monthly maintenance contracts covering:

Mitigating initial costs for your On-Premise EHR

• Predictive maintenance: Preventing software and hardware issues through regular updates.
• Corrective maintenance: Fixing bugs and system errors.
• Adaptive maintenance: Customizing the system based on your evolving business and regulatory needs.

B. Customization & fine-tuning

SaaS providers often claim that their systems offer flexible subscription options and selection of variable features, but they lack deep customization capabilities. Standard SaaS features may not align with a client’s business rules or regulatory requirements. In contrast, On-Premise EHR solutions like Intellia EHR allow extensive customization to meet specific client needs. Further enhancements can be made through an Agile approach, ensuring continuous development of new features and optimization of existing ones.

C. Data Security & Control,.

Patient data is one of healthcare Providers’ most valuable assets. Regulatory requirements for data storage, processing, and security vary by jurisdiction, but in any case, require rigorous handling of patient data. With SaaS, patient data is stored in external servers, often outside your country, raising concerns about data privacy, unauthorized access, and third-party use for purposes such as AI training.

An On-Premise EHR provides full control over data, allowing for:

• Custom security policies and access restrictions.
• Strict contractual clauses on data confidentiality.
• Audit trail tools for monitoring system events, ensuring traceability.

D. System Performance & Scalability

SaaS vendors allocate processing resources as needed, but users have no direct control over system performance. Upgrades typically occur in response to widespread customer complaints, leading to potential delays in resolving performance issues.

With an On-Premise EHR, you control system scalability, deciding when and how to upgrade hardware or network infrastructure based on your needs.

Final Considerations

SaaS EHR: Solution for small practices with standard needs

SaaS EHR may be suitable for small healthcare providers (up to 10 users) who require basic functionalities and have no immediate plans for business expansion.

On-premise EHR: Best for growing medium and large practices

For medium to large practices, On-Premise EHR provides greater customization, long-term cost savings, and enhanced data security. While the initial investment is higher, the long-term financial and operational benefits outweigh the upfront costs.

Migration Challenges

Transitioning from SaaS to an On-Premise EHR can be extremely complex and costly. Data migration, especially of historical records, is often technically challenging or even impossible. This makes choosing the right EHR model from the start critically important. You may have not a chance to fix your initial wrong decision.

Intellia EHR: A Tailored On-Premise Solution

Intellia EHR is an On-Premise solution designed for businesses seeking high levels of customization and control. Our offering includes:

• Flexible pricing & gradual payment plans
• Deployment services at no additional cost
• Initial system tuning based on business workflows
• Optional maintenance & server administration services
• Continuous adaptation to regulatory and business changes

Conclusion

Carefully evaluating your needs, budget, and growth potential will help you make the right EHR choice. Intellia Management is open to discussing technical, financial, and business aspects with potential clients to find the best-fit solution for their healthcare practice.