According to Dave Ott, Vice President for Technical Services with NextGen Healthcare Information Systems (which offers both client-hosted and vendor-hosted servers), an ASP has a lower start-up cost because the hosting fee is billed monthly, so there is no initial outlay for server hardware, operating systems, installation systems, and the like. Any size group could deploy EMR using the ASP model, but typically the smaller physicians’ offices do not have the budget for IT and IT staff to support an internal network, he said.
Heather Caouette, a spokesperson for the EMR company eClinicalWorks, noted the different costs with their systems: the upfront purchase of a client-server, integrated physician management, and EMR solution would be $10,000 for the first provider and $5,000 for each additional physician; a subscription model (i.e., monthly installment payments) is $400 per provider, with decreases by 10% for each additional provider up to six; and with an ASP model, the cost would be $400 per month per provider plus a $100 hosting fee.
At Texas Ear, Nose & Throat Specialists, Ms. Eddy said that her group chose to have its own in-house server because practice members weren’t comfortable having patient data reside on someone else’s server. However, she believes that the ASP applications have a lot to offer, particularly for small group practices.
Another option in determining the type of system to purchase is EMR certification. This year, the Certification Commission for Healthcare Information Technology (CCHIT), a nonprofit group formed by health IT associations and awarded a contract by the US Department of Health and Human Services, announced the first 20 ambulatory EMRs that met more than 300 criteria for functionality and security. The certified products are listed on its Web site: www.cchit.org .
Although the concept of certification is widely approved, there was criticism that the first CCHIT process was geared to primary care, with requirements for templates covering well-baby check ups, ob/gyn visits, and other items not pertinent to specialty practices.
The CCHIT Web site noted that the 2006 Ambulatory EHR Criteria represent basic requirements that the Commission and its Workgroups believe are appropriate for many common ambulatory care settings. CCHIT acknowledges that these Criteria may not be suitable for settings such as behavioral health, emergency departments, or specialty practices and our current certification makes no representation for these. Purchasers should not interpret a lack of CCHIT Certification as being of significance for specialties and domains not yet addressed by CCHIT Criteria.