Types of EHR Systems

You likely know Electronic Health Record (EHR) systems can be beneficial, but picking the right one can be difficult. Several criteria distinguish EHR options and make them more suited to certain needs and usage. Healthcare providers know that selecting a system for their practice sometimes isn’t a simple choice of one or the other. As you will see below, most EHR systems currently available do not come in a one-size-fits-all format. We suggest looking for the application that can most easily be adapted to your existing needs.

What Is an EHR?

An EHR, or Electronic Health Record, functions as an all-encompassing system that a physician can use to keep track of their patient’s health information. This is usually a computer software that keeps a file of every single aspect of a patient’s care record.

“EHRs transform practices to meets its needs and the needs of its patients.”- American Academy of Family Physicians (AAFP)

One of the main goals of keeping everything stored in one computer system is increased efficiency due to enhanced workflows and access to information.


Electronic Health Records have far-reaching benefits. Not only do EHRs make it much simpler and commonplace for a physician to access a chart remotely, but they can also be made aware of potentially dangerous medication errors far sooner. An EHR, which shares information between multiple healthcare providers, also allows a physician to learn about critical lab values quickly. This kind of information sharing leads to knowledge that is a step towards improving a patient’s overall health outcome long-term.

In fact, 78% of physicians equipped with an EHR system report that it enhanced their patient’s care overall.

Types of EHR Systems

There are different ways EHR systems are configured. Each has its advantages and disadvantages, depending on a medical practice’s unique needs and requirements.

1. Physician-Hosted System

Physician-hosted systems very basically mean that all data is hosted on a physician’s own servers.

This means that a physician is responsible for purchasing hardware and software, as well as the continued maintenance and security of the data stored on their servers.

An EHR system hosted by a physician at their medical practice may be beneficial for larger practices that can cover the overhead costs of the complex software. Having on-site servers also helps speed up an EHR system and makes it a more reliable source of information.

2. Remotely-Hosted System

Remotely-hosted systems shift the storage of data from the physician to a third party.

This entity must deal with maintenance, data backup, and security. This type of system puts the responsibility for maintaining data somewhere else besides a single physician or medical practice. This shift of responsibility might be attractive to smaller practices or any healthcare provider that wants to focus more on collecting the information and not storing it. This type of system eliminates some of the IT headaches that can take away a physician’s attention from their patient’s care and wellbeing.

3. Remote Systems

There are three different varieties of remote systems.

  • Subsidized: A subsidized system involves a relationship with some entity that subsidizes the cost of an EHR. Generally, a physician forms this relationship with a hospital, which then controls the data. Keep in mind that a remote system involving a subsidizing entity can bring up certain legal issues, including antitrust and data ownership concerns.
  • Dedicated: A dedicated host system means that physicians store EHRs on a vendor’s servers. These servers are usually in specific locations. A physician cannot control most aspects of data storage with this system.
  • Cloud: One of the most popular EHR remote systems is a cloud, or internet-based computing system. A physician doesn’t need to store data on their own servers, but a vendor stores it “in the cloud.” This means the data is always stored away somewhere secure on the internet and can be accessed through the vendor’s website.

Choosing an EHR System That Meets Organizational Needs

Some EHR systems are more attractive to different healthcare providers. Cloud-based systems are a cost-effective means of storing data, which is attractive to organizations not capable of hiring a dedicated team of IT professionals for maintenance and management of the data.

However, larger health systems might have the organizational capacity to afford expensive hardware and to employ an IT team. An on-premise (physician hosted) system is ideal for organizations that want absolute control over the data, including its security, optimization, and infrastructure.

Comparing EHR Systems

One Electronic Health Record system may not be inherently better than another, but one can be a better fit for a healthcare provider’s requirements than another.

Hosted EHR vs. Server-Based

A hosted system means that all EHR software is hosted by another entity on its own servers outside of a medical practice. This entity handles data backups and security. Despite a lower cost upfront, a hosted EHR can be slightly slower due to the distance of a practice from the servers hosting the data.

A server-based system involves servers on location at a medical practice that house EHR data. There are more upfront costs, mainly in hardware and installation, included with this type of system. Over time these costs may work themselves out in comparison to leasing software for a hosted EHR.

Cloud vs. On Premise

The main difference between cloud systems of any type and an on-premise EHR system is who manages the data. Cloud systems always involve third parties, which manage and maintain the cloud. On-premise systems let physicians host their software locally and manage their data on their own.

Potential Liability Risks Associated with Using an EHR System

When using an electronic health records system, there are inevitable risks with data storage. Here are a few tips to navigate potential liability risks.

  • Confidentiality and security
    To protect their patients, a physician should be conscious of the terms of their agreement with any EHR vendor. This includes knowing where the data from their practice is stored and who can access that data. Choose a vendor that closely follows all the relevant state and federal requirements for confidentiality and security of health and personal information.
    Unauthorized access to patient data is a huge liability, too. Proper training in EHR use for employees ensures the continued security of data and no breach of patient confidentiality.
  • Data entry and integrity
    An EHR system can only be as accurate as the information put into it. If incorrect information is entered, this could disrupt the efficacy of the entire system. Make sure to emphasize that information is properly entered for the correct patient and that the correct author is credited for the entry of data. Otherwise, there is no easy way to determine which physician or staff member recorded some important piece of information.
  • Too much information
    Similarly, too much information can lead to difficulties with an Electronic Health Record. You should print out patient records to evaluate them periodically. Consider a record from the point of view of someone new to the patient’s history. You might be adding too much information if you cannot parse relevant information quickly and easily.

Contractual Matters Associated with Choosing an EHR System

You should enter into a contract with an EHR vendor only after carefully considering the terms. It's imperative to pay attention to these vital contractual matters as this can mean the difference between being held liable for medical malpractice or lost information.

Signing a decent contract:
A good EHR vendor will sign a contract that works with you and helps you guarantee the safety and health of your patients.

A good EHR vendor relationship begins with a clear understanding of who owns the information. A physician should hold ownership of patient information to serve as a record of their responsible practice of medicine. Patients can also be hurt if they cannot have access to their vital health records for personal litigation, continuation of care, or disability claims.

Operational problems:
You should be vigilant in identifying any errors in your EHR system that could lead to patient harm. Outdated information can make drug interaction alerts useless. This type of system failure is up to a physician to catch and fix before it can make you liable for harm.

Termination issues:
You should not enter into an agreement with a vendor that does not include a plan for the potential termination of a contract. This is necessary to protect access to medical records in the long term. Your patients will also be interested in knowing how their health data is stored and how it can be accessed over time.

Obsolete technology:
Do not choose an EHR system that will render data useless in the event of a vendor’s insolvency. It can be a major risk to your medical practice if you cannot access the data that you stored in an EHR.


The first step to finding the right EHR system for your office is to understand the pros and cons of your different options. You want to choose something that will work for you and not something you will need to alter your entire practice around to fit into your organization.

You should also carefully consider other factors:

  • Budget
  • Organization size
  • Any existing software and hardware already in use or otherwise available

If you do not have the flexibility in your budget or the hardware already, it might not be in your best interest to opt for a system that requires infrastructure or costly installation. However, a physician-hosted system with a server on-site guarantees speed and reliability.

The choice between how data is hosted or stored might appear superficial if you only consider it in the short term. In the long run, however, you need to be able to guarantee the protection of patient records. This is necessary not only for improving overall patient health outcomes, but also to protect your medical practice and make your life a little easier

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