For this survey, KLAS defined SaaS products narrowly as browser-based EHRs that have a single database for all customers and the ability to apply software updates to all customers' EHRs simultaneously. Although the leading EHR vendors offer both onsite client-server and remotely hosted applications, none of them provide a system that meets this SaaS definition, according to Bermudez, so they were excluded from the report.
The researchers randomly called 300 practices that use SaaS products from vendors such as AdvancedMD, athenahealth, Bizmatics, CureMD, MedPlus/Quest Diagnostics, MIE, OptumInsight, Practice Fusion, Sevocity, and Waiting Room Solutions. The practices included a number of specialties, but were mostly primary care groups. The average size of the practices was two to four physicians, Bermudez said.
"SaaS technology really caters to that small physician practice," he noted. "When you look at the dynamics of a small practice, it's not going to have a full-time IT person to keep its systems up and running and to customize the EHR to its needs. Nor do these practices have a ton of money to dump $50,000 to $100,000 into an EHR system. So because of the features of SaaS, whether it's IT or the money, SaaS is very attractive for those smaller physician practices."
[ Practice management software keeps the medical office running smoothly. For a closer look at KLAS' top-ranked systems, see 10 Top Medical Practice Management Software Systems. ]
SaaS EHR vendors charge a monthly subscription fee that covers both the software cost and the cost of maintaining the remote server and updating the EHR. Aside from the workstations and mobile devices within the practice, "all of the hardware, IT, updates and maintenance is taken care of remotely," Bermudez pointed out. "So that takes a lot of the headache and worry away from single practitioners."
The monthly fee per provider for a SaaS EHR ranges from zero for Practice Fusion, an advertiser-supported system, to $600-$700, he added. But the average is only $200 to $400 a month, which is less than remotely hosted EHRs cost a few years ago. That can be very attractive to small practices, especially when weighed against the $44,000 in federal incentives they can garner by showing Meaningful Use.
The KLAS report noted that SaaS EHR users shopped for vendors by looking at four factors: EHR response time, customer support, product quality, and bang for the buck. A few years ago, Physicians Practice Magazine quoted some physicians as saying their remotely hosted EHRs loaded Web pages too slowly. But Bermudez said that his researchers saw few complaints in this survey about response time. "People are pleased with the speed of their SaaS EHR," he said.
A more persistent concern about SaaS and other remotely hosted EHRs is data security. However, the level of concern has diminished, said Bermudez, partly because of the acceptance of cloud-based applications such as G-mail and Sales Force.
Other research done by KLAS but not yet released, he added, indicates that the SaaS model is gaining popularity among physicians. When doctors were asked which kind of EHR they'd consider purchasing in the future, many said they were thinking about an SaaS application. "Client server is a big percentage of those future purchases, but SaaS is definitely on the increase over the past six years," he said.
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