Most physicians have concerns about financing their investment in EMRs. While there has been some loosening of the Stark and anti-kickback laws which would allow for some physicians to receive financial assistance from hospitals, it is not clear how this will impact adoption of EMRs. Consequently, the burden will remain with the physician at least for the short term.
There are basically three financing models for EMR systems: Licensing, Leasing or ASP.
Many practices license a vendor's software. This requires you to purchase individual licenses or “seats” for you and each member of your staff. The arrangement may require you to purchase a license for all potential users or it may require you to purchase a license for a maximum number of “simultaneous” users (ie maximum number of people on the system at one time). A license agreement typically means that the software will be owned by the physician with some restrictions. Make sure that you purchase enough licenses or “seats” to avoid competing for access.
A leasing arrangement includes a monthly fee paid to the vendor in exchange for use of the software product. However, physician must purchase the server hardware to support the software application and may also have to pay for customizations & initial installation support.
Application Service Providers (ASP)
Another alternative that combines technology support for your practice and reduced hardware costs is the introduction of ASP products.
ASP vendors sell products that are typically web-based applications that run on the vendor's equipment at their site or at a secure data center facility. They do not require a physician or practice to own or maintain the server and some related equipment since the software and database contents (patient data) are stored at the vendor's site. In addition, the backups, servicing and upgrades are all done by the vendor so there is less disruption to the individual practice to perform these functions. These may be a good choice for practices that want to concentrate on changing their business processes and leave more of the technology upgrades to the vendor.