The technological infrastructure dedicated to clinical information is a priority for all hospitals, as all operations performed are linked to it: patient details and the medical evolution in the electronic health record, levels of supplies and drugs in the hospital pharmacy and warehouses, user charges or insurance requests, among other topics.
Now, the inevitable question from the executive team is where all the information generated by the hospital software, such as HIS, EHR, ERP, and RCM, will be centralized and managed. Two alternatives to answer this question: use an on-premise or a cloud-based software. Let's compare these options in various aspects.
Definition of on-premise software and cloud-based software:
On-premise software is a model where the program is installed and operated from the users' servers and physical infrastructure. It utilizes the hospital's native computational resources and only requires a license or a copy.
On the other hand, cloud-based software allows users' devices to access data via the internet from anywhere, operated by remote servers.
Infrastructure and accessibility
For on-premise software, it is necessary to have physical space to house the servers that will serve as receivers and warehouses for the information and the conditions needed for their operation, such as electricity and air conditioning. Additionally, under this model, all devices seeking to connect to the server must physically be located in the same hospital.
On the contrary, for cloud-based software, computers connect remotely, with no need for physical space or electrical installation. The hospital only needs a stable and high-speed internet connection. It is recommended to have a second internet provider as a backup.
With Software as a Service (SaaS), users can work remotely and access their applications and data from different internet-connected devices.
Since the servers do not leave the building in the on-premise model, the hospital's IT team is fully responsible for data security. They are also responsible for updating antivirus software and implementing barriers against potential information breaches.
If the hospital selects to store data in the cloud, there may be concerns about security and privacy. This is why cloud service providers implement and demonstrate the security strategies they have in place. Similarly, they are also responsible for system updates and maintenance. By delegating this responsibility, the hospital's staff does not have to worry about installing patches or updates, saving time and effort.
Initially, price may seem like an essential and decisive factor, but it is crucial to consider both short- and long-term perspectives. If we compare a monthly or annual subscription to cloud-based software against a multi-year contract for on-premise software, the investment in cloud-based software would likely be optimal.
Short-term, on-premise software installation may require a significant investment in hardware, servers, and software licenses. In addition, implementation and customization expenses are related, such as salaries of the personnel in charge, server maintenance, license renewal, and software version upgrades.
With cloud-based software, most of the investment is in the subscription fee (monthly or annual). At the same time, the implementation, customization, and training of the internal hospital team represent the second and final part of the expense for this type of software.
The most significant advantage of on-premise software for hospitals is that the organization has complete control over the system and data, with the option of customizing and adjusting it according to specific needs without depending on an external provider's limitations or response times.
Remote software providers install a base system, and although they customize and select functionalities according to the project, it may still contain limitations or workflow processes different from what the hospital was already doing.
Improvements and scalability
Managing internally the system updates is one of the most time-consuming activities for the hospital's IT staff. In addition to planning and scheduling, the times when the system crashes must also be considered, increasing the workload.
Similarly, additional hardware costs are likely to arise if hospitals need to increase storage capacity or software performance with on-premise systems.
SaaS models provide updates and improvements that, depending on the provider, do not incur additional charges for the healthcare organization. Additionally, most cloud services offer scalability options, allowing for easy increases or decreases in storage capacity and performance without extra hardware investments.
As we can see, there is no simple answer to which system to use. While one option provides absolute control over the information, it is tied to the management and expertise of the IT department. On the other hand, the cloud offers software at a small portion of the cost, but the service depends entirely on the cloud service provider. The decision lies on the executive team, who must determine the objectives considering all factors.