Server vs. Web


Freeware: selecting an EMR in the age of the cloud.

Heidi Jannenga, PT, MPT, ATC/L

The value of electronic medical records (EMR) relates not only to your business’s bottom line, but also to the quality of care delivered to your patients. Of course, not all EMR systems are created equal. Most do not take into account the workflow or treatment style specific to physical therapists. Beyond that, there are three very distinct types of EMR: server-based, freeware, and web-based. This article will examine all three and recommend the best investment for your practice.

Cloud. Server. Freeware. What is the Difference?

In a cloud- or web-based system, the EMR stores your clinic’s data—which can include anything from patient records to appointment schedules—within secure data centers. You can then access that data online using any web-enabled device with an Internet connection. (Think online banking.) You do not store your data on internal hardware (e.g., the computers at your practice). Instead, you access your EMR—and all of the information it contains—via your web browser (e.g., Google Chrome, Mozilla Firefox, or Internet Explorer). With that kind of flexibility, you can document, schedule, and bill from anywhere, at any time. In addition, many web-based EMRs charge month-to-month and do not have contracts—making them a very affordable option.

In contrast, server-based systems require your practice to store all its data, as well as the EMR software itself. This means you need a server, corresponding hardware, and quite possibly an information technology (IT) person or staff member simply to maintain everything. In addition, you can only access the EMR from the computers on which it is installed. To offset the costs associated with producing and supporting such expensive equipment and software, server-based companies use long-term contracts to ensure returns on their investments. Frequently, they also include maintenance and support charges, both of which increase the upfront expense and budgetary burden on your end.

In an attempt to compete with the web-based EMRs hitting the market, many server-based systems have developed “web-enabled” versions. With these “pseudo-cloud” options, you still have to install software on your computer, and your computer still does all the processing. However, at certain intervals, the software will connect to the Internet to synchronize your account and data to the cloud. Even though your access is a bit more flexible, your EMR and its data does not update online in real time. Furthermore, such software may require you to manually synchronize the software with the web. Not only is this process tedious and time-consuming, but your practice will still need the aforementioned hardware, servers, and IT staff.

Finally, freeware is exactly what the name implies: free software. Typically, these are web-based, ad-supported applications. Thus, ads often interrupt your workflow—although some freeware applications offer ad-free versions (a.k.a. “freemium”) for a fee.


Server vs. Web

The server-based options of yesteryear are already well on their way to becoming obsolete. In fact, systems that were on the cutting-edge 10 years ago are basically dinosaurs today. Why? Business in the modern world is inextricably tied to Internet capability. Workers in every sector—health care included—have come to expect the convenience of anytime, anywhere access to their files. In May 2011, Manhattan Research LLC reported that 30 percent of physicians were using tablets specifically to access electronic health records.¹ That was the usage three years ago—just imagine how many therapists and practices are using tablets and iPads today.

You may be wondering about Internet outages—since a web-based application depends on an Internet connection. In the grand scheme, Internet outages happen infrequently. However, if one does happen, many businesses use mobile hotspot devices as Internet backup. In addition, you need not worry about patient data—Internet outages do not compromise web-based EMR data. The same cannot be said for server-based systems; if a computer or hard-drive crashes or fails, your data could be lost.

While you might hesitate to store patient information outside of your clinic, realize that storing data on a server underneath your front desk is just about as secure as keeping your money under the mattress—you do not have a failsafe. The cloud, on the other hand, offers top-notch security features like unique password-protected access, bank-level security encryption, and automatic data backups. The gold standard is to keep your data in a secure, defensible facility with 24/7 surveillance.

Because cloud-based EMRs undergo regular updates, they can easily integrate new compliance measures as they are introduced. Built-in alerts ensure you always document completely, correctly, and defensibly. Most cloud-based EMRs provide all of this at a fraction of the lifetime cost of a server-based system as they usually feature low month-to-month costs and require neither a contract nor a hefty upfront investment. With cloud-based services, you get all the benefits of security and expertise with none of the typical costs associated with hiring additional employees, conducting training, and replacing, repairing, or adding to your hardware. And with tech support always a phone call or email away, you can spend less time scratching your head and more time treating and healing your patients.

Web vs. Freeware

Web-based and freeware EMRs are similar in that they are both cloud-based. However, the question must be asked whether freeware is appropriate to store and transmit your patients’ protected health information, ensure that you are HIPAA and Medicare compliant, and help you run a better practice and receive proper payment? In addition, consider the advertisements. Most freeware uses advertising dollars to cover the would-be cost of their services to the consumer. Therapists need to consider whether they want ads bombarding them while they are documenting and more importantly, interacting with patients. You should also ask questions related to any hidden fees or charges to “unlock” additional products, services, or features, whether there will be updates or innovation, and support when you need it.

Documentation is critical in demonstrating your expertise and value and is your method for proving that the services that we provide are beneficial and necessary. Your EMR should be a reliable business partner, dedicated to helping you achieve greatness in practice. Do not settle for an EMR that provides you with anything less.

Heidi Jannenga, PT, MPT, ATC/L is a PPS member and founder and chief operating officer of WebPT in Phoenix, Arizona. She can be reached at


1. McLaughlin P, Crespo M. The Proliferation of Mobile Devices and Apps for Health Care: Promises and Risks. Bloomberg Law. Posted June 2011. Accessed January 2014.

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