Our programs are all written in-house. This gives an extreme amount of flexibility and the ability to work with any EHR that is able to export sufficient amount of data to bill. In most instances this isn't a problem, but we have seen times when the EHR is unwilling or that it is prohibitively expensive to export the data daily because of their licensing structure.
Do they cater to your specialty?
How large is their staff? Are they going to be able to accommodate the practice's needs or is it sold as is.
Does it meet meaningful use?
Can you get the data out of the EMR?
Does it interface with other applications, and how expensive is it?
How does it manage Disaster Recovery?
How often do you upgrade your product?
Is it subscription based or one time fee?
This model depending on the cost can be very attractive. You don't need any special equipment for it to work other than a computer and internet connection. If you have a computer that dies, which everyone has experienced, you don't have to worry about data being lost and having to reinstall programs to get it working again. Another nice feature is that the program always has the latest up to date version. No need to upgrade. Another positive is that you don't have to manage, maintain, backup, and secure your own server. Lastly if you work from multiple locations this model is significantly more simple to set up. The main disadvantage is that if the internet is unstable or inaccessible, then so is your EHR.
This model usually consists of buying a server and the software and hosting it at your office. This is usually a onetime cost unless it is leased. The difficulties are maintaining the server with the latest security patches and installing client software on individual machines. Another challenge is setting up a VPN if remote access is necessary. The advantage is that you know where your data is stored, and you can often skip the subscription costs. But there are certainly other costs such as upgrades to the software, buying a new server every 5 years or so, and making sure that it is secure.