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Should You Consider Co-Location of Your EMR?

In previous columns, I wrote about the differences between an on-premise electronic medical records (EMR) systems – running on servers located in your office – and a web-based EMR system, also known as Software-as-a-Service (Saas).

For many practices, especially smaller ones, the Saas model for EMR is compelling. There are little or no upfront costs and no major hardware such as servers to purchase. Only a good internet connection is needed.

But many practices want more control over their data and don’t like the idea of being completely cut off from it if their internet goes down. So they have servers on-premise and store the EMR application and its associated data on them. The downside to this is the maintenance required for this hardware: a controlled AC environment, security protocols, software licensing and updates, a robust backup power system or standby generator, just to name a few. If some natural catastrophe should befall your office, you could lose everything.

So what could be a better option?

Co-Location is a service where servers which belong (or are assigned) to the practice are physically located elsewhere, usually in the same geographic area but in a data center which is specifically constructed to host computer hardware. It is essentially like having your IT department in a secure location. Depending on the arrangement, your IT people can have access 24/7 to the center but it is taken care of when they’re not there, day and night.


  1. Little to no capital expenditures for hardware – multiple physical (or virtual) servers to run your various applications including EMR, EPM, and Optical, and a specialized, secured, air-conditioned environment with standby backup generator to house them
  2. Increased redundancy – a good data center will have data backed up to more than one facility as a failsafe
  3. Improved reliability – data centers typically refresh their hardware on a 2 to 5 year plan (as opposed to 5 to 10 years for the typical practice)
  4. Scalability – the data storage grows as your practice grows without fear of ‘running out of space’


  1. Dependent on a fast internet connection, just like the SaaS model – although in many cities, high-speed fiberoptic lines with redundancy can make a local connection more reliable
  2. May still require practice staff to maintain, depending on the arrangement
  3. Possible concerns about the data backup and who is responsible – again, depending on the arrangement

Chris Johnson, CEO of Untangled Solutions, an IT services company, says, “The main take-away here is to ensure redundancy in your data storage. Don’t keep all of your eggs in one basket. Do you have a contingency plan if that natural disaster strikes your office? If you don’t, then from a redundancy standpoint you are no better off than when you were a paper-based practice.”


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