4 Types of Electronic Health Record Systems: How to Choose

You already know that Electronic Health Records (EHR) systems are all but essential these days. The U.S. electronic medical records market size was estimated at USD 11.38 billion in 2023 and is expected to grow at a CAGR of 2.24% from 2024 to 2030.

The main issue with EHR solutions, though, is that there are many different tools on the market.

How can you know which is the best option for your practice?

In this article, we're going to tell you about the different types of electronic health record systems and help you decide which one's the best option for your clinic.

Here's what we're going to cover:

• What is an EHR?
• Different Types of EHR Systems.
• 7 Benefits of Using an EHR System.
• How to Pick the Right EHR Solution—6 Essential EHR Features.

So, let's dive right in!

What is an Electronic Health Record (EHR)?

EHR is a digital version of patient healthcare data. Keeping medical information on physical documents has a lot of downsides:

• The documents can get lost, misplaced, or destroyed.
• Low level of interoperability: if a patient wants to go to a different type of healthcare facility, moving their data around is inconvenient.

Storing clinical data online solves both of these problems. For starters, the data is a lot more secure, as it's stored and backed up online. At the same time, the patient's medical history can be easily shared with other healthcare organizations, pharmacies, laboratories, emergency facilities, clinicians, and more.

An EHR system is exactly the type of software that allows medical practices to digitize their data storage. Such software, in addition to securely storing patient records, also allow for other features such as:

• Online patient booking.
• Medical CRM.
• Medical billing, reporting and online payments.

We'll explain the exact EHR features in detail a bit down the line, but first, let's talk about the different types of EMR systems.

4 Types of EHR Systems Explained

There are several distinct types of electronic health record systems, each with its own deployment model, cost structure, and technical trade-offs. Understanding the differences helps you make a much more informed purchasing decision.

In this section, we'll walk through each type.

#1. On-Premise EHR (Physician Hosted)

An on-premise EHR is installed and hosted directly on servers located at the physician's practice. This is the traditional deployment model, sometimes called "physician hosted" or "installed" software. The practice owns the hardware and is fully responsible for server maintenance, security, and software updates.

On-premise EHR systems typically require a large upfront capital expenditure to purchase servers, networking equipment, and software licenses. You will also need dedicated in-house IT staff to manage day-to-day operations and apply patches or upgrades, which often come at additional cost from the vendor.

Pros

• You have full control over your servers and data.
• In the long-term, owning your own servers can be cheaper than renting them (if you already have an IT team).
• Data never leaves your physical premises, which some large organizations prefer for compliance reasons.

Cons

• Requires a significant one-time capital investment in hardware and setup.
• Software upgrades and bug fixes must be applied manually, often at extra cost.
• Patient data exists in a silo and cannot be easily shared with outside providers.
• You are responsible for all security, backup, and disaster recovery procedures.

Cost structure: On-premise EHR typically involves large upfront license fees, hardware procurement costs, and ongoing annual maintenance fees. Total cost of ownership (TCO) over five years is often higher than cloud alternatives once you factor in staffing, hardware refresh cycles, and upgrade costs.

#2. ASP (Application Service Provider) EHR

The ASP model is a step up from on-premise. The EHR software is still installed on a dedicated server, but that server is located off-site and managed by a third-party vendor rather than by the practice. You access the system remotely over the internet.

This model reduces your infrastructure burden because the vendor handles hardware maintenance and some security responsibilities. However, the software itself is still installed on a single dedicated machine, which means it shares some limitations with on-premise systems, such as less flexible scaling and less frequent updates compared to true cloud solutions.

Pros

• Lower infrastructure costs compared to on-premise EHR.
• The vendor manages the physical hardware.
• Easier initial setup than fully in-house deployment.

Cons

• Still relies on a single dedicated server, which can create a single point of failure.
• Less flexible and scalable than SaaS or cloud-based options.
• Updates may still require scheduled maintenance windows.

#3. Cloud-Based / SaaS EHR (Software as a Service)

A SaaS EHR is delivered entirely over the internet on a subscription basis. You do not install anything on local machines or rent a dedicated server. Instead, you pay a recurring monthly or annual fee to access the software through a web browser or app. The vendor manages all infrastructure, security, updates, and compliance in the background.

Cloud EHR solutions like Medesk are built so that your data is replicated across multiple data centers, meaning there is no single point of failure. Performance scales automatically as your practice grows, and disaster recovery is built into the architecture.

Because there is no hardware to buy and no installation required, the upfront cost is minimal. Updates are pushed automatically, so your team always works on the latest version without any disruption. This makes SaaS and cloud-based EHRs the best EHR for small practices looking to minimize upfront costs.

Pros

• Low upfront cost with predictable monthly subscription fees.
• Extremely easy to get started. Sign up online and the software is up and running almost instantly, with no on-site installation needed.
• Automatic updates and security patches with no manual work required.
• Accessible from any internet-connected device.
• Vendor handles HIPAA compliance infrastructure on your behalf.
• Scales easily as your practice grows.
• High availability with built-in redundancy across multiple data centers.

Cons

• Ongoing subscription fees add up over time and may exceed on-premise TCO for very large organizations.
• You depend on the vendor for uptime, security, and data availability.
• Requires a reliable internet connection.

Cost structure: SaaS EHR replaces capital expenditure with a predictable operating expense. Most vendors charge per provider per month, typically ranging from a few hundred to over a thousand dollars monthly depending on features. This makes budgeting straightforward and eliminates surprise maintenance costs.

#4. Open-Source EHR

An open-source EHR is built on publicly available source code that any organization can access, modify, and deploy. Well-known examples include OpenMRS and OpenEMR. These systems are popular in academic medical centers, research institutions, and resource-limited settings where customization and cost control are the top priorities.

Open-source EHR can be deployed on-premise or in the cloud, depending on the organization's technical capacity. The software itself is free, but implementation, customization, and ongoing maintenance require significant developer resources.

Pros

• No software licensing fees.
• Highly customizable to match unique clinical workflows.
• Active developer communities contribute ongoing improvements.

Cons

• Requires in-house technical expertise or expensive consultants for setup and maintenance.
• Support is community-driven, not guaranteed, which can be a risk for mission-critical systems.
• Compliance certifications (such as ONC certification for Promoting Interoperability programs) may not be included out of the box.

Specialized vs. Integrated EHR Systems

Not all types of electronic health record systems are categorized purely by their IT deployment models. They can also be classified by their clinical scope. Understanding this distinction helps narrow down your choices.

Specialized EHR systems are built specifically for particular medical disciplines. They include tailored workflows, templates, and clinical tools. Examples include oncology EHRs built around chemotherapy protocols, or pediatric EHRs featuring growth charts and immunization tracking. They are often the preferred choice for focused practices.

Integrated EHR systems, sometimes called enterprise systems, serve as massive platforms that cover all departments. They combine clinical records with back-office HR, supply chain, and finance applications. Large hospital systems typically use these integrated solutions to unify their entire operation under one roof.

Key Factors When Evaluating EHR Architecture

Choosing between these deployment models is only part of the decision. Before committing to a particular EHR type, enterprise IT decision-makers and practice administrators should evaluate the following criteria.

Clinical Workflows and Documentation

You must ensure the software supports your daily clinical workflows. Key considerations include e-prescribing capabilities and clinical documentation tools. The system should allow practitioners to chart quickly and send prescriptions electronically without navigating clunky menus.

Data Interoperability

Can the system exchange data with external providers, labs, pharmacies, and health systems? The two core standards to ask about are HL7 (the older messaging standard) and FHIR (Fast Healthcare Interoperability Resources), which is now the modern standard for API-based health data exchange. A system that supports FHIR APIs allows your EHR to connect with patient portals, insurance payers, and third-party clinical tools far more easily. If a vendor cannot confirm FHIR support, that is a serious limitation for any practice that needs to coordinate care across organizations.

Scalability

Will the system grow with your practice? On-premise and ASP systems often require expensive hardware upgrades to handle increased patient volume. SaaS and cloud-based EHRs scale automatically, which is a significant operational advantage for growing practices or multi-location groups.

Compliance and Certification

For U.S. practices, ONC certification is essential. Modern systems must support the Promoting Interoperability (PI) program and MIPS reporting requirements. The old Meaningful Use standard has transitioned into these new programs. Vendors should also clearly document how their architecture supports HIPAA compliance, including data encryption, access controls, and audit logging. Ask specifically which compliance certifications the system holds before signing a contract.

Total Cost of Ownership

Look beyond the sticker price. On-premise systems have lower monthly fees but require capital for hardware, IT staffing, and periodic refresh cycles. SaaS and cloud systems convert those capital expenses into predictable operating costs. Over a five-year horizon, many practices find that cloud TCO is equal to or lower than on-premise even when subscription fees appear higher on a monthly basis.

7 EHR Software Benefits

An EHR system has countless benefits, but the most important ones are the following:

1. Care Coordination. EHR software makes it easier for different clinics to collaborate. Whenever your patient needs to visit a specialized clinic, their care providers can instantly access their patient records through the EHR.
2. Better Quality of Care. Using an EHR allows your clinic to provide better overall patient care. Your healthcare practitioners can access a patient's entire medical history with the click of a button, which makes it significantly easier to accurately diagnose patients and avoid medical errors.
3. Better Medication Management. With EHR and an e-prescribing function, practitioners can keep track of patient prescriptions in real-time. This can help avoid double-doctoring, as well as prevent prescription errors.
4. Simplified Document Management. With an EHR system, you can streamline all your document management. Some of the best solutions on the market allow you to handle patient intake forms, treatment plans, as well as billing, payroll, and other administrational work.
5. Improved Clinic Efficiency. By streamlining and automating a lot of your clinic's administrational tasks, an EHR system allows your healthcare practitioners to focus on the one thing that really matters: providing excellent patient care with clinical decision support tools.
6. Improved Security. Paper charts are not secure. They can be lost, misplaced, or destroyed. An EHR solution, however, allows you to digitalize your data, back it up, encrypt it, and more.
7. Simplified Clinic Management. Some of the best EHR solutions also come with practice management features that can really simplify many clinic management processes. Meaning, you can use the software to manage your patient bookings online, conduct online consultations through the platform, manage your clinic payroll, track patient engagement, and more.

How to Choose the Right EHR System—6 Essential EHR Features

Looking to adopt EHR software, but not sure how to pick the right one? Here are the 6 essential EHR system features you should be on the lookout for.

#1. Online Patient Portal

An online patient portal is essential for any health information technology system. A patient portal, in a nutshell, is an online app that allows patients to manage their bookings, access their medical records, and more.

While the exact features of an online patient portal vary from software to software, some of the most common are:

• Scheduling appointments online.
• Managing bookings and appointments.
• Securing access to personal medical records.
• Providing access to diagnostic lab results.
• Securely communicating with healthcare providers.
• Making payments online.
• Viewing relevant educational materials provided by the clinic.

#2. Medical CRM

Your EHR solution should also come with a medical CRM feature. Medical CRM allows you to keep track of your clinic's interactions with all patients in a single location.

E.g. if a patient calls your clinic with a question, your receptionists can instantly look up the patient in the CRM and provide them with accurate information.

This allows you to provide significantly better customer service. But that's not all—medical CRM also lets you:

1. Discover patient trends. You can see which demographics respond better to your marketing communication, what's the average no-show rate, which of your marketing channels perform better, and so on.
2. Personalize communication with your patients. You can send targeted messages to specific types of patients. For example, you can reach out to patients who haven't been to your clinic in a while and offer a discounted checkup.
3. Improve patient retention. You can send automated reminders to people who have an appointment the next day.

#3. Billing Module

Your EHR solution should come with a billing module. This allows your patients to:

• Add their patient information to the platform.
• Make payments online.
• View their billing history.
• View their health insurance information.

On the other hand, a billing module also helps with the administrational aspects of running your clinic. For example, your administration staff should be able to see any patient's account balance, outstanding debt, or active medical loans in just a few clicks.

Billing also becomes more secure—you are able to give access only to specific, authorized employees.

#4. Simplified Analytics

The EMR system you pick should allow you to create analytics dashboards with ease.

For example, let's say you want to find out which of your marketing channels is bringing in the most patients. Normally, you would spend hours cross-referencing several Excel sheets and whatever marketing software you're using.

If, however, you're using the right EHR solution, you can simply pull out all this data in a single click.

Some EHR solutions make this process a breeze. Medesk, for example, comes with 70+ ready-made reporting templates that allow you to track your clinic's performance.

#5. Option for Telemedicine

Telemedicine has been on a steady rise for the past 6 years.

And it's projected to grow even faster in the upcoming decade. As such, it's very important that your electronic medical records system gives your healthcare staff the option to conduct online consultations.

A solid telemedicine module should come with the following features:

• Online booking for patients.
• Secure consultations through the platform.
• Integration with payment providers.
• A separate app for quicker connection.

#6. Inventory Management

Another essential EHR feature is inventory management. The right system will allow you to:

• Keep track of all inventory, including medication and consumable items.
• Generate tailored reports.
• Write off products and consumables sold.
• Notify relevant stakeholders when specific inventory is low.
• Calculate the costs and profitability of specific items.
• Request new stock through an automated approval process.

Try All-in-One System for Free

Want an EHR solution that does it all? Try Medesk!

Medesk is a mix of EHR and practice management software. Meaning, in addition to allowing you to digitally track your patient data, it also comes with robust features for managing your medical clinic.

Some of these features include:

• Managing your patient bookings through a cloud-based patient portal.
• Centralizing all your patient communication through a robust medical CRM module.
• Creating tailored reports with ease. Just pick from one of our 40+ report templates and uncover key data about your clinic.
• Managing billing, payroll, reporting, and more.
• Conducting secure online consultations with your patients through our patient portal.

But don't just take our word for it—here are about dozen-plus awards we've received from Capterra for being a leader in the EHR space:

Sign up for free today and get a 15-day access to all benefits of a modern SaaS solution. We don't ask for your credit card number or make you sign any contracts. Creating an account takes only 5 minutes—aren't you interested to check Medesk yourself? Navigate here to start a journey with us.

EHR System FAQ

1. What is the difference between EMR and EHR? EHR and EMR are terms often used interchangeably, but they differ in scope. An EMR is a digital version of a patient's chart from a single practice. It is stored locally and does not easily travel outside the clinic. An EHR is a comprehensive record that spans multiple providers and can be securely shared with other clinics.

2. What is the most common type of EHR system? Cloud-based and SaaS EHR systems are currently the most commonly adopted models. They are popular because they require very low upfront costs and eliminate the need for servers. This makes them highly accessible for practices of all sizes.

3. Does My EHR System Need to Be HIPAA Compliant? Yes, any EHR system used in a U.S. healthcare practice must comply with HIPAA (Health Insurance Portability and Accountability Act). HIPAA requires that patient data be stored, transmitted, and accessed securely, with strict controls over who can view or modify health records. When evaluating EHR vendors, ask specifically how they handle data encryption, access logging, and Business Associate Agreements (BAAs). For practices that bill Medicare or Medicaid, it is also worth confirming whether the system holds ONC certification and supports MIPS reporting requirements, as these are necessary for quality program participation and avoiding reimbursement penalties.