Before implementing electronic health records, physician group practice administrators invariably hit a significant fork in the road. One path they can choose is the longstanding "do-it-yourself" approach of licensing and installing the application locally. The other path involves relying on a vendor to remotely host the software and provide related services. Because both approaches have pros and cons, selecting the right strategy is a big challenge. Users of remotely hosted systems tout ease of use and instant access to software updates. They also point to dramatically lower start-up costs because there's no need to license and install software on a local server. But practices that have chosen to install EHR software locally cite concerns about remotely hosted systems that include the unreliability of Internet connections and the potential for disputes over ownership of data, among other factors. Locally installed software, they argue, offers speedier performance and peace of mind about control of valuable information.

Regardless of which path they choose, some clinics feel a new sense of urgency to implement electronic records. That's because the federal economic stimulus package provides financial incentives for practices that make "meaningful use" of such software. To gain the maximum financial incentives, practices must have qualifying records systems up and running by 2012.

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