There are a ridiculous number of emr systems out there, several with available 3rd party support to manage your IT setup, and some that will offer a VPN or secure citrix environment to work in.
I worked as an intern in IT for a large medical group a couple of years ago, and the consulting firm i work with now does a lot of support for just clinics/doctor offices and the IT aspect alone is expensive. In particular we help them upgrade IT infrastructure in a clinic so they can go live with their central EMR system.
there are workflow assessments to be done, and IT assessments to be done. We charge $95/hour per person, i can spend 3 - 8 hours doing an assessment and documentation for an office. They have staff to do the workflow assessments. We have assessed and rolled out 40+ offices in the last 12 months.
There are PCs to buy (Figure ~1 grand each, though they use thin clients now and again....just not often) and even a small clinic may need 6, a large one may need 30 or even more. Dont forget printers, patients are required to receive after visit summaries from their providers. and a couple of scanners for each clinic.
There is cabling to run...a lot of older buildings have zero cat5/6 wiring so that can be expensive.
there is networking equipment to buy (switches and wireless APs)
there is bandwidth to pay for (most clinics for this group have metro to get them to the main IT office)
there are laptops to buy (often with rolling carts for mobility/convenience)
sometimes we install mounts for the desktops in patient rooms.
there is labor required to image and prep the PCs and laptops, and labor required to roll them out and train the users on the very basic IT concepts they need.
There is training needed to prep users for the EMR system and massive training to get into details and customize the EMR system for a practice or provider.
I don't want to know what the average cost is to take a clinic live with EMR for this group. I know we billed out $300k in IT and cabling services last year, so thats several grand per clinic, minimum, in IT support. nevermind the emr staff and all of the equipment needed. Then the follow up IT support for misc PC issues, misc EMR issues, misc printing issues.
Some clinics already had a 3rd party supported EMR system that got replaced, but they have to keep it available for years. some of them were on their second system before we took them live on the new one...i have no idea how the very first one is supposed to get supported as legally required, but they were told to keep vendor support for anything they can as long as legally required because the medical group cant support anything but their own system.
for some clinics its a nice, welcome change. for some they equate to some level of hell. for everyone clinic there is a pretty serious cost to consider, and a lot of clinics had a very old or limited IT infrastructure to support what they already had.