Doctors, Here’s What the Windows Server 2008 End of Life Means For You


Deciding Whether to Upgrade Your Servers or Switch to Cloud-Based EHR Software


Do you use a server-based EMR system running on the Windows Server 2008 or 2008 R2 server operating system?

If so, you will most likely have some big—and expensive—changes coming. In January 2020, Microsoft will permanently end all support for Windows Server 2008 and 2008 R2. This will leave your practice vulnerable to potential security threats and technical problems if you continue using the 2008 version.

If you’re not sure which version your servers are running, ask your IT technician—they should be able to tell you. They might have already upgraded your servers, but they may be waiting until closer to the deadline due to the large cost involved.

If you haven’t upgraded yet, you have an important choice to make: pay somewhere in the ballpark of $25,000 to upgrade your servers or switch to the cloud.

If you choose the former option, you’ll face this same dilemma in another decade or so, when support is ended for the current server operating system version. But with the latter, you won’t have to upgrade your onsite servers again because you won’t have any.

Please keep reading to get a closer look at the pros and cons of each option, including cost, convenience, support and security. By the end, we hope you’ll be better informed and ready to make the choice that’s right for your practice.

Windows Server 2008 End of Life Options: Cost Breakdown

Below are the main options you have for moving forward with your server-based EHR software after the Windows 2008 R2 end of life, along with the costs you’ll face with each.

If your vendor doesn’t offer a cloud option, you’ll likely have to spend a substantial sum of money this year, one way or another. But the good news is, with the third option listed below, you can choose to make that sum a one-time upfront switching cost rather than a recurring hardware investment.

Option 1: Upgrading your servers after the Windows 2008 R2 end of life

Costs include:

  • New server licenses – cost recurs approximately every 10 years
  • Potential server hardware upgrades – cost recurs every 3-5 years
  • Vendor fee to migrate data to new servers – recurs every 3-5 years
  • Salary or hourly wages for onsite IT personnel
  • Ongoing costs of server maintenance, hosting, security, database, backups, electricity to run servers, and A/C bills to keep server rooms cold

The server license and hardware costs can easily add up to many, many tens of thousands of dollars, depending on the size of your practice.

In addition, the vendor migration fee is typically several thousand dollars because moving data to your new servers requires a large amount of work on the vendor’s part, and the process can take six weeks or more.

For right now, this may be the simplest option for handling the Windows Server 2008 R2 end of life, but consider how you’ll feel in a few more years when you face another expensive infrastructure upgrade.

Even if you switch to Windows Server 2019, which is currently the newest server operating system, Microsoft will most likely stop supporting it eventually, too, and then you’ll have the Windows 2008 R2 end of life situation all over again.

For Matthew Harris, MD, of the Illinois Dermatology Institute, this level of IT involvement was an EHR dealbreaker:

“We’re a giant group, and we absolutely refused to implement a server-based EHR system. We didn’t want to create an onsite technical institute where we had to pay IT staff to run our servers and troubleshoot problems. That’s not the business we’re in. The server-based systems were also very expensive. We wanted a solution that was cloud-based, flexible, reasonably priced and didn’t require onsite IT support, so we chose EMA for dermatology.”

Option 2: Switching to your vendor’s cloud-based option

Costs include:

  • Monthly subscription for cloud-based EHR
  • Potential one-time vendor fee to migrate your data to the cloud

With this option, you won’t have the large upfront costs of buying new servers when the Windows Server 2008 end of life occurs.

Of course, the monthly subscription fee for a cloud EHR system could be somewhat higher than the server version because the vendor is now providing cloud services in addition to the software. However, switching to cloud can eliminate the cost of server licenses, hardware and hardware upgrades, onsite IT staff, server maintenance, hosting and backups.

When you look at these factors over the long run, switching to cloud after the Windows Server 2008 R2 end of life may pay for itself over time. In some cases, it may actually cost significantly less than continuing with a server-based EHR system.

For instance, David Smith, chief information and security officer at Capital Digestive Care, found significant savings by switching to gGastro® Cloud from the server version of gGastro EHR:

“Since switching to the cloud, we’ve saved over $200,000 in hardware and software upgrades and over $120,000 in ongoing annual costs, so it’s been financially strategic for our organization. We’ve also experienced significant improvements, such as increased performance and less downtime, plus issues are quickly addressed.”

However, make sure that the cloud EHR meets your needs.

With certain vendors, the cloud-based option may require you to learn a completely different workflow than the server-based system you’re used to using. If that’s the case, switching to cloud would almost be like switching to a new vendor, so you should take the opportunity to investigate some other cloud EHR vendors as well. If you’ve been unhappy with your current system, this is a great time to find a new one that’s a better fit.

Option 3: If your vendor doesn’t have a cloud option, switching to a vendor that does

Costs include:

  • One-time training and implementation fees
  • Potential one-time data migration charges
  • Monthly subscription for cloud-based EHR

Unfortunately, many vendors don’t offer cloud options. If yours doesn’t, it may be worthwhile to invest in a new cloud-based EHR system instead of upgrading your existing infrastructure when the Windows Server 2008 end of life arrives.

There will be some upfront costs for training and data migration, but they may end up being less than the cost of new server licenses and hardware. And unlike infrastructure upgrade costs, they won’t recur in a few years as long as you stay on the same system.

Even though the monthly subscription for a cloud EHR could cost more than the server-based EHR software licenses, it may well save you money over time because it eliminates the costs of maintaining your server environment yourself.

If there are any issues you’re having with your current EHR software, you can choose a system that helps address them. Find an easy-to-use cloud EHR with a customizable workflow and a first-class support team, and you may be surprised at how quick and smooth your transition is.

Once the Windows 2008 R2 end of life is past and you’re up and running with your new system, you may find that your practice is not only saving money and IT headaches, but also running more efficiently and effectively.

For instance, Eric W. Niemi, DO, of Advanced Eyecare, PC, found that switching to a cloud ophthalmology EHR helped his team work together better:

“Thanks to EMA, our communications and documentation are more efficient than ever. We also have much easier on-call access to patient data as our physicians in any office can read each other’s notes instead of relying on the patient’s explanation.”        

Practice Manager Jessica Nin of Palm Beach Hand to Shoulder had a similar experience:

“For us, the biggest advantage of our new orthopedic EHR and Practice Management software is having all of our information in the cloud. It enables easy access to patient information, in one system, with just a few clicks or keystrokes. It is more fluid in sharing of information between provider and staff and leaves a digital footprint as we communicate and care for our patients. It has challenged us to come out of our comfort zones to share in the patient experience.”

Option #4: Using a third-party cloud vendor

Costs include:

  • Vendor fee to migrate your EHR data to the third party’s servers
  • Monthly subscription for third-party cloud vendor
  • Onsite IT resources

With this option, you keep using the server version of your current EMR system after the Windows Server 2008 R2 end of life. But instead of hosting it yourself, you have a third-party vendor such as Microsoft Azure host it for you remotely.

This may look like a cloud solution because it’s delivered through the Internet, but it’s not true cloud.

As with using your vendor’s cloud option, it’s cheaper upfront than buying new servers. The difference is that here, you need to take some responsibility for managing the software environment. As a result, you may have to keep paying for onsite IT resources, even though you’re not doing the hosting yourself.

Why is this the case? EHR vendors generally don’t design their server-based software for third-party hosting, so their technical documentation doesn’t include specifications for it. As a result, your IT team must try to figure out how to translate the specs so that the third-party cloud vendor can comply with them.

Every time the software is updated, you’ll need to check to make sure you still comply with all the specifications. You may also need to perform backups yourself, which can be expensive and time-consuming.

Bottom line: this option for the Windows 2008 R2 end of life is likely more expensive and more difficult than getting cloud services directly from your EMR vendor.

EHR Cost Model: Large Lump Sum Investments Vs. Stable, Predictable Costs

Before we move on to convenience, security and support, let’s take a moment to look more closely at the cost distribution of cloud vs. server as it relates to the Windows Server 2008 end of life.

With a server-based EHR, it can be hard to tell how long your servers will last. Even if you follow the usual 3-5-year replacement schedule, a server may fail at any time, and you’ll need to find the money to replace it.

The same goes for storage space. Even if you try to keep a close eye on usage, it can be hard to predict exactly how quickly you’ll fill up your storage space and when you’ll need to buy more.

However, with a cloud system, the costs are evened out as a monthly subscription fee. The vendor manages server upgrades and scales their storage space to accommodate their total client base, without charging you extra fees for these functions. Plus, you won’t need to buy additional server hardware if you add a new location.

By paying a stable monthly fee, you can greatly simplify your budgeting process. You don’t have to try to predict the future or worry whether you’ve saved enough to cover large, unexpected charges.

Windows Server 2008 R2 End of Life Options: Server vs. Cloud Convenience

We’ve touched on some aspects of this already, but it’s worth evaluating the convenience factor in detail when determining the right course of action for the Windows Server 2008 end of life transition.

Because the vendor manages the IT issues and infrastructure for you, cloud can offer greater convenience than server. It frees you up from worrying about keeping your servers running and having IT personnel to manage the hardware, backups, interfaces and performance, so you can focus more on taking care of your patients.

Also, by skipping the server hardware upgrades, you can often save a significant amount of time and work. With a server-based system, any time you add a new server, your team has to set it up and make sure it complies with vendor specifications. Migrating data onto the new server can take weeks of work from both your practice and your vendor.

In contrast, with a cloud-based system, there are no servers to upgrade. If you want to add a new facility, you can simply log into the system from your web browser, rather than having to set up and manage VPN access.

Some practices worry that if they use the cloud, it will be more difficult for them to get their data if they ever decide to switch systems. You may need to pay the vendor for a data extraction if you use cloud, but you’ll likely need to pay a third party a similar fee for data extraction if you use your own servers.

Cloud vs. Server: Tech Support

Another component to consider when evaluating your options for after the Windows Server R2 end of life is tech support.

With a server-based system, if the system is slow or goes down, you have three numbers to call—your EMR vendor, your internet provider and your server provider (or your third-party cloud provider, if you use one). In some cases, it can be hard to determine on which side the problem lies, and this can delay resolving the issue.

With a cloud-based EMR, you have one less phone call to make, which can mean faster and simpler issue resolution.

Michael Weinstein, MD, president of Capital Digestive Care, found this to be one of the biggest motivators for their organization’s switch to cloud.

He explains, “Our connectivity to the server had not been completely reliable; whenever there was a glitch in the access to our medical records, it was our responsibility to diagnose if it was a server or software problem. By choosing to go with just one vendor, we were able to turn the responsibility over to them. That, among other reasons, is what made us decide to move to cloud-based technology.”

The transition from server to cloud can also be a concern, but Dr. Weinstein found that having high-quality customer support allowed their organization to switch seamlessly and start experiencing benefits immediately.

He shared, “Since we went to gGastro Cloud, we’ve had significant improvements in consistency and speed. Most physicians just want to concentrate on their patients, and they don’t really know what goes on behind the scenes during a project like this. Thanks to Modernizing Medicine Gastroenterology and the commitment from our team, the transition was seamless and we’ve had higher satisfaction.”

Cloud vs. Server: Security

These days, medical practices must take many protective measures to defend against security issues such as viruses and ransomware. There’s no way to guarantee safety, but a strong security team can go a long way toward helping mitigate threats.

If you use a server-based system, your IT team needs to constantly stay on top of emerging threats in the industry and put new protocols in place to protect against them. Especially for a one-person IT team or a contractor who also has many other issues to address on a day-to-day basis, it can sometimes be difficult to keep up.

However, with a cloud system, the vendor can dedicate an entire security team of engineers to monitoring their cloud infrastructure, keeping up with new threats and keeping the system available when you need it. Plus, a cloud vendor may have more resources to allocate to staying up to date and compliant with new industry regulations.

When it comes to on-premise physical security issues like natural disaster and theft, onsite servers can also be more vulnerable. By implementing measures such as frequent backups, resilient storage, load balancing and multiple availability zones, a cloud EHR vendor can help protect your data and provide uninterrupted service if a server fails or a physical disruption occurs.


So when the Windows Server 2008 end of life comes, which option will you choose: cloud or server?

As we’ve seen, a cloud-based EHR can provide you with greater convenience, enhanced reliability, faster support and more resources for protecting your security. And if you ask your vendor—or another vendor if your vendor doesn’t offer cloud—for pricing on their cloud offering and then calculate the 10-year costs for each option, you’ll likely find that cloud may cost the same or less.

That said, depending on your practice’s unique needs and situation, you may prefer to remain on server. The most important thing is that you choose what’s best for you.

Whatever you ultimately decide, I hope this article has left you more informed and prepared to face the Windows Server 2008 end of life transition with ease.

Arnold G. Levy, MD

Arnold G. Levy, MD

Dr. Arnold Levy’s medical career spans 40 years, beginning in Montgomery County, Maryland, in 1977. In that time, he has cared for patients with a wide range of digestive disorders, performed thousands of endoscopic procedures devoted his time to advancing digestive health care as a member of the National Digestive Diseases Advisory Board and the Board of the National Digestive Disease Information Clearing House and as the immediate past President of the Maryland Patient Care and Access Coalition. He also maintains an academic appointment as an Associate Clinical Professor of Medicine at the George Washington University School of Medicine and Health Sciences.

In 2006 as the healthcare provider environment was growing more complex, Dr. Levy joined forces with colleagues across the Washington Metropolitan area to lead discussions on how to address the challenges in their industry. In 2009 Capital Digestive Care was formed through the merger of seven diverse private practices and Dr. Levy was elected President and CEO where he served until 2017.

Dr. Levy obtained his BA in 1968 and MD in 1971 both with distinction and both from The George Washington University, in Washington, DC.

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