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 An introduction to the key differences between on-premise software and cloud-based technology for ambulatory surgery centers (ASCs).

It’s no surprise that cloud computing has grown in popularity as much as it has in the healthcare industry.  

As the needs of surgery providers evolve with shifting procedure volumes, price-sensitive patients, and the transition to value-based care, on top of the day-to-day operational responsibilities, many surgery centers are turning to cloud-based technology to help improve patient outcomes and satisfaction, reduce costs, and drive revenue growth. 

With that being said, on-premise software – installed on a surgery center’s own computer servers – was the only offering for ASC technology for quite some time, and many facilities continue to use this model to achieve business goals. 

On-Premise vs. Cloud-Based Software: At-A-Glance 

While there are many ASC decision-makers who take the approach of “if it ain’t broke, don’t fix it”, it’s clear that innovation waits for no one. For surgery centers looking to leverage the latest in ASC technology, they will eventually be faced with the question ‘When do I make the move to cloud-based software?’  

Let’s pause for a moment though. Before you make a decision on moving to the cloud, here’s a friendly introduction to these data hosting options.  

What is on-premise software? 

On-premise software, also called “on-prem”, is technology that is installed locally, on your facility’s computers and servers.  

For many years, this was the traditional form of software installation. On-prem software is often more expensive than cloud models and requires an investment from the surgery center for hardware, software licenses, and in-house or contracted IT staff. Additionally, the surgery center will be fully responsible for data security and software management including applying software updates, security patches, etc.  

What is cloud-based software?  

Cloud software, also known as “software as a service” (SaaS), is a technology that is hosted remotely on the vendor’s servers and accessed by the surgery center via a web browser.  

The more modern form of software delivery, cloud-based software often has a lower total cost of ownership by allowing the user to pay an annual subscription fee and not requiring the surgery center to provide its own servers. The vendor also focuses on data security and software management on the servers. 

What is the difference between on-premise and cloud-based software?  

Essentially, the fundamental difference between on-premise vs. cloud-based software is where the technology application resides. But there are numerous distinctions between the two that results from this infrastructure variance. 


  • On-premise software is installed directly on the hardware (server/computers) owned by the facility and is generally accessed using in-office devices. Remote access requires additional layers of remote access software and controls. 
  • Cloud-based software, with appropriate permissions enabled, can be accessed anytime and anywhere via a web browser, from any device. This allows surgery center staff to work from both the facility and remotely.  


  • On-premise software tends to be more expensive because it requires the ASC to provide its own servers, purchase maintenance agreements, and, retain or contract IT staff for technical support, updates, and data security. 
  • Cloud-based software helps to reduce overhead costs by removing the need for the ASC to purchase their own servers and placing the responsibility for operating, managing, and maintaining the software and the infrastructure on which it runs with the vendor. 


  • On-premise software implementations and updates often take longer due to the time needed to complete installations and configurations on the facility’s servers and each individual computer. 
  • Cloud-based software is quickly deployed over the Internet and facility-specific configurations can take place over days and weeks versus months. In addition, nothing needs to be loaded or maintained on the facility’s workstations.  

IT Support  

  • On-premise software requires the surgery center to maintain server hardware and software, data backups, storage, and disaster recovery. This can be an issue for smaller facilities that have limited budgets and technical resources. 
  • Cloud-based software is hosted by the vendor, so the surgery center doesn’t need to worry about the maintenance of software or the servers it resides on, and updates and software releases are taken care of by the service provider.  


  • On-premise software requires the ASC to manage data security, employing security measures such as retaining or contracting IT staff to monitor cybersecurity vulnerabilities, performing proactive backups and patches, and conducting incident response plans in the event of a data breach, often beyond the affordability of most surgery centers. 
  • Cloud-based software is designed to offer advanced security tools and monitoring technologies, managed by the software vendor. In addition, disaster recovery and backups are handled by the vendor.  


  • On-premise software does not have native interoperability capabilities without the additional purchase of third-party technologies to share data with other systems. The facility is also required to manage and license these additional technologies. 
  • Cloud-based software delivers centralized interface capabilities through modern interfacing capabilities, including application programming interfaces (APIs) that allow two applications to talk to each other in a secure manner. In cloud-based software, these connections are implemented and managed by the vendor.  


  • On-premise software requires a license for each server and device, meaning an increased case volume will eventually require the facility to purchase additional servers and licenses to handle the caseload.   
  • Cloud-based software runs on web servers – as in, servers that the facility does not have to provide or maintain – and provides greater flexibility by allowing the vendor to easily scale to meet demand; for example, adding and scaling back licenses.   

Should I stay or should I go (to the cloud)? 

Every surgery center is unique with different needs and goals that influence if and when they move from on-premise to cloud-based ASC software.  

Here are a few helpful questions to consider as you compare:

  • Cost of ownership – Is maintaining on-premise hardware and software maintenance agreements getting too expensive?  
  • Backup and disaster recovery – Do you have the tools, focus, and expertise to ensure top-level security
  • Software maintenance – Is it important for you to have access to the latest functionality and software updates?  

Cloud-Based Software as a Service (SaaS): Final Thoughts 

At the end of the day, your ASC is likely getting by on your current ASC software. But as you look for advanced capabilities, lower total cost of ownership, and enhanced security, you will need to start planning your move to modern cloud-based software.