Lot of companies are waiving upfront fees, because there is so much pricing pressure. I know owners of several EMR companies, most of them have their support and training staff offshore. That is not necessarily bad, but then you don't get the quality of training you deserve.
Plus, so many studies have shown that successful implementation has to do with the level of training and support.
Rather than zero upfront costs, what you should be asking for is -
- One day of Onsite Training during 'Go-Live'.
- Unlimited Remote Training
- Dedicated Phone support number for you.
Rather than compromise on a bit of upfront cost, it is imperative that you focus on making your practice more efficient and profitable.
This is not a Trivial System you are going for - EHR and Health IT has business implications. If not done right, it can slow you down, create chaos and you end up suffering.
If cashflow is really a concern, work out creative ways to spread it out. I'm sure your vendor will work with you.
If you think you can train yourself and your staff (assuming you have a lot of time on your hand), and setup the system yourself, why not go with the Free software Practice Fusion. Of course, if you add up your time and cost of time, you will conclude very soon that free system was actually more expensive.