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Good question, I'm certainly no IT specialist!

However I think your market would dictate the costs. Over the last couple years I had been toying around with some ideas based on operational realities we had in our business- a healthcare group using a remote EMR w/ approx 45 computers and a Dell Server. We did not jump on anything new directly outside of what we were doing but I will say some of this was due in part to the research involved in answering your questions for ourselves and lack of solicitation of someone offering us ready options and pricing we wanted to hear. I worked pretty closely with an IT consultant discussing some of these projects for a while- if she had or knew of someone locally that would have been doing what you are planning on doing could have been essentially a plug-in requiring a proposal and a thumbs up- do you follow me here? If you are ready to invest in the hardware/ software ( removing the investment off another company's shoulders ) and have the know how to deliver satisfying results ( deliverables/ reliability/ service ) then the costs of getting your business off the ground could essentially be pass through from a client over your extended risk. The extension preventing us from making the go ahead decision on some of these ideas had to do with the commitment to do it ourselves considering we could do it less expensively for ourselves. However, if you assume the investment costs up front and offer exit if the company is unsatisfied then they might be willing to move forward with some needs. You can also split your utility across several or more clients yadayada-

So

• we had a RAID platform for triple redundant backup that was innefective. We ended up purchasing a fourth blade to manually back up our "backup".

• we wanted to go to VOIP by integrating our own additional T-1 or going cable with a couple of dedicated blades which would offer further redundancy in our internet connections and bandwidth capacity for our expanding usage. Most of the VOIP options worth considering for serious business applications imply purchase of 30K box which was ridiculous in our opinion. We'd heard of some people putting together their own for far less- an ambitious and difficult project to take on considering the necessary research and potential risk in reliability.

• our EMR had initially implied some great patient relationship tools such as online patient access to charts and scheduling boards etc. We had been using e-mail through the parent EMR vendor's server assuming it was secure for patient information and had a variety of forms such as new patient applications on our website that were underutilized and undersupported by the EMR provider. When we learned the data was being sent without encryption, we deactivitated these features in order to comply with integrity to HIPAA and found ourselves considering paying for a third party database/ secure transaction host- in medicine, patient relationship features will be a key distinguisher/ hot app in determing healthcare providers of choice; especially with the dynamics of reimbursement forcing practices to be selective to either lower quality reimbursement markets or higher paying "cream of the crop" markets- we'd need a boutique/ concierge application supporting outstanding customer relationship tools and so on. Most EMR providers are still drooling over the extensive market of practices still yet to convert to paperless.

...and many other ideas along these lines. you sound like you could be positioning yourself as a needed solution for some companies. The start up costs could be projected based on what you are willing to do and who is willing to "go in" on it with you for their own benefit. You might mitigate a lot of the start up costs by approaching your concept in this way. Once you've done your homework, you could save some other companies time and money in doing this for themselves and motivate them to go ahead sooner rather than later.

Not necessarily the advice I think you were looking for...but perhaps some ideas you might not have thought about. Let me know if you found useful.