Survey documents EHR implementation costs

The median out-of-pocket expense related to the first-time installation of an electronic health record (EHR) system was $1,750, according to a recent survey conducted as part of the Medical Economics EHR Best Practices Study.

But expenses related to the EHR implementation (computer equipment, set-up, connectivity, and technical support) for 27 of the primary care physicians (PCPs) participating in the survey varied widely. Although these expenses did not factor in costs associated with the EHR system, they did address those extra expenses associated with its implementation.

In fact, the average out-of-pocket expense to support the implementation of the EHR system jumped to $3,121. One practice even spent $12,000 at the time of the survey, whereas the median costs for the six practices that already had EHR systems was just $250.

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These data were gathered by Medical Economics as part of its 2-year EHR study, which is aimed at documenting best practices when implementing EHRs as you and your fellow physicians work toward achieving Medicare's meaningful use incentives.

Much of the activity for study participants during this pre-implementation phase focused on investigating and purchasing computer hardware and developing processes for EHR implementation.

"We are a start-up practice and invested in quality hardware from the start-with an eye to optimizing performance of the EHR," says Dana Simpson, MD, medical director and chief executive offier of Life Center Family Medicine in Summerville, South Carolina, and a Medical Economics study participant. "We are striving to create processes and procedures that minimize duplicate data entry and do not generate additional paperwork."

The experts agree with this approach. "What is more painful than an EHR implementation? A second EHR implementation. Do it once; do it right," advises consultant Lydia Mays Washington, who spoke during a recent presentation at the American College of Physicians (ACP) annual meeting in New Orleans, Louisiana.

According to the Medical Economics survey, 93% of the study participants are implementing an EHR system to attain meaningful use to capture Medicare incentives. Fifty-nine percent of the survey participants hope to improve the quality of patient care. (See the chart, right.) Factors that were less significant for study participants included reducing practice costs (26%), improve communications with patients (26%), and improve financial/accounting record-keeping and documentation (19%).

Excessive time to implement (96%) and disruption to the practice (89%) were top two concerns expressed by physicians. About 82% of survey respondents expressed concern about the time it will take to implement and be eligible for meaningful use. About 78% of the participants were concerned about the cost of implementation.

When it comes to readiness, only 37% reported they were extremely ready, whereas 52% said they were ready.

But the first 6 months of an EHR implementation are the most difficult, experts say. You are building an electronic infrastructure, reinventing processes and workflows, and learning an entirely new way to document and conduct patient assessments. You are also taking all of your paper records and converting them to a digital format. 

Mitchell A. Adler, MD, JD, MPH, FACP, also speaking at the recent ACP conference, says that you should expect a 30% drop in productivity for the first 6 months.

To make this transition smoother, Mays Washington says that every doctor looking to implement an EHR should conduct a thorough workflow analysis. The goal, she says, is to look at patient volume and identify bottlenecks in the workflow. You will then need to redesign your processes and workflow around this new EHR system.

"You want a vision, because it will get rough," she says.

Once you start down the path of maintaining an EHR system, you can't turn back, either. In fact, Mays Washington says that running parallel processes is both dangerous and very expensive. "Shadow charts compromise integrity of records for care and compliance purposes." And the longer the paper record exists, the greater the risk of reverting to paper. Although state and federal rules govern storage of paper records, when implementing an EHR system, strive for efficiency, data accuracy, and accessibility, with the end game of improving patient care.

"Data quality is very important, and data entry is key to data quality," Adler adds. "Remember, this is a tool, and if you use it improperly, you can cause a lot of damage."

Study participants reported making progress in areas such as e-prescribing, maintaining active medication lists, recording and checking vital sign changes, recording active medication allergy lists, and recording smoking status for patients aged at least 13 years. Only 30% of respondents reported making reasonable progress toward protecting medical records, and 7% could provide clinical summaries for patients for each office visit at this stage of implementation. A median of two staff members, including the doctor, have been trained to use an EHR system, the survey reports. The median number of staff was four.

Out of the 27 practices participating, about 78% had not worked with an EHR previously. Before implementing the EHR, the practices reported seeing a median of 25 patients per physician each day. Doctors in the study logged a median of 35 direct patient contact hours per week, and the median nonclinical hours worked each week for this group was 10.