Sunday, March 13, 2011

Implementing EHR Systems

The HealthTexas Provider Network with 26 primary care practices in North Texas has successfully implemented electronic health records with funding from AHRQ. Neil S. Fleming, PhD., Vice President, Health Care Research at the Baylor Health Care System in Dallas along with his colleagues authored the study “The Financial and Nonfinancial Costs of Implementing Electronic Health Records in Primary Care Practices” as appears in the March 2011 “Health Affairs” publication.

At the Health Affairs event on “Innovation and Health Care Delivery” held March 8, 2011, Dr. Fleming discussed the details in the study in terms of the costs to the HealthTexas Provider Network that included hardware and software costs plus the time and effort it took to implement the EHR system.

The study’s authors found that hardware costs for one time infrastructure purchases amounted to $25,000 per practice for switches, cables, and wireless internet connections per practice, and $7,000 per physician for personal computers, printers, and scanners. Software and maintenance costs involving licensing, hosting, networking, and technical support for the first 60 days resulted in $2,850 and $17,100 per year. The total costs were $32,409 per physician and $162,047 in a five physician group for the launch of the EHRs through the first 60 days.

The researchers examined how the adoption of EHR systems can affect work flow in terms of numbers of patient visits, staff requirements, practice expenses, revenues, and net income. Other issues examined included patient safety especially related to drug adverse events and the impact on the quality and outcome of diabetes care.

Some economies of scale can be achieved with larger practices due to variable nature of some of the costs. However, smaller practices still make up a large fraction of the U.S. healthcare system, and the resources needed for small practices to implement EHR systems can be quite different than from larger healthcare organizations.

Another report “Realizing the Full Potential of Health Information Technology to Improve Health Care for Americans” was released last December by the President’s Council of Advisors on Science and Technology (PCAST). The report specifically addresses the issue of how small provider practices should approach implementing new electronic medical systems as opposed to how large practices and large hospital systems operate.

According to the PCAST report, one of the major differences is that small organizations need low-cost off-the-shelf products and services to enable them to have the benefits of health IT without having to undergo a costly customization and maintenance process.

The PCAST report also points out that one solution to help small providers implement EHR systems would have the practices adopt a cloud-based EHR product, since cloud-based technology allows software to be run and data to be stored on remote servers. This cloud model would help small providers benefit financially in costs for data storage and processing.

For more information on the March 8th event, go to and to view the PCAST report, go to