Understanding the true costs of an EHR implementation plan
Plan for unanticipated expenses so they don't slow your progress or delay a 'return to normalcy'
The best course of action is to educate yourself on the true costs before you begin the EHR installation via sources such as Medical Economics and its ongoing 2-year EHR Best Practices Study. In addition, your local regional extension center's (REC's) mission is to help you implement an EHR—any EHR. RECs hold live events at which you can hear other PCPs discuss their experiences implementing EHRs in their practices and where you can meet one-on-one with their experts. Also:
Unexpected overtime cost is regularly named as a prime culprit when practices find themselves failing during an EHR implementation. It's one of the "difference in time constants" that Haughton says can catch practices off guard.
"Business process and change—and health reform—is measured in months and years," he says. "A small practice may not have the capital reserves to invest that would buffer it from a revenue slowdown, especially in a time when you've got a bigger administrative burden. A lowering of dollars per unit of care delivered puts primary care in a pretty tight vise from a revenue perspective."
To make matters tougher on physicians, today's EHRs are not really designed to "optimize speed of throughput for the clinician," Haughton says. In many instances, a quick handwritten note in a patient's chart is all that's needed to record the encounter. Today's EHRs, however, with their quality reporting and meaningful use integrations, make it challenging for doctors to complete their notes swiftly. They must enter, and often re-enter again and again, patient data that are not immediately germane to the medical issue at hand. Thus, it can take physicians a significantly longer time to input their notes into an electronic record than it took with their old paper processes—thereby increasing practice costs after EHR implementation.
"That's the giant 'gotcha,' " Haughton says. "That fast, brief note in primary care works like lightning from a speed perspective. And that's where the collision occurs."
In addition, Haughton says that PCPs probably aren't making the kind of long-term decisions on capital and time outlay that a chief executive officer of a Fortune 500 company would be making. They're thinking in terms of "Do we have enough money to pay the bills at the end of the month?" And thus, they don't instinctively consider the long-term effects installing an EHR will have on their practices, he says. Worst of all, Haughton adds, they may not even be aware of the situation until it's too late.
"Physicians are used to making decisions with imperfect information in a short time," he says. This short-term problem-solving, however, can irreparably damage a practice's ability to survive an EHR implementation—especially when the time to recoup the original financial outlay, in addition to the induced costs, can take years.
VALUE YOUR TIME
These are the types of unanticipated costs that over time can put enormous financial burdens on practices. So much so that Neary recommends that practices implement EHRs in stages.
"Implement slowly," she says. "Don't do everything all at once. First do e-prescribing, then take it step by step."
Whether it's a client/server, software-as-a-service, or cloud-based system, implementing any EHR will send shockwaves through your practice, reducing staff efficiency, decreasing practice revenue, and dramatically affecting your bottom line. Count on it.
To survive the process, be constantly aware that when you're calculating the time and dollars it takes to implement the EHR, the true costs can remain hidden until you're well under way. Plan for this contingency and you dramatically improve your chance of success.
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