EMR Cost Categories
The following EMR-related costs have been identified within various health care organizations. Before one assumes that just because some other organization was able to purchase and implement a specific feature, one must ensure that they are talking about the same EMR features and functions available AND that the organization will be able to implement them at their organization. See related EMR Benefits and Return on Investment Categories page...
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Common EMR Cost Categories
Financial
- High startup costs attributed to hardware, software, network and communications enhancements, consulting services, and facility improvements. One study estimated these hard costs for a new EMR system at $13,100 per physician.1 When the opportunity costs (see #Operational) are considered, this amount is consistent with a report by the CBO that initial costs can range from $25,000 to $40,000 per physician.2 In addition, the technical skills and capabilities of the current technical staff must be evaluated to determine if training is required or perhaps if new personnel must be added.
- The systems often will require new workstations, laptops, servers, storage systems, and backup devices. Depending on existing capabilities, firewalls and routers may also be necessary.
- On the software side, the application software must be purchased, and often the application will require a database system. Both of these items can be very expensive, depending on the vendor that is selected.
- System management and monitoring software and backup software will often be desirable to reduce the manpower demands and to ensure that system software is kept current.
- For companies that are making a big jump to computerized systems, they must also acquire security software to protect against unwanted intrusions, data theft, or malware infections.
- Enhancements to the networking infrastructure, such as vastly improved wireless capabilities and high-performance, secure fiber interconnects between systems or floors, should be anticipated.
- High bandwidth internet services should also be anticipated in order to facilitate increased usage of online resources, including information sources, email, and remote access by physicians.
- Consulting services are likely to be necessary for initial requirements gathering, application design, implementation planning, database administration, training, and advanced technical support.
- Facility improvements that might be necessary include additional space to house new equipment, biometric security devices to control physical access, additional HVAC and electric required by the new systems, and the installation of networking cables or installing wireless devices.
Clinical
- Resistance to using EMR systems can be expected from a percentage of the professional staff. In the best known case, Cedar Sinai Hospital in Los Angeles felt compelled to stop using their CPOE system due to four issues:
- Physician complaints about the additional time and ease-of-use of the system.
- Inadequate appreciation of the impact on workflow.
- Deficient initial implementation meant having to cope with numerous changes to improve the user experience once the system went live.
- Insufficient training and support.3
- A study by Koppel, et al. at the University of Pennsylvania determined that CPOE systems can contribute to 22 different types of medication errors. Several of these errors are common and occur no less than weekly.4
Operational
- There is a high opportunity cost because EMRs require an investment in training that takes medical professionals away from their primary duties. A 2003 study by Wang, et al. estimates this cost to be $11,600 per physician. The determination of this amount is based on a model that assumes a revenue loss following implementation of 20% in month 1, 10% in month 2, and 5% in month 3. The model assumes that after 3 months that users have achieved an acceptable level of proficiency.1
References
1. Wang, S. J. et al. (April, 1, 2003). A cost benefit analysis of electronic medical records in primary care, The American Journal of Medicine, 114, 397-403.
2. Congressional Budget Office. (May 2008). Evidence on the Costs and Benefits of Health Information Technology. [1]
3. Langberg, M. L. (February 1, 2003). Challenges to implementing CPOE: a case study of a work in progress at Cedars Sinai. Modern Physician. Crain Communications, Inc. Retrieved September 12, 2009 from http://www.accessmylibrary.com/coms2/summary_0286-22602156_ITM.
4. Koppel, R. (March 9, 2005). Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. JAMA: The Journal of the American Medical Association, 293(10), 1197-1203.
