The cost-benefit calculation of electronic health records systems

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It's discouraging to read that more than half of physicians say the costs of electronic health records systems outweigh the financial benefits. But it's also heartening to see that, in the survey of 1,200 employed and independent physicians, most agree the benefits to patient care do justify the investment.

Reminds me of the much-spoofed MasterCard commercial: Electronic health records system: $15,000 to $70,000. Patient safety and quality: Priceless.

And, oh, if only an EHR system really was a mere $70K. There's more to the cost than the initial investment in hardware and software--a lot more. There's training costs, loss of productivity as clinicians and other staff learn new systems. There's IT staff to hire. And don't forget ongoing maintenance and the inevitable updates to buy and install.

One Health Affairs study put the cost for an average five-physician practice at $162,000 for implementation, plus $85,500 in maintenance expenses during the first year alone. Meanwhile, clinical and nonclinical staff spent 134 hours per person, on average, to prepare for use of the record system in clinical encounters, according to the study.

The cost for a physician practice sounds like a bargain when compared to a large, complex system. For Detroit's Henry Ford Health System, the price tag was a whopping $356 million, an outlay it said was a major factor in a 15 percent decrease in net income in 2012.

Of course, there are resources for financial and technical support, such as through regional extension centers and from the U.S. Department of Health & Human Services and its Meaningful Use incentive program. And EHR systems surely will bring dividends in the form of data providers can use to work more efficiently and market more effectively. 

Then there are the less tangible rewards--it makes it easier to recruit younger docs, who never practiced in the all-paper world and expect a well-functioning EHR. And, as a patient, I feel safer and more satisfied when I'm visiting a doctor who has my medical history and other information at the tap of a keyboard (although I know not every patient feels the same or even notices.)

To the outside world, calculating a return on investment on technology designed to improve outcomes--indeed, to save patients' lives--may sound callous, but healthcare leaders must keep an eye on that bottom line.

So what is your bottom line? When you consider financial returns and clinical benefits together--not as two separate benefits--do EHRs come out as a winning choice? And a question the initial survey mentioned above didn't address: Which is more important--the financial or the clinical?

Finally, on a side note, there were some findings in the study that boggled my mind. For starters, the number of physicians who say patient care benefits outweigh the costs is down 5 percent since 2012. And 17 percent of docs think EHRs "somewhat" or "significantly" worsen patient care, for example. Makes you wonder what, exactly these docs are (or aren't) doing with their EHRs. Perhaps they fall into the group that is only "somewhat familiar" (24 percent) or "not at all familiar (3 percent) with the technology. Seriously: What's up with that?

Love to hear what you think, as always. - Gienna (@Gienna and @FierceHealthIT)

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