A Frugal EHR Implementation: Is There Such a Thing?

Money isn’t everything … or is it?

Seventy-three percent of office-based physicians who haven’t yet adopted an electronic health record (EHR) say the cost of purchasing an electronic system is the biggest barrier, according to a 2014 report published by the Office of the National Coordinator (ONC). Other barriers include the following:

• Loss of productivity (59%)
• Annual maintenance costs (46%)
• Finding an EHR to meet the practice’s needs (46%)
• Adequacy of training (40%)

Here's a closer look at the costs associated with purchasing an EHR and some tips on how to stay on budget during implementation. 

Open your wallet … and your mind
The average up-front cost for an in-office EHR is $33,000, according to HealthIT.gov. Up-front costs for a web-based EHR are reported as slightly less at $26,000. However, these estimates don't indicate what is included, and there can be a wide variation in expenses related to training, implementation, staffing, and patient load. Even with reduced patient load and some added staff costs, there are some EHR vendors that provide solutions at a far lower cost.

Still, there are both upfront and ongoing expenses when implementing an EHR. And many physicians are concerned about that impact and whether or not there is enough return to warrant the investment.

The good news is that with a little strategizing, physicians can make frugal decisions that won’t make or break their EHR implementation. Consider these five cost categories and tips for how to save money:

1. Hardware
Examples include costs associated with database servers, desktop computers, tablets/laptops, printers, and scanners.

Tips to save time and money:

• Look for a cloud-based EHR vendor. These vendors manage all record creation, sharing, and storage over the Internet, thereby minimizing the costs associated with hardware and licenses while still providing many robust features. Cloud-based computing means there are also no costs associated with expensive in-house servers. Many cloud-based solutions are also mobile and can be used on less expensive devices, such as tablets and laptops.
• Take advantage of tax write-offs. The federal tax code (section 179) includes provisions that allow practices to purchase up to $500,000 worth of hardware and write it off during the first year.
• Don’t have a sizeable amount of money saved for an EHR? Consider options such as leasing, a low-interest bank loan, or a low-interest line of credit.

2. Software
Examples include costs associated with EHR applications and upgrades as well as interface modules (e.g. lab interface module).

Tips to save time and money:

• Look for an EHR vendor that provides automatic upgrades at no cost—or low cost—to the practice. Also remember that month-to-month subscription-based services can be more affordable because there are no up-front costs, and it’s easier for practices to budget a reasonable monthly fee.
• Contact your medical association to inquire about additional vendor discounts.
• Ensure that your EHR vendor is capable of sending diagnostic orders to the lab information system and receiving results for review and inclusion in the patient record. Without these capabilities, practices may face significant costs associated with interface design.

3. Implementation assistance
Examples include costs associated with hiring an IT contractor, attorney, electrician, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support.

Tips to save time and money:

• Reach out to your nearest Regional Extension Center (REC). RECs are funded by the ONC specifically to help primary care physicians adopt and use EHRs. Center services include outreach, education, change management support, workflow redesign, and other types of technical assistance.
• Network with other practices. Can you pool resources to fund a full-time IT position that can be split among each setting, for example?
• Look for an EHR vendor that will provide free or low-cost implementation assistance with tasks such as data migration.

4. Training.
Examples include costs associated with hardware and workflow training for physicians, nurses, office staff members, coders, and others.

Tips to save time and money:

• Look for an EHR vendor that provides a whole host of online help and teaching materials that staff members can access anytime and from anywhere. Ask to see examples of these training materials before signing the dotted line.
• Ask for references. Ask other practices about their experience with each vendor. How easy was it to adapt workflows and learn the system? How accessible was the vendor before, during, and after the transition?
• Look into tax credits for retraining. For example, Georgia offers a retraining tax credit of 50% of direct training expenses (up to $500 per full-time employee, per training program). The annual maximum of the credit amounts to $1,250 per employee. Other states may offer similar incentives.

5. Ongoing network fees and maintenance.
Examples include costs associated with hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees.

Tips to save time and money:

• Look for an EHR vendor that automatically includes a service package for ongoing support. What does this support entail, and how is it offered (e.g., via onsite, telephone, or email)?
• Shop around. Take your time before choosing an IT consultant and network provider. You should feel confident that you’re getting a good deal.
• Identify a super-user. This is someone in the practice who can attend ongoing trainings and then share that information internally. He or she can also troubleshoot as questions or problems arise.

For more tips on how to effectively implement your EHR to get the most of our it, download this helpful guide.