Hidden Cost of Implementing an EHR for a Small Medical Practice…Time

I just had my annual physical. The medical practice I go to is a typical small Connecticut practice with three physicians and two physician assistants. The practice also employs several medical assistants, an office manager and four receptionists. They provide excellent service and care to my family, and I can always get an appointment when I call, which I really appreciate.

Over the past year, I have had several conversations with members of my practice as they have considered going down the road of implementing a certified EHR.   The practice has considered the potential of implementing the EHR for several years now; however, it delayed the implementation because of the initial purchase cost of an EHR product. The practice was unsure of the financial impact  of potential  reductions in Medicare reimbursement, and  healthcare reform,  and  did not want to risk the practice’s escrow savings on an EHR implementation. Over the last year, practice members spoke with the local hospital CEO and CIO, Regional Extension Center, a consulting firm and four EHR software vendors to identify the best solution for the practice.  Now, this medical group has selected an EHR vendor based on  its own analysis of what was right fit for the practice. The vendor is offering them free certified EHR software and free training for the next year.  

The practice is fully aware that there could be hidden cost for implementing the EHR (go to the September 2011 issue of the Digital Office), such as training for the clinicians and staff, as well as addressing the integration of the EHR with the patient billing system.  The practice also purchased some new laptops (replacing the current PCs) as well as a few new printers.

In my conversation with the clinicians, they understood the need to implement the EHR as a tool to assist them in improving their overall care for their patients.  They specifically selected a system with the ability to free text patient notes. One clinician explained they selected a system that allowed them to continue with the ability to free text patient notes “as medicine is an art and not just a science.” She reminded me that many clinicians practice medicine so they can truly assist their patients, rather than  just to practice based on what a computer advises them they should do, which in many cases, may not be the best solution for a patient. One of the practice physicians previously used an EHR at another practice and felt that the EHR order templates/screens were not flexible enough to accommodate the needs of the clinician.

Overall, the clinicians in my practice seem happy with their EHR system choice. In addition, they will be focused on qualifying for the incentive offered by the meaningful use EHR incentive program this year.

As I was leaving at the end of my appointment, the receptionist showed me her new lap top and informed me she was excited to have the new equipment and begin assisting with the EHR implementation. She told me the clinicians have already begun working with the product even though some of them are not computer-literate, so it is taking them a while to learn how to use the system. Obviously, one of the hidden costs for my practice has been the training required to assist the clinicians and staff to become computer-literate! This is an issue that many practices experience.  

As I look back, it seems obvious that the biggest hidden cost for my practice was time,

• the time it took to select a system,
• the time it took to train on a system, and
• the time it will take to fully implement a meaningfully used  certified EHR system.  

I understood this first-hand when my practice’s EHR Champion emailed and called me from his vacation to discuss an EHR product or when the practice gave me the pharmacy rep’s slot at lunch one day to come in and review the meaningful use EHR incentive program with them.   

I hope we are all working to assist the small medical practices who take care of us and our families to help them save some time in their journey to achieve the meaningful use of EHRs.  I welcome you to share your thoughts on what techniques you use to help practice staff and clinicians address a hidden cost of an EHR implementation.  After all, we know time is precious and can never be given back.