The adoption of an electronic medical record (EMR) or electronic health record (EHR) in an ambulatory care medical clinic is an effective re-engineering of clinical processes, in order to achieve (via digital information technology) an improvement in quality and efficiency in the provision of medical services.
To achieve a return on investment, adoption of such a significant organizational change must create a positive impact on the organization’s income statement. Organizational leaders for EMR adoption must demonstrate that the initial capital expenditure (which may be funded over a reasonable period of time), and the ongoing maintenance costs associated with EMR or EHR adoption, will benefit the “bottom line”.
Most ambulatory health care clinics already have a smaller network of computers used for training management software functions. Adoption of electronic medical records (EMR) will require the expansion of this network to all clinical examination rooms and all clinical stations. Thus, in addition to the initial and maintenance EMR software costs, the cost-benefit analysis of the cost-benefit calculation should include an estimate of the initial and expected maintenance hardware costs, and an estimate of the upfront costs and maintenance network support (IT work). The organization may obtain a reasonably accurate estimate of such costs by using the services of a reputable local network administrator, for a fee for the service. Of course, EMR software costs (initial and maintenance) can be obtained directly from the EMR vendor.
While an analysis of the impact on the cost side of the income statement can be measured relatively easily, an analysis of the savings or benefits is rarely ‘obvious’ and speaks to the heart of the problem – the effectiveness of the electronic medical record in delivering clinical services with enhanced quality and enhanced efficiency.
More than that: Physician or ancillary service providers are the largest cost item on a clinic’s income statement. In the event that an EMR program does not improve the quality and efficiency of a clinician’s job, the plan is a lost cause. It is for this reason that the successful adoption of most EMRs is usually led by a physician “hero”. Such a “hero” physician would no doubt seek out an EMR that provides AI to enhance their clinical acumen and, at the same time, facilitate many of the daunting tasks associated with healthcare plan documentation and implementation. No human being is free from error, however, and a thoughtful clinician “champion” will seek out an EMR that may be flexible enough to incorporate and remind him/her of the changing standards of clinical care while matching well with his or her style of practice.
The efficiency of electronic medical records may result in practice savings in the areas of transcription costs, use of support personnel, and medical record supplies. However, these savings must not be provided at the cost of clinician dissatisfaction with the clinical electromagnetic radiation function. In most cases, replacing a dissatisfied but good and productive doctor may be more expensive than hiring, mentoring, and initial training.
Furthermore, replacing a failed electronic record may be more expensive than the costs of its initial adoption.
Choosing an EMR or an EMR is a huge financial decision for an intermediate ambulatory care medical clinic. At stake is the organization’s long-term integrity. Due diligence is mandatory.