Comments on: Readers Respond: The Exorbitant Cost of Meaningful Use

By: Mitchell Jay Wolin, MD

Mitchell Jay Wolin, MD — Fri, 30 Jul 2010 20:54:49 +0000

I was asked recently by a friend why the government is so intent on forcing EMR on all physicians. Since EMR systems that currently exist can not communicate among each other typically (such as getting the patients lab and MRI results from whatever institution did the work – ideally even in the absence of the patient knowing where the study was done which is a frequent problem!), then the most important reason for the government to push EMR does not exist with current systems. In other words, improved communication among medical providers should be the real reason to push EMR, but it is not. Therefore, I can only conclude, as have others, that the primary goal of universal EMR systems is to increase and maximize government control over the practice of medicine. Otherwise, the government would accept that doctors actually have the patient’s best interest at heart, and we do what we feel is justified in regards to adopting EMR or not.

By: Koshy Thomas

Koshy Thomas — Tue, 27 Apr 2010 01:18:50 +0000

There is initial cost for implementing EMR or for that matter any software. There is a learning curve for any software. But if the EMR architecture, design, workflow management is right the ROI will be fully recovered in 5-7 years. In the current physician office setup there are cost and overheads that are not very obvious but there are capital cost to run any practice. Everyone tend to overlook the cost of the number of staff employed to due various mundane things like handling incoming calls to make appointments; inquire about lab results, calling patients to remind them about their appointments, calling labs for getting results and sending across orders, calling in medicine to pharmacy etc. These are few of the things that come to mind. All these functions can be automated and handled by software thereby reducing staff and improving efficiency of the practice functioning.

You can get web based EMR with no upfront cost just a monthly fee with the option of hosting for an additional cost. The annual customer support fees will be around $5000/year.The training cost will be one time cost with documentation for an updated features.Most software also have online help documentation.

Yes you can decide to buy fancy EMR solutions for which you will pay a good packet. At the end of the day you have to decide what is your budget, what are your minimum requirements and what is your wish list of features and then you have to make an educated intelligent decision. But don’t tell me you have to bust the bank to get an EMR solution that is simply not true….!

[From Evan Steele]

Koshy,

The #1 reason why physicians have not and will not adopt EMR systems en masse is because of the lost productivity stemming from the data entry requirements. There is not one landmark study by a venerable institution that concludes that EMR use is beneficial to physicians (note that there are many studies that outline the benefits to other stakeholders): http://srssoft.com/assets/files/DoTraditionalEMRsWork.pdf.

You mention great web-based products that are a fraction of the cost of some of the more expensive, traditional EMR packages. I have yet to see any traction in the marketplace with such solutions – notwithstanding the fact that it is 2010 and we are 15 years into Internet service offerings.

Moreover, studies have documented a 50-80% failure rate of point-and-click systems (most recently, a study reported in the Milbank Quarterly – http://www.milbank.org/quarterly/8704feat.html), and the evidence I’ve seen is that the success rate decreases precipitously below even that level when productivity-based, high-volume, high-revenue practices (e.g., ambulatory specialists) try to implement traditional EMRs. Meaningful use requirements only makes existing, difficult to use EMRs even more complex and onerous for physicians. The potential $44,000 in stimulus incentives over the next 5 years are dwarfed by the loss in productivity of using such systems.

By: Lee Schoeffler MD

Lee Schoeffler MD — Mon, 26 Apr 2010 14:29:24 +0000

To Koshy Thomas—-You did err on thew low side. You will NEVER financially recover from EMR. NEVER. I always thought the reason for technology was to make it work for you, but when you go “paperless” you work for it. LS

By: Koshy Thomas

Koshy Thomas — Sat, 24 Apr 2010 15:46:11 +0000

Actually, I would argue that if I erred, it was on the low side, since the numbers quoted do not include the cost of lost physician productivity. However, let me address Steven Finch’s allegations. Most of the numbers come from the government’s own published estimates or from industry (MGMA) data. To review, here are the numbers I used in last week’s blog:
Capital cost to purchase point-and-click EHR: $54,000 1
Annual maintenance & training ($10,000/year): $50,000 2
Cost of reporting for 5 years (9 hrs/year of physician time): $22,000 3
Cost of additional staff needed to input required data: $75,000 4
Total: $201,000

1 The capital cost is stated in the CMS Proposed Rule on Meaningful Use, in the table on page 361, and includes all the acquisition and implementation costs.

2 $10K/year for annual maintenance comes from the same table, and includes ongoing training and upgrades that will be necessary as vendors change their products to keep up with the increasingly stringent requirements for “meaningful use.”

3 In the same table, the government estimates that it will take physicians 9 hours/year to report and document their “meaningful use” for the government. Using MGMA estimates of average physician revenue, this comes to approximately $500 per exam hour for primary-care physicians, and considerably higher for specialists.

4 The cost of additional staff time is an estimate—I believe a conservative one—based on the anticipated need for one staff member for every three physicians to input the information a physician would typically not input, at a cost of approximately $15K/year/physician. Even if you took this number out of the calculation entirely, the costs far outweigh the potential incentives.

Add in the cost of lost productivity (use Productivity Calculator to estimate), and it is clear that the government’s EHR program is a losing proposition for high-performance physicians.

I am a health care software professional. The numbers quoted above are highly inflated and misleading.

There are lot of small EMR companies who can provide you web based software for $250/month. The annual maintenance is the customer support cost which is not more than $5000/year.Training cost is once when new EMR is installed. Reporting cost is null. These report can be run by any administrative staff and can also be setup for automated running.There is no additional administrative cost for data entry this function has to be done even in a paper setting. In fact you can reduce staff and overheads by proper EMR implementation and usage.

I feel all the above facts are totally incorrect and inflated.There is an initial learning curve where the practice productivity will be reduced but with constant usage the productivity will be improved and practice efficiency enhanced.

By: MedInformaticsMD

MedInformaticsMD — Thu, 14 Jan 2010 21:09:39 +0000

I question use of the very term “Meaningful Use”:

See:

“Meaningfully Experimental Protocols and Interfaces to Nowhere: Nagging Questions On Healthcare IT Remain”

http://hcrenewal.blogspot.com/2010/01/meaningfully-experimental-protocols-and.html