Saturday, January 06, 2007

The cost of EMR

My cost to start the EMR was approximately $30,000, half for software and half for hardware. This is comparable to buying a new car (not a SUV), but does not depreciate as quickly. There are additional costs to the EMR, such as my upgraded VPN router (which cost $1,000 for parts and labour); as well, I have a backup internet line, at $500 per year. I have not had significant additional hardware costs beyond the router; however, I do expect to put in additional things, such as an automatic temperature logger for my fridge vaccine (about $100 for sensor and kit). The cost for scanning and shredding my charts was $300 for hardware (DVD reader, external hard drive), and about $1200 in labour costs for a student. My staff continued to scan and shred after the summer, during quieter office times, and I have a student coming in the evening to do this. Total labour costs to completely get rid of old paper charts are in the $1500 to $2000 range.

Once our 3 year EMR contract runs out, I expect yearly support and maintenance costs to be in the order of $3,000 per year.

It is difficult for me to say whether this makes business sense without government subsidies. There is a cost to continuing to carry paper records: The approximately $4500 in yearly rental costs taken up by filing cabinets and papers; the cost of the cabinets themselves (my 6 drawer end-file cabinets cost $1,054 each, new); the time for staff to manage the paper; the cost of inefficiency (lost files etc).

As well, there is the cost of managing preventive services on paper. The maximum incentive payment for reaching targets for five preventive services in Ontario is $11,000 per year. Doing this on paper is very difficult; either the physician or their staff has to do the audits, or it has to be contracted out to a private company for a fee. I understand that there is a company that does this; I have heard that the cost per physician is anywhere from $800 to $3,000 per year. Now that I have finished doing my CPPs, the EMR keeps track of preventive services for me. It generates a list of patients overdue, to print letters; I expect to look at the list about once a month--I may now assign this task to one of my staff. The letters are personalized and are very easy to print; a copy is automatically kept in the patient's record. I expect to see more pay-for-performance incentives in the future.

Private bills are much easier to manage with EMR. I print things like notes for massage therapy or sick notes at the front printer, where the patient collects and pays for the note at the same time. We have a PinPad at the front, so people can pay by credit or debit card. As well, the notes are all templated, and are much easier to generate than with paper records. A copy of the note is always and automatically generated in the electronic record; there is no longer any need to photocopy for the file.

Many of my colleagues are now contracting out block billing and private bills to outside companies. I contracted out block billing in the past, at an annual cost of approximately $2500. I have to figure out how to do the block billing, but the private bills are certainly done more easily and efficiently in the EMR.

Having said all that, I strongly believe that government subsidies are needed to kickstart the EMR process. In Ontario, there was a recent lottery, where physicians in FHGs (Family Health Groups, receiving fee-for-service payment) could apply to receive the $28,600 subsidy. They allocated $15 million to this initiative; 2100 physicians out of the 4,000 FHG physicians applied. If a physician gets funded and already has an EMR (provided it is from one of the approved companies), the funding is still given, provided the EMR continues.

There is now lots of physician interest. The initial cost continues to be a barrier, and governments can certainly do a lot to address this. However, I think a reasonable business case can now be made for EMR, if the ongoing cost of paper is taken into account. Additionally, it appears that if there is funding down the line, this funding will be retroactive.



Anonymous said...

What is block billing?

Michelle Greiver said...

The provincial billing plan (OHIP in my case) covers all "medically necessary services" by a physician. This does not include forms for insurance/work purposes, faxed drug renewals etc. In many practices, patients can pay for these as they are done, or can choose to pay an annual fee to cover the services instead.


Botox Wellington said...

I started writing my own EMR back in 1986. Initially it was just a list of my patients with things like birthdays, phone numbers, etc. Over the last 20 years it has grown a lot. It now type my notes, fills out my perscriptions, fills out lab requisitions, does all my billing, determines how much to charge, payroll, scheduling etc. My dream is to get a group of docs together that would finance the cost of rewriting it professionally and then having the software available for very little money to other doctors.

Neel said...

You can check out OSCAR, which is an open source EMR suite developed at McMaster University. You can do the complete A to Z implementation yourself and support it yourself if you wish (is Linux based, so no MS Windows needed). Alternatively there are a few companies who will implement and support for a fee.

kevin said...

A $30,000 EMR is expensive, maintenance would be an additional cost too!

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