The adoption of an electronic medical record (EMR) or electronic health record (EHR) in an ambulatory care medical clinic is effectively a re-engineering of clinical processes, in order to achieve (via digital information technology), enhanced quality and efficiency in the delivery of medical services.
To achieve a return on investment, the adoption of such major organizational change must create a positive effect on the organization's income statement. The organizational leaders of the EMR adoption must demonstrate that the initial capital outlay (which may be financed over a reasonable period of time), and, the ongoing maintenance costs associated with EMR or EHR adoption, will bring benefit to "the bottom line".
Most ambulatory care medical clinics already have a smaller network of computers in place used for practice management software functions. EMR adoption will require extension of this network into all clinical exam rooms and all clinical stations. Thus, in addition to initial and maintenance EMR software costs, an analysis of the cost side of the cost-benefit calculation must include an estimation of anticipated initial and maintenance hardware costs, and an estimate of the initial and maintenance network support (IT labor) costs. The organization may obtain a reasonably accurate estimate of such costs using the services of a reputable local network administrator, on a fee for service basis. Of course, electronic medical record software (initial and maintenance) costs may be obtained directly from the EMR vendor.
While the analysis of impact on the cost side of the income statement is relatively easily quantified, the analysis of the savings or benefit is rarely "clear cut" and speaks to heart of the issue - the effectiveness of the EMR in the delivery of clinical services with enhanced quality and enhanced efficiency.
More to the point: physician or ancillary providers are the largest line item cost in the clinic's income statement. Should EMR software not enhance the quality and efficiency of the physician's function, the plan is a lost cause. It is for this reason that the successful adoption of most EMR's is usually led by a physician "champion". Such a physician "champion" will no doubt be seeking an EMR which offers the artificial intelligence to enhance his/her own clinical acumen, while at the same time, facilitating the many tedious tasks associated with the documentation and implementation of the health care plan. No human being free from error, however, the thoughtful physician "champion" will seek an EMR which may be flexible enough to incorporate and remind him/her of the changing standards of clinical care while conforming well to his style of practice.
The efficient EMR may accrue to the practice savings in the realms of transcription costs, support staff use and medical record supplies. Nevertheless, such savings must not be made at the expense of physician dissatisfaction with clinical EMR function. In most cases, the replacement of a dissatisfied but good and productive physician may be more costly than his/her initial recruitment, orientation and training.
Furthermore, the replacement of a failed EMR may well be more costly than its initial adoption costs.
The selection of an EMR or EMR is a monumental financial decision for the average ambulatory care medical clinic. At stake is the long term integrity of the organization. Due diligence is mandatory.
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