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It's pretty easy for hospitals to get their staff doctors--the ones on their payrolls--to use EHRs. Those doctors might not like the changes, but ultimately they have no choice. Trickier is getting the independent doctors that hospitals work with on board.
First there's the cost: Systems run $30,000 to $50,000 per doctor in a practice, says Dr. Steven Waldren, director of the American Academy of Family Physicians' Center For Health IT. Vendors such as eClinicalWorks, Athenahealth, Allscripts, and NextGen supply these full-fledged systems. Hosted and software-as-a-service systems are less expensive. EClinicalWorks, for example, offers a $500-per-month SaaS setup. InformationWeek Analytics estimates that startup costs for a hosted system typically run $45,000 for a three-physician practice (see box, p. 19).
Some vendors offer free Web-based packages supported by advertising, and free and lower-cost options are available to doctors in rural and underserved areas. Hospitals have offered affiliated physicians versions of their systems tailored for outpatient facilities, but they're often geared for a hospital environment and don't meet the needs of smaller practices.
Then there's the disruption factor: The move from paper to electronic records is huge. Not only do physicians and their staffs need to learn how to use the new electronic tools, but they also have to learn new workflows. For example, patients' vital signs might have to be captured and entered in the system in a different order or at a different point in the exam from what clinicians are used to. Tests and drugs must be looked up and ordered electronically. Count on several months or more of disruptions that will affect productivity and add to costs.
When the Center for Cancer and Blood Disorders, an 18-doctor practice in Fort Worth, Texas, began using EHRs, doctors went from writing notes and handing them to nurses to typing or dictating information into patient records. "Getting doctors in a new comfort zone, from papers in-hand to seeing information online, typing, pointing, and clicking--that's the hardest part," says Barry Russo, CEO of the center.
Once physician practices get beyond the initial challenges, enthusiasm for EHRs takes hold. Russo says it's now impossible for his physicians to work without all the new capabilities EHRs provide.