Electronic Medical Records Make Sense-At Last

By Terry, Ken | Medical Economics, May 24, 1999 | Go to article overview

Electronic Medical Records Make Sense-At Last


Terry, Ken, Medical Economics


After tantalizing doctors for decades with the promise of more accessible clinical data, electronic medical records are finally starting to deliver. A new generation of EMRs offers combinations of structured elements and _free text that are flexible enough to aid doctors in their daily work.

Some physicians who use EMRs say the electronic records have improved their efficiency and their ability to access information when and where it's needed.

"The electronic record has become such an integral part of how I practice that if I had to go back to paper, I think I'd quit medicine," says FP Dwight Eichelberger, who practices with three other doctors in Littleton, NH, and directs a community health center

For the past three years, Eichelberger's practice has been using the Logician system, produced by MedicaLogic of Hillsboro, OR. Although he isn't charting faster than he did before, Eichelberger says, "The accuracy of charting is much higher; the legibility is much better. I have access from home and from the hospital. That's something you can't say if you use paper.

EMRs can also cut costs significantly in such areas as chart pulls and transcription. For instance, three young FPs in Ada, OK, began using an EMR made by Medic Computer Systems of Raleigh, NC, when they opened their practice last September Without the EMR, they'd have needed an additional full-time staffer to pull charts, says office manager Karen Landry. And by reducing the need to transcribe dictation, the EMR has allowed the practice to devote two-thirds of an LPN's time to other tasks.

Okay-if EMRs are so terrific, why have only 2 to 3 percent of practicing doctors made the switch? One reason is that, until recently, most systems haven't been user-friendly or suited to the clinical work flow. "EMR technology has advanced significantly over the past two years. It's much easier to use now," says Nancy Reese, information-services coordinator for Regional Primary Care in Cape Girardeau, MO.

Nevertheless, electronic records still intimidate many doctors. The idea of changing how they practice scares them even more. The majority of today's physicians don't even work with a personal computer; having to click away on a terminal in the exam room would turn their routines upside down.

Another deterrent is cost. The up-front investment in hardware and software can range from $8,000 to $40,000 per doctor, depending on the system and the size of your group. (Very low-end programs cost as little as $150 per user, but can't do much more than retrieve dictated visit notes.)

Dwight Eichelberger's group in New Hampshire got its EMR free under demonstration grants. If the practice had had to pay for the system, he figures, PCs and network servers would have cost $45,000. Add $70,000 for 14 software licenses, and the initial cost would have been $115,000, or $28,750 for each of the four doctors. Including annual fees for software maintenance and updates, the five-year cost would total $185,000, or $46,250 per doctor

Regional Primary Care, a nine-doctor primary care group in Cape Girardeau, MO, recently paid about $70,000 for an EMR program from San Francisco-based McKessonHBOC (see page 140). Including hardware, network connections, and interfaces between the EMR and the group's new HBOC practice management system, initial costs totaled $250,000, or about $28,000 per doctor. With annual maintenance for five years, the cost will escalate to $35,500 per doctor

Such a large investment may make EMRs inadvisable for smaller practices. These practices typically lack the economies of scale and the ability to achieve operational efficiencies that would justify the purchase of an up-to-date EMR. "You'd have to find the right middle-of-the-road product that's feature-rich enough to realize some of the benefits without making the doctors go broke," says internist Jeffrey Hertzberg of Medformatics, a Minneapolis-based consultant on medical informatics. …

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