Tuesday, March 24, 2009

What Does An EMR Really Cost?

I had an interesting conversation with a cardiologist-colleague of mine who works in an 8-man private practice cardiology group in North Carolina last evening. He discussed with me the challenges his group is having wrapping his head around trying to convert his practice to an electronic medical record (EMR) system.

"They want $350,000 for 8-man practice," he said. "And that doesn't include the need for new hardware every five years, and the costs of ongoing on-site technical assistance. No one talks about the future costs of maintaining an electronic record, but boy, they sure are eager to get you to buy one."

"Over $40,000 per doctor? What would it cost to add another person to your practice?" I asked.

"I really don't know, the conversation never got that far."


Addendum: Just after posting this, the Wall Street Journal reported the following from the economic stimulus package:
"Physicians using electronic records will be eligible for more than $40,000 each in Medicare incentive payments over several years starting in 2011. Hospitals can also qualify for millions of dollars in incentive payments (editors note: huh?). Doctors and hospitals not going electronic by 2015 will be subject to penalties."
Add to this, the following tidbit:
Both bill outlines would give docs who e-prescribe a 2% bonus in 2009 and 2010. Those who don’t use e-prescribing would see their payments cut by 1% in 2011, and by 2% in 2013 and beyond."
Now, do you wait until 2011 to make a purchase and get penalized by the government's own e-prescribing rule, or bite the bullet now and risk losing the government's stipend for an EMR purchase?

I bet they wait 'til 2011. I would.


Anonymous said...


Very good questions you ask regarding what it costs to run an EMR, and, more importantly, modify it after it's installed. My experience with even simple billing software is that these companies realize they have a captive audience after they install there often crappy systems, which they then proceed to upgrade every year for an additional charge. They are not designed for easy modification, so you have to have them (and pay them) every time you need to change the templates.

This will help to drive the final nails in small practices who will not be able to afford or manage this technology on a small scale.

You can get free e-scribing software however through Allscripts which offers a web based portal for e-scribing at no charge that could tide you over nicely till 2011, which is what I currently do. The big problem is going to be the fact that you will have to document for your Meidcare patients, as part of the billing process, whether you sent your script out electronically or on paper every time you see a patient and write a script; likely something that will negate the 2% bonus (or deduction) you will receive in time and trouble.

Chris said...

Why the cost difference with the system described by The Independent Urologist?

Anonymous said...

That's a ripoff and a non-starter. Ask the vendor to itemize the cost for you, hardware, software and maintenance. There is no reason IT for medical practices should be more expensive than IT for other small businesses.

DrWes said...


It depends on the capability and interoperability of the system being purchased. I looked at your link, and unfortunately IU doesn't disclose the name/type of EMR he's leasing at $600 or so per month. It also may depend on the type/quantity of the materials to be contained on the EMR->graphics like EKG's vs just text, for instance. This group has nuclear scanners in their office, treadmills, echos, EKG's - the works - all that they want to integrate, PLUS an on-line patient portal. It starts to get expensive quickly.

Anony 02:55PM -

I only call 'em as I hear 'em. That was the price quoted to this group. I do find it interesting that the price per doctor quoted by the EMR vendor ($43,750) is remarkably close to the government subsidy being proposed by Congress....

Gee, I wonder where Congress came up with that generous amount to reimburse per physician? Don't think the EMR lobby had anything to do with it, do you?

scalpel said...

Or we can just stop taking Medicare.

Unknown said...


Check out Google Health beta. It's free. All you need is a PC and an Internet connection. The barrier will be the comfort level of patients in trusting the ability of Google to maintain confidentiality. I am trying it out myself.

The cost to your practice would be about the same as what you are spending on PC's now.

Anon 2:55

DrWes said...


Thanks for the suggestion, but Google Health is a personal health record and should not be confused with an electronic medical record used by your doctor. The later is a medicolegal document as well as a health record.


Andy Stones said...

EMR is expensive at this time for it is just starting. Many companies, offer is as cheap but mostly will ask more and more money. It is highly price for EMR is the electronic, legal record of health-related information on an individual that is created, gathered, managed and consulted by licensed clinicians and staff from a single organization (hospital, clinic or other ambulatory environment) involved in the individual's health and care. It is composed of clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy and clinical documentation applications. It supports the patient's electronic medical record across inpatient and outpatient environments and is used by health care practitioners to document, monitor and manage health care. The payment you've made can have a money back guarantee in the future especially that the government is helping.