Ideally, EHRs make the clinical exams more efficient and effective, ultimately saving or even making more money for medical practices. But the reality is that they bypass other parts of the patient encounter where much of the costs and inefficiencies are generated, according to a whitepaper by athenahealth, “The Economics of Patient Workflow: Cracking the Code of Successful EHR Design.”
As the paper notes, 100 percent of practice revenue is generated by the patient exam. Other stages of managing a practice, such as orders and results management, generate 30 percent to 40 percent of costs but no revenue at all. So having an EHR in place which does little to improve exam efficiency — or actually reduces it — is a dangerous thing to do to a practice.
Worse, as the paper points out, there are some major flaws with typical, software-based EHRs:
* They’re too expensive: Typical cost is $33,000 per physician plus $1,500 per doctor per month for maintenance.
* They don’t save money because they slow doctors down: Most EHRs force physicians to do a lot of data entry, much in time-consuming, structured formats.
* They aren’t designed to manage the P4P cycle seamlessly: With most EHRs, doctors have to dig out the data needed to create pay for performance reports.
* They usually don’t offer an efficient, closed-loop solution to the problem of monitoring paper and electronic orders and results: Remember, orders and result management generates as much as 40 percent of practice expenses. EHRs’ failure to make such tracking efficient is a major obstacle for medical practices.
* Few EHRs support follow-up work from orders and results effectively: Most EHRs don’t include built-in management and tracking of patient communications, forcing providers to do inefficient and potentially risky manual follow-up.
The white paper goes on to make the argument that there are several reasons why Web-based EHRs solve these problems, largely by requiring no up front cost, using up less physician time on data entry, optimizing collection of data for P4P programs, digitizing all paperwork and tracking practice results.