Consultant Vinson Hudson says he sees three distinct EMR markets for outpatient encounters.
- Groups of 50 physicians and more can afford to buy so-called "enterprise" electronic medical records systems, though they don't implement them all at once. For an outright purchase of an EMR software license, "right now, it can cost between $3,000 per user all the way up to $10,000 per user and that's without training or installation," he says, although Internet-based systems will lower the software startup costs substantially.
- Smaller groups, down to 15 physicians, are the prime market for modular systems, says Hudson, president of Jewson Enterprises of Menlo Park, Calif., a healthcare technology marketing firm. "They're betting the vendor they'll deal with will have a breadth of products they can purchase as they need them."
- The smallest groups, fewer than 15 physicians, typically look for whole EMR systems, either through direct software purchase or on a lease basis via the Internet and an application service provider (ASP), he says. For physician executives of these smaller organizations, choosing whether to buy part of all of an EMR depends on a fair reading of the adaptability of your physician colleagues, the size of your checkbook and your information technology plan.
"You have to make sure a component fits into a long-term strategy," Waegemann says. At one time, just moving toward the lofty goal of developing an electronic medical record may have motivated change, but after a number of expensive failures, "people are asking what is that implementation going to bring me?"
Waegemann says first diagnose and treat the greatest point of pain in your practice. "The component should only be purchased on the benefits it can provide today," he says.
Hudson says groups "have to sit down and analyze their needs and what they can implement now."
One advantage of deploying a full EMR is its potential impact on quality of care. Most EMRs have patient safety features like pathways at the point-of-care and drug reaction prompts. Some are wired to help physicians analyze patient outcomes.
The Institute of Medicine report "Crossing the Quality Chasm," while emphasizing that computerized clinical information and decisionmaking tools are "essential to enhance quality and improve safety," recognizes that "a fully electronic medical record . . . is not needed to achieve many, if not most, of the benefits of automated clinical data."
What most half-measure EMRs lack--and full EMRs have--are plenty of quality-of-care functions. Scott Yates, M.D., says he bought and learned how to use a full EMR because he wanted quality control features with his patient records.
Yates practices internal medicine with a group near Dallas.
"I don't think you can address the IOM report issues with a paper system, particularly where your system is complex," he says.