Those were probably not the words most health information technology advocates like to hear during a congressional hearing on electronic health records, but those words were part of the candid assessment given by Philip Tally on behalf of the American Association of Neurological Surgeons, on whether physicians nearing retirement age should invest in an EHR system.
"If you're not thinking about practicing more than five years, don't bother because the transition and the cost and the time to make it proficient for you in a small practice is probably not worth itwith one exception and that would only be if you intend to sell your practice some day," said Tally during a July 31 House Small Business Committee hearing on the unforeseen challenges of EHRs in small specialty practices. "Whoever buys your practice is going to want an electronic" record format.
Tally, who works in a three-physician Bradenton, Fla., practice and chairs the Florida Medical Association's healthcare IT committee, told the panel in his prepared remarks that it took his group some 1,000 hours to properly configure their system and to become only the fifth medical practice in the country to go paperless in 1992.
He added that it cost his practice $50,000 for the initial EHR setup and then about $5,000 a month to maintain it.
A representative from the American Academy of Family Physicians was unavailable for comment on Tally's remarks, but a spokesperson cited AAFP policy that states: "The American Academy of Family Physicians believes that every family physician should use information technology that includes electronic health records with the ability to access and communicate needed clinical information to achieve high-quality, safe and affordable healthcare."
Patricia Wise, vice president of healthcare information systems for the Healthcare Information and Management Systems Society, Chicago, said that she applauds Tally's early and overall commitment to EHRs, but added that she believes he was off on his remarks to Congress that it takes five years for physicians to get a return on their health IT investment.
Wise, a nurse and retired U.S. Army colonel who works on HIMSS' Nicholas E. Davies Awards for excellence in IT implementation, said that it typically takes between 28 and 36 months to see a return. She did note, however, that she is not that familiar with IT implementations at neurosurgery practices.
"It's difficult to measure ROI," Wise said. "Consequently, some practices don't appreciate the ROI they achieve."
That's why she recommends that, before a practice implements an EHR system, physicians stop and measure where they're at in terms of transcription costs, how much staff time is spent tracking down elements of a patient's record, how much time it takes for a laboratory result to be entered into a record, and how much time it takes to process patient requests for prescription refills.
As far as older physicians adopting EHRs, Wise said one practice in its Davies Award application noted that one senior doctorwho kept meticulous notes and recordswas always the last to leave the building every night. Since the practice implemented its EHR, he leaves on time and the staff has "never seen him smile broader," she said.
"How do you put dollars and cents on that in terms of return on investment?" Wise asked.
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