Future benefits include the ability to report quality-of-care measurements and health outcomes needed to participate in pay-for-performance initiatives.
“The computers help you take a disease like rheumatoid arthritis or lupus and create your own tracking systems for following patients over time, and then export that in a format that ultimately you will be reimbursed on,” says Dr. Robbins.
Paul H. Waytz, MD, who leads a 10-member rheumatology practice in Edina, Minn., believes the EMR system installed four years ago paid for itself through lower staff and transcription costs in about 18 months.
“I would never go back,” he says. “I’m not much of a techie, and I was able to learn it—and I don’t have any paper notes.”
Even Karen S. Kolba, MD, who says EMR technology has saved neither time nor money for her solo practice in Santa Maria, Calif., would not choose to return to pen and paper.
“The advantage is that I now have better documentation,” she says. “If I were ever audited, I could point to it and say, ‘Look, here are the things I did on this patient,’ and those things probably weren’t all there in my dictated notes.”
What’s the Cost?
The expenses associated with moving to EMR vary so widely that the oft-touted “$20,000 per physician” may be too general for planning your budget. Here are some actual EMR setups used in rheumatology practices and their costs.
Large, multi-office group practice: Installation costs are still being tallied at Arthritis and Rheumatism Associates P.C., the largest rheumatology practice in the Washington, D.C., area. As of November, Dr. Baraf, the managing partner of the practice, estimated that nearly $500,000 would be invested in the system, including hardware, software, new phone lines, and start-up expenses such as chart extraction and scanning.
“We’re in multiple offices, and that involves linking the offices by high-speed wireless or wired technology,” says Dr. Baraf. “It gets to be fairly expensive the more offices you have.”
Some of the costs were unanticipated. For example, three-year-old servers had to be replaced, adding $50,000 to the original cost estimate.
Mid-sized group practice: Arthritis and Rheumatology Consultants, a 10-physician practice in Edina, Minn., invested about $350,000 on EMR software, hardware, and start-up costs in early 2003. Software licenses cost $9,400 per provider; hardware and training costs were about $125,000, says Dr. Waytz, a partner in the practice.
More hardware was needed when the physicians decided to give up on their original goal of using wireless laptops. “Each doc and nurse had a small laptop that we carried from room to room,” he says. “It wasn’t reliable, it was cumbersome, and the laptops were too small. It wasn’t working right.”
