How the Best of Intentions can Backfire

My meanderings through LinkedIn last evening uncovered a recently released study entitled, “Physician Practice EHR Price Tag” published by CDW Healthcare.   The authors are not named but there does not appear to have been any physician input.  The study, presumably written by IT folks at CDW, appears to be aimed at an audience that includes physicians. It is an admirable attempt to measure both the obvious and subtle costs associated with setting up and maintaining an electronic medical record system. The study also attempts to assess the return on investment by estimating the increase in revenue from having a more efficient EMR–driven practice.   Any study like this will by nature be heavily dependent on assumptions; this report outlines them well.

Without regurgitating the entire study here, there are two numbers worthy of discussion. The first is their estimate that the first year of EMR implementation will cost approximately $120,000 per physician. Most of this ($100,000) represents decreased revenue due to decreased patient volume during the first year.   This figure was derived by asking 200 paper-based group practices to estimate how far patient volume would drop during EMR implementation.  The average (? mean) of the estimates, 10%, was then run through some normative data to calculate the $100k figure.  The second number is their estimate that after EMR is “fully implemented and adopted,” the practice will benefit as much as $150,000 per physician from improved practice efficiency and increased patient volume.

While I respect CDW’s efforts to provide guidance to physicians, I have two major problems with this study. First, why would you ask group practices with no EMR experience to guess how far their patient volume would drop while they were learning EMR?  Why not ask practices who have already implemented EMR and get real data? And while we’re thinking about it, why did they assume that patient volume has to drop in the first place? When we implemented our EMR system almost 6 years ago, our transient drop in patient volume was near zero.   We recognized upfront, as the CDW study does, that any drop in patient volume represents a greater cost to the practice than the EMR system itself.   To us any drop in patient volume was unacceptable.  Our implementation strategy was the opposite of what CDW suggests; instead of moving as quickly as possible we moved slowly enough to avoid any drop in patient volume. Without that economic pressure we were able to take as much time to implement as we needed.  I will cover the details of our implementation strategy in the future.

My second objection is that this study will hurt the EMR movement because it will discourage physicians from getting EMR.   This is yet another example of how IT people and physicians see the world differently.  IT people see the $120,000 upfront cost compared to the $150,000 per year benefit and conclude that the benefits of EMR are, once again, obvious.  Who wouldn’t invest $120,000 to get a $150,000 annual dividend?

The physician sees the data from a more personal perspective.  We see the $120,000 upfront loss as a valid and terrifying figure.  We dismiss the $150,000 per year benefit as a pipe dream and conclude that EMR is economically unfeasible. The physician cannot regard these figures as just cold numbers on a spreadsheet.  That $120k is a direct, devastating loss of personal income.  Doesn’t matter what could happen in future years…we wouldn’t survive the first year.   And an annual $150k / physician benefit after EMR is “fully implemented and adopted?”  Who are they kidding?  Even as one of EMR’s biggest physician supporters I can’t accept that figure as credible.  I also don’t know how you define “fully implemented and adopted.”  Our experience demonstrates that EMR is never “fully implemented.”  It is always a work in progress with bugs to fix, new features to add and improvements to make based on experience.

This study’s sophomoric approach is typical of a “me too” latecomer to healthcare.   Doctors regard this kind of thing just like we do a brand-new pharmaceutical rep that shows up at our office, bright-eyed and ready to sell us all over again on an old drug that’s been around for years.  Listen politely, check your watch, hope the lunch they brought is pretty good and pray your pager goes off to get you out of there.