What will it cost to do nothing?

Casey Quinlan wrote a really fantastic article about why “What’s the ROI?” is only half the question in healthcare IT. She quickly identifies the real challenge with putting an ROI on an EMR implementation by acknowledging that an ROI discussion quickly leads to a financial discussion. Indeed! The financial side is only have of the EMR ROI question.

I’ve written about the EMR ROI up down backwards and forwards. You have the camp that wants EMR software saying that it provides a great ROI and you have the camp that doesn’t want EMR saying that it doesn’t. The correct answer is that they’re both right. Your EMR ROI is often what you make of it. Not to mention that what you make of it starts with your EMR selection.

In any ROI discussion, I quickly point people to this list of EMR benefits. In EMR presentations, I like to divide that list of benefits into “Guaranteed Benefits,” “Possible Benefits,” and “Debatable Benefits.” In fact, I should probably do the same on that page when I have some free time.

However, Casey, in the article linked above asks a very important additional question, “What will it cost to do nothing?” Then she suggests, “The answer to that question shows the way forward.”

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Thanks for the shout-out, John – and for making it clear that the “do nothing” approach can have a much higher cost than an EMR deployment might. Patients are connected and mobile. Providers who resist a connected/mobile approach to interaction w/their patients will find themselves on the wrong side of the digital divide: the side with no $…

  • Docs need to fully understand that an EHR really doesn’t have an ROI. Most of the fluff from the sales weasels is just that, fluff.

    “You can get rid of the transcriber!”

    Um, sure, but now you seem to be doing a lot of that typing.

    A Doc needs to look at an EHR as a necessary too.
    Yes, it can help make the practice more efficient, but that efficiency will cost you.

    If you try to get wrapped up in ROI, you are focusing on the wrong metric in this situation.

    Get an EHR, but don’t get it because you might be able to get rid of a few employees.

  • Are we looking at $$$ here ???

    The way I see it is that EMR brings better healthcare for people. Forget about the incentive. EMR is all about the efficiency that can be improved with the use of computers in health processes. For many eons medical practice has been trying to dismiss that there is a need for computer modernization. Now is the time. The fed is pushing the move with money, and thank you for that. America has to rise above the rest. Statistics shows that America ranks poor in overall (healthcare) system effectiveness. (wikipedia keyword healthcare in the united states). We now have to lift our own seats and be in the forefront of technology. We have to do this.


  • You know what a businessperson calls an EMR system that has no return on investment?

    A hobby that raises the cost of care.

  • Another school of thought, and I hate to say, this is the reality. I must be dreaming. Some doctors think of medicine as an enterprising business. No wonder I, the patient, cannot afford health insurance.

    OK, then. Leave those businessman out in glacier, and see what happens. With EMR I firmly believe that ROI will just follow through. History can repeat itself.


  • Yes, and this hobby is going to raise the cost of care…at least not bring it down.

    As I’ve said, if an EMR was really desirable & really an efficiency driver…physicians would have switched to them years ago.

    The fact that the Gov has to throw cash at docs should tell everyone something.

  • John, I agree, I hope that the HITECH will be enough to push EHR out. I saw another post on MU Dashboards. Our company has one that works to track, monitor, document and create an audit trail of Meaningful Use. Works with any EHR. Many hopitals and docs currently using it. Would love to show it to you. Visit our website. Josh

  • I’m a bit surprised the debate is still focused on whether or not an EMR is required for a physcian’s practice. Yes, there are some practices whose provider profile and specialty make it possible not to adopt an EMR (“I’m retiring in a few years”). But there are few people who doubt that 95% + physcian’s offices will have an EMR in 5 years.

    What’s truly the interesting dynamic in this situation is that most of the benefit of an EMR accures to patients (better care) and to payer’s (lower cost) while most of the expense is borne by the providers. Is it no wonder that government incentives have dramatically changed the adoption curve?

    I’m amazed how easy it is for people to suggest providers should just fork over the money for an EMR because it’s better medicine. Or to scoff at providers who treat it as an “enterprising business”. These are naive ideas which fail to grasp the basic idea that people are motivated by their self-interest. There is nothing right or wrong with that. It just is.

    The ROI discussion is useful to move people’s thinking about what is in their self-interest. But most providers are capable of making these judgments for themselves. And whatever those judgments are we should respect them.


  • Casey,
    Always happy to highlight smart people saying interesting things.

    John Brewer,
    Certainly they shouldn’t get fixated on the ROI, but it is still an important part of the process. Understanding where you will get an ROI and where you won’t I think is the key. Just being realistic about what you can and can’t achieve is the important part. Then, they usually make good decisions.

    Yes, talking about $$$ matters a lot to doctors and it should matter. If they don’t take care of it, they won’t be practicing medicine very long.

    I do think technology can benefit healthcare, but I don’t think it’s the major factor in why America’s overall healthcare system effectiveness is lower.

    D. Kellus Pruitt,
    Some hobbies are quite expensive.

    John Brewer,
    Just because something is the financially best decision doesn’t mean people automatically do it. Although, I think most doctors were ready to go with an EMR. Then, the EMR stimulus money came and so they decided to wait and see what would happen.

    I always like to see MU dashboards. Drop me a line on my contact us page: https://www.healthcareittoday.com/contact-us/

    I wouldn’t say that most of the benefits of EMR are for patients and payers. Although, better patient care seems like something that should benefit the doctor. Pretty sad to consider that the customer (patients) getting better service has little effect on a doctor’s business.

    Also, I definitely don’t mind people doing what’s in their self-interest. The biggest issue I see is that the providers aren’t capable of making these judgments. Not for lack of skill, intelligence or intellect. More so from a mixture of these things: 1. a lack of desire 2. a lack of motivation 3. a lack of good and unbiased information 4. a lack of time etc.

  • Thanks John! I agree. The focus has been so much on meeting meaningful use that the real question of the cost (both human and financial) of doing nothing is too often ignored. Even without meaningful use, the benefits realized over the years by many care providers, large and small, will outweigh the costs (both upfront and of maintenance) of a system that is matched to the provider’s size and needs.

  • Well put, Cole Libby. And as time goes by, I think more voices like yours are bound to be heard. I feel certain that common sense will ultimately trump even subsidized technology in healthcare.

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