The topic of converting medical practice from paper to electronics seems to appear daily in news, blogs, radio, and seemingly everywhere. Earlier this week, NPR’s Marketplace had a segment about the costs of implementing an EHR.
Several factors have brought this question to light: ARRA stimulus money set aside to encourage physicians to take on e-adoption (up to $44,000 cumulatively from 2011 to 2015, as an add-on to Medicare payments): the emergence of a national Health IT policy that defines goals, objectives and “meaningful use;” and the debate around federal health reform – all these factors add juice to adoption of EHRs.
One of the presumptions in the discussion has been that EHRs are expensive. Several studies have shown that the biggest barriers to EHR adoption historically have been (1) cost, and (2) usability (or the lack of it). Traditional EHR vendors have offered very large, self-contained, locally-installed client/server systems – and these systems have been very costly. Not only is there the cost of the EHR software itself, but there is the cost and burden of establishing a server, with data backups, security, connectivity and the like. This is something beyond the resources available to smaller practices, and therefore (not surprisingly) such EHRs have been implemented in larger organizations: hospital-based systems, large medical groups, staff-model organization like Kaiser, etc.
But how much does an EHR need to cost, really? Firstly, a locally-installed client/server system involves server-end costs. Even if that EHR software were given away free, the server costs remain – and this is considerable. Again, a major challenge to small practices. However, web-based, hosted EHRs completely remove this layer of burden from the practice. No longer are there server-maintenance, data backup, security, and network connectivity issues – all you need is an internet-connected computer and a browser.
Even beyond the benefits of a hosted, web-based “software as a service” (SaaS), there is also the question of paying for the service. Some SaaS-based EHR vendors charge a monthly use fee, sometimes per-MD and sometimes per-user. Practice Fusion has developed a unique business model that allows the SaaS service to be offered for free to all end-users. Revenues come from ads, and other alternative revenue sources.
By eliminating the cost barrier of EHR adoption, Practice Fusion can focus on the issues that are truly significant – usability, flexibility, portability, connectivity to other data sources, and true establishment of “meaningful use.”
Robert Rowley, MD
Chief Medical Officer
Practice Fusion, Inc.