The 6 hidden costs of EHRs

If you haven’t spent much time analyzing the costs of EHRs, this part of the process may be an eye opener. Why should one consider the hidden costs of EHRs?

EHR costs are much more than just the initial purchase, implementation and maintenance fees.  If a budget misses the hidden costs, an implementation could fail, degrade over time and worst-case scenario – bankrupt an organization.

To help sort out these expenses, several broad cost categories should be considered: Initial, Repeat, Future and Special Project costs.

 

Cost Area	Initial	Repeat	Future	Special Projects
EHR licenses	X		X
EHR maintenance and support fees	X	X
Hardware (servers, computers, mobile devices, printers, cameras, etc)	X	X	X
Data center or hosted costs	X	X	X
Internet Bandwidth	X	X	X
IT Staffing	X	X
EHR staffing (management, trainers, implementers, support, etc.)	X	X
EHR staff facilities	X	X
Reduction of patient schedules during go lives	X		X
Staffing the “bubble”	X		X
Supplies, cell phone & mileage reimbursement	X	X
Data migration and system conversions	X		X
Interfaces	X		X
Reporting	X	X	X
Customizations	X	X	X	X
Specialty requirements	X		X	X
Third Party Software (e.g. Dragon, education materials, code sets)	X	X	X	X
New modules or technologies (e.g. kiosks, Dragon, patient portals, encrypted email for e-health visits, digital pens, mobile applications)			X	X
Policies and procedures	X	X
Regulatory compliance	X	X

So which of these are the hidden costs?  Many total-cost-of-ownership (TCO) computations do not include the following costs. Often, as a result, the C-Suite is blindsided a year or so later when these costs appear.

Hardware:  It is a no-brainer to include the cost of upgrades and new hardware for the TCO. Rarely does the TCO exceed three to five years. In that time frame, almost all hardware needs to be replaced, including the servers, a multi-million dollar initiative in organizations of 200 or more.

Reporting: EHR vendors will often tell you they have great reporting. But it is rarely enough. Almost always, the provider purchases a third-party reporting system. Even if the existing reporting system is capable, rarely is the staffing included for developing the reports.

Customization: Although the mantra in the industry has shifted from “customize first and learn how to use second,” a lot of customization still happens. Most people consider the upfront costs of customizing – developer time and any tools required.

What is not figured into the costs is regression testing at the time of upgrades and bug fixes.  Too often, a rollout occurs and your customizations are broken, and sometimes, even the fields you have used no longer exist.  Customization isn’t a part-time job; it requires a close relationship with your vendor throughout the life of the EHR.

Specialties: Somespecialty templates turn out to be insufficient for the physicians who request unplanned customizations or require a new product all together. Oncology and ophthalmology templates partially use inventory, and most EHR systems are not capable of this. The oncology flow sheets are more complicated than most EHR templates allow for, so workflow becomes cumbersome. Thus, these and other sub-specialties may require this type of added cost.

Support: No one ever completely explains how much support will cost. The EHR environment becomes vital for physicians, nurses and clerical staff. If any one component – and there are a lot – goes down you, have to be ready for those costs incurred. And you have to have systems in place to mitigate down-time.

Regulatory Compliance: The cost of meeting regulatory guidelines goes up each year.  Committees, consultants, policies and procedures and more have to be considered into the costs of maintaining an EHR.

Keep in mind that other costs exist as well, depending on product and type of rollout. It is unlikely a total-cost-of-ownership analysis will capture all costs, but using the list above will help capture the vast majority.

This article was originally posted at http://ping.fm/4utiA