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Making the Case for Electronic Records
March 2006
Physician practices face several challenges after making the decision to adopt electronic medical records.
Even if clinicians and staff have philosophically accepted the need to automate clinical processes, a practice still must make a sound business case for such a radical change.
That business case, however, does not always have to revolve around money. At Hanover Family Physicians in Mechanicsville, Va., finances were not the compelling business reason to convert from paper to electronic records.
"The vision for having an EMR was based on the fact that we are a residency program," says Gerard Filicko, practice administrator. Residents, training during an era when clinical automation is becoming crucial, need to be proficient with computer systems, he explains.
State the case
Still, EMR advocates at the two-site practice with 11 physicians and two physician assistants needed a business case that would bring the more reluctant fully on board. They developed a business plan for the records system-from Cary, N.C.-based A4 Health Systems Inc.-that estimated a return on investment within three years, which turned out to be almost on target.
"We didn't get a return until the fourth year, so we missed the ROI target, but not by much," Filicko says.
Putting together a financial business case for a physician practice to adopt electronic records is an inexact science at best, say some of those who have done it. As a result, EMR advocates should not make a return on investment the main goal of a records implementation.
Darin M. Camarena Health Centers in Madera County, Calif., didn't view its business case in black and white financial numbers.
"We believe information technology is for improving care," says Kenneth Bernstein, M.D., chief medical officer at the three-site, federally qualified health center. "It's not the business case, but the quality case. The return on investment is to be the improvement in the quality of care."
The organization has some experience in the matter. A few years ago its EMR advocates implemented a records system that proved to be inadequate. The lessons they learned from that first attempt helped them make a more realistic pitch last year. (See story, page 42).
The best business case isn't based on financial ROI, but a return on quality and outcomes, adds Vinson Hudson, president at Jewson Enterprises, an Austin, Texas-based physician information technology consulting firm.
The push by patients and other health care stakeholders for widespread use of EMRs to improve patient safety and quality of care is real and won't fade away, Hudson contends.
"Practices can't fight this, it's a political animal," he says. "The financial ROI will take care of itself when physicians using EMRs improve their care quality and use that improvement as a marketing tool. The case should be made that they shouldn't fight it, but exploit what's going on."
Still, a business case requires an analysis that justifies the financial investment in EMRs, especially to make the case to younger physicians, who are more business savvy than their older peers, Hudson says.
Surprising twist
The desire to participate in clinical trials was the primary reason for automation at OB-GYN Associates at the Veranda, a seven-physician practice in Albany, Ga.
But the practice-which in early 2003 implemented practice management software from Carrollton, Ga.-based Greenway Medical Technologies and the vendor's EMR in July 2004-also wanted to improve charge capture. And it has found that electronic records bring substantial financial benefits as well.
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