When it comes to EMRs, cost is an easy target

When it comes to EMRs, cost is an easy target

Today, in one of the stories I scanned to prepare this issue, I came across this headline in the august pages of Modern Healthcare: "Survey: Financial support is No. 1 for EHR adoption."  My reaction was "no kidding." But did we really learn anything new or I important here? I'd argue, nowhere near as much as we should have. Sure, only 4 percent of practices had a high-end EHR, and the rest are scared to spend big bucks on one. But that's only part of the story.

It's not that the research, which reached out to 5,000 physicians drawn randomly from the American Medical Association's Masterfile, wasn't thoughtfully designed. Among other things, the researchers made sure that doctors knew what they were talking about by asking physicians whether they used 17 important functions or at least six basic functions they considered central to functional EHR platforms.

Not only that, they mixed things up by asking not only physicians themselves, but also another party within the practice "knowledgeable about the practice characteristics and HIT use." That's a nice way of getting a more detached viewpoint into the mix.

Still, I'm less than impressed by the way in which lack of capital was cited by those who didn't have an EHR (66 percent) and those who had a bare-bones system (36 percent). It's interesting the way resistance to spending money seems to have slid down in importance as soon as the EMR system got a "foot in the door" in a given practice.

It's worth noting, too, that nearly as high a percentage said that finding the right EHR (55 percent) and making a good return on investment (51 percent) were ranked nearly as high in their list of concerns. How come those numbers don't make headlines?

I'm afraid, dear readers, that my colleagues have been guilty of reporting the EMR adoption story in such a way as to make it seem largely as though a massive infusion of cash would solve everything--that virtually all practices would be online in a year if we just paid for it.

The truth is, as this study suggests, there's lots that goes into making an IT investment decision, and while money is a factor, cost recedes in importance a bit when you can see the value of what you're buying. (I'll bet you anything that in their personal lives, well-compensated physicians don't balk much at the cost/value trade-off inherent in buying, say, a Mercedes sedan--they've already done the mental math and know what they're getting!)

In this space, I'm going to continue to pound on the issue that if we want physicians to adopt EMRs, we're going to have to help them work through all the aspects of a tough IT investment decision--not just the most obvious one. It seems to me that unless we take the broader mix of EMR challenges into account, we're not going to get anywhere. - Anne

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