Most of the medical practices are now using an electronic practice management (EPM) system. These products have typically been proprietary software, in a great departure from simple pegged ledgers and hand-written calendars. Within the last twenty years the EPM market has mushroomed into a huge industry full of products running on a variety of platforms. However, although these systems were put in place across the board, still the vision of the paperless office is largely unattained.

The earliest versions of EMR systems were successful for subjective-objective-assessment-plan (s.o.a.p.); certain specialties like internal medicine and family practices, which are mostly driven by text, did well. The more graphically and visually-oriented specialties such as ophthalmology were quite a bane to the EMR developers, and more than a few medical practice consultants still maintain that ophthalmological EMR systems aren't ready to go live.

Room or ROM?

At our practice, we've had an EPM system in use since 1983. Our first vendor told us that they wouldn't offer support in the year 2000, so we changed over to another system. While this solution worked well for scheduling and billing, we soon realized that we would need more physical space to store medical records. So we faced an important decision: will we use more space or consider eliminating paper records? The question: would it be more cost-effective to convert to an EMR system? At our practice of five office spaces, we use a central records storage area within the main office. This system is centralized to secure the charts; however, there are costs to secure storage to consider. We considered a scanning solution to help reduce our storage quandary. However, we realized we would have to before more efficient without limiting our access to older stored data.

EMR Costs

To implement an EMR system incurs the following costs:

- Software licensing and training

- Hardware including servers and computers

- Technical support

- Consulting and IT

- Capital infrastructure including wiring and communications

There are additional costs when considering the staff time being trained and doing data entry. Often there are software customizations and conversions necessary to bring old data over to the new system. Usually, a practice will operate both the old and new systems in concert until the conversion is complete. During the transition there could be some duplicate tasks occurring.

Make the Call

We made our choice based largely on the necessity to stop the growth of the mound of paper we were accumulating, while proactively facing the HIPAA regulations regarding privacy and patient record security.

We realized we could benefit for some of the advantages offered by EMR, such as:

- Better compliance and coding

- Improved business and administration integration

- Remote access to enhanced documentation

- Improved communication and efficiency

When calculating the final costs of software, tech support, hardware, and infrastructure, we expected it could be recovered within five years. This was based primarily on the abated need to rent more office space, including reductions in clearing-house services and lower print costs. Improvements to job efficiency and other benefits are difficult to accurately calculate, but we are monitoring these types of returns on investment as we go forward.

The greater trend seems to point at a future in which EMR is a standard at all medical practices. Government and insurance carriers are putting increased pressure to standardize documentation, and may soon make EMR an obligation. As competitors bring down the costs of hardware and software, even smaller offices can suddenly afford to make a switch to paperless. The ultimate EMR system implementation plan is within the commitment of the physicians involved in actualization.