Electronic Medical Record May be Cost-Effective
Given the lack of evidence that an electronic medical record (EMR) either prevents medical errors or is not prohibitively expensive, anyone purchasing such a system may sweat bullets until his or her organization can decide whether it was worth it (see what I've written about this here).
Well, this is news that may gladden such a person’s heart. The Journal of the American College of Surgeons recently published a paper suggesting that for some facilities, an EMR may in fact be cost-effective. Apparently, when one factors the costs of creating new patient charts, pulling
and refiling charts, transcription costs and clerical salaries; an EMR actually recovers its cost in an average of 16 months.
Five ambulatory offices with 28 providers participated in the study. The average annual savings per provider was $9,983 which for most of us is serious money. Other measures of improvement:
- A reduction of 4.5 clerical staff despite the addition of six care providers.
- A $27,872 reduction in the costs of creating new patient charts.
- A 96% reduction in chart pulls at two years.
- The average number of items (i.e. labs) filed per minute went from 3.4 to 1.0 (annual savings of $25,000).
- A $35,560 reduction in annual transcription costs (for offices paying for transcription).
- An increase in billing revenues per visit of $0.17 when compared with control offices.
- A 13.8% reduction in the number of days an account is in accounts receivable.
Patient flow also appears to have been speeded up by 5% although this difference wasn’t statistically significant.
So what can one conclude from this work? At least for these offices (three primary care internal medicine practices, one dermatology office and one pediatric endocrinology office), some real benefits may have accrued.
Clearly, there are intangibles that weren't measured. For example, EMR's encourage the use of progress note templates which can easily result in uninformative "cookie-cutter" notes that are cut and pasted from visit to visit. This can degrade progress note quality and usefulness.
One also needs to question the quality of a patient-physician interaction in which the doctor spends his or her time staring at a computer screen rather than actually making eye-contact with the patient.
On the balance however, medical office managers and software venders everywhere may have cause to rest a little easier.