Wednesday, April 6, 2011

Electronic Health Records: Going Up in the Cloud, and Bringing Costs and Ease of Use Down to Earth

April 6, 2011 - In the course of my reading, I ran across this item on the cost of implementing electronic health records.

“The March 2011 issue of Health Affairs reports on the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in North Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance costs during the first year.”

“The study estimated that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the health record system, and that “end users” – physicians, other clinical staff, and nonclinical staff – needed 134 hour per physicians , on average, to prepare for use of the record system for clinical encounters.”

Source: Neil S. Fleming, et al, ”The Financial and Nonfinancial Costs of Implementing Electronic Health Records in Primary Care Practices,” Health Affairs, Vol. 30, No. 3, March 2011. 481-489, abstract.

Let’s break these costs down by individual physician. Installing an EHR in a primary care setting cost $32,400 per physician to implement, $17,100 for first year maintenance, 122.2 hours of staff time per physician to prepare and implement, and 134 hours per physician to prepare for use in a clinical setting

The total cost of putting in an EHR system for an individual primary care physician is in the neighborhood of $50,000 for hardware, software, staff and physician training. That does not include the physician’s time away from patients, learning how to enter data, and does not include the costs of trying to interface with a hospital system.

Small Wonder

Small wonder, then, that small, and even large primary care practices, are leery about implementing EHRs, particularly when there is little tangible return on investment, except for the federal government’s promise in its stimulus bill to reward practices with a 2% bonus for using EHRs that meet “meaningful use” criteria.

The Cloud

Enter the Cloud Computing Concept, which has been evolving over the last several years and has been adapted by EHR companies like Practice Fusion in San Francisco. Cloud computing is computation, hardware, software, data access, and storage services that do not require physician knowledge of the physical location and configuration of the system that delivers the services.

Non-Needs and Need

In other words, physician and staff do not need to know the ins and outs of EHR hardware and software. They do not need an EHR system on site. All the need is a computer that connects to the Internet.

They simply tap into the information they need through a distant browser, which can be used simultaneously by countless other “end-users – hospitals, other health care facilities, and physicians to whom they refer. In essence, cloud computing allows the creation of a large, scalable, virtual system transcending the individual user by ascending into the “cloud.”


The advantages of this approach are obvious.
• Reduced investments in infrastructure, technology, and training.

• Quicker implementation.

• Less physician distraction from clinical medicine, the main source of physician income.

• Easier access to important applications, such as speech recognition and diagnostic support systems.

• Only paying for access with use.


There are questions.

One, how much does access to the “cloud” cost?

Two, how does this cost compare to more traditional on-site implementation?

Three, what are the risks of security of security breaches by hackers?

These are things that need investigating before going up in the cloud.

But keep in mind two things.

One, $20 billion is sitting out there provided the government to support implementation of a national interoperable health electronic health record system.

Two, by going up in the cloud, you might be able to bring your costs down to earth.

Tweet: Cloud computing, transferring electronic health systems from doctor offices to Internet browser, may be EHR's salvation & huge opportunity.

Richard L. Reece, MD, has posted 1722 blogs at medinnovation blog over the last four years. His main themes concern health reform and innovation and how they impact physicians and American culture as a whole. He works closely with the Physicians Foundation but his opinions are his alone. He has written ten books. His latest book, The Health Reform Maze, is now at the publishers and will be released in June. Doctor Reece’s website,, will be up and running in several days. He invites comments on his blog and will respond to each comment on his blog or to him directly at 860-395-1501 or


James said...

The cloud computing concept is a very efficient way of backing up all the important medical history files of these patients. If clinicians fear of losing these medical files, then this software can definitely gain their trust and guarantee that they can keep all these documents safe and protected.

James Guertin

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Almeta Tai said...

EHR is indeed a wonderful addition to the medical industry as it allows the physicians to see the complete history of their patients prior to providing them treatments. It's efficient when the patient is in a critical case scenario too. This will let doctors deal with questions that needs instant answer –the patient's blood type, previous medical conditions, prescribed drugs, etc. But its cost and complexities are the thorns in its side. Hence, going for cloud computing is a sound alternative. Thanks for sharing your insights, Richard!

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