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Going Electronic Can Pay Off

Most experts agree that electronic health records (EHRs) can improve the efficiency and quality of care. But what are the costs and benefits of this technology, particularly for the solo or small group practices in which more than two-thirds of U.S. physicians work?

Fund-supported research by Robert Miller, Ph.D., and colleagues at the University of California, San Francisco, finds that for small group practices with EHRs, initial costs average $44,000 per physician or nurse practitioner, with ongoing costs averaging $8,400 per provider per year.

IMPORTED: www_commonwealthfund_org__usr_img_miller96x96caption.jpg While these expenses may seem steep, the researchers estimate that the average practice would cover its costs in less than three years and, after that, profit considerably. Still, most providers who adopted EHRs worked longer hours initially, and some practices faced substantial risks, including long payback periods, billing problems, and data loss.

For the study, The Value of Electronic Health Records in Solo or Small Group Practices, (Health Affairs, Sept./Oct. 2005) Miller and his team conducted 14 case studies of solo or small primary care practices that had used EHRs for one to three years. They interviewed EHR "champions," observed providers' use of EHRs, and reviewed vendor contracts and practice reports.

They found that use of EHRs provides physicians with improved data organization, accessibility, and legibility. While all of the practices used EHR capability to improve quality—through patient reminders, for example—only two used EHRs to systematically improve chronic and preventive care.

The authors say that support services for practices, such as technical and office redesign, could promote use of EHRs to improve their performance and care.

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