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What Are The Hidden Costs and Surprises in Your EHR

The Cost of Electronic Medical Records in Hospitals and Practices

By now your office has implemented an EMR, possibly more than one, and you are well aware that the initial price you were told is well below what you have actually paid to fully implement the new application and software. But WHY?

Why was one price shown to you, promised, and agreed upon, yet the costs have been ticking up ever since go-live?

Despite challenges involved with purchase price discovery, organizations must understand the broader costs associated with different EMR systems. Only then can they ask the right questions and avoid unexpected costs.

I’d like to highlight key areas of potential hidden costs that providers and practice managers should consider when embarking on an EMR implementation.

EHR Implementation Cost Breakdown – How Much do EHR Systems Cost?

Hidden EMR Add-On Costs

At HIMSS this year, the topic of Interoperability was on everyone’s mind and the focus of about 15% of the presentations. Buyers should ensure that they understand exactly what support for achieving or maintaining interoperability between the EMR and other systems is covered in the contract. Such work can be increasingly expensive over time.

If the EMR system does not include analytics and/or dashboards, customers may need to purchase expensive third-party solutions.

Many providers find they are able to purchase EMR software and use it right out of the box. But other time the organization needs to customize it to fit their needs. You may need to pay more for special features such as electronic prescribing and quality reporting that your clinic will require for compliance.

On the flip side, some EMR vendors have a one-size-fits-all software that is designed for and sold to many different specialties. These may include many additional features that your clinic will never utilize. Consider a chiropractic office who would not have a use for an e-prescribing tool or interoperability with labwork.

ASK: “What else will we need that we are not buying from my vendor right now?”


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Hidden EMR Implementation Costs

Implementation assistance encompasses all technical support required to implement the EMR system. This typically involves support from staff outside your organization. Most vendor service contracts include some amount of system support and troubleshooting, especially during the initial installation phase. Even with this support, your organization is likely to need some IT support of their own once the training wheels are removed.

Potential implementation assistance costs include bringing in an outside IT contractor, assistance with chart conversion or product installation. Third party contractor charges begin at about $175/hour and even more for after hours and emergency support. A $5,000 bill could easily be accrued.

ASK: For references from other companies who have recently implemented the same EHR.

Hidden Hardware & Third-Party Infrastructure Costs

Check with your EMR vendor or IT experts to confirm that your existing hardware will accommodate the new software. Your current servers, network, or computer workstations may not be up to snuff. Additionally, if you’re using a cloud-based system you may need to upgrade your internet bandwidth.

A primary stimulus for moving to EHRs was to keep medical records safe. Therefore, in order to protect data and comply with HIPAA regulations, you may need to upgrade encryption, network monitoring, and firewalls.

EMR solutions commonly require third-party software that is not included in the contract. If not, the cost of third-party infrastructure – including software licenses and data storage – will be the responsibility of the client.

ASK: “How long can this EMR software run SMOOTHLY off my current hardware configuration?”

ASK: For a list all third-party vendors that your EMR relies on.


Read More About EHR Costs and Implications,


Hidden Productivity and Training Issues Costs

If your staff experiences a difficult time learning to use the new system, that will likely add to your system’s hidden costs. EMR software can be challenging for providers, nurses, and office assistants to learn. It may take substantial time for your clinic to be capable of using all the features your new software provides.

  1. Sources of Additional Training

Budgeting time to learn and train in a low-pressure, demonstration environment can help you reduce productivity loss and retraining expenses.

ASK: Does my vendor offer application training. If so, how much training?

Additional Sources of Hidden Costs

The New Hampshire Health Information Organization recently published a list of sources which may incur significant costs when implementing a new EMR.

Be sure to ask your vendor if the following are included in your original contract:

  1. Server Updates
  2. Direct Capabilities
  3. Practice Management software updates or upgrades if the new system doesn’t integrate with the current practice management software
  4. Patient eligibility check services
  5. E-prescribing functionality
  6. Revenue cycle management add-ons, such as claims management and tracking denials
  7. Population health management quality reporting to payers, CDC, registries and state health departments
  8. Patient portals, automate patient reminders and the ability to schedule appointments and pay bills online
  9. Telehealth functionality
  10. Clinical decision support tools
  11. Integration engines to connect the EHR with labs and registries
  12. Software updates and upgrades
  13. Updates for Logical Observation Identifiers Names and Codes, ICD-10 and Systematized Nomenclature of Medicine
  14. Services for assisting with the Quality Payment Program
  15. Customizations, such as note templates with custom fields and analytics capabilities
  16. IT staff overtime to maintain servers
  17. Extra storage for patient data
  18. Initial productivity loss as providers and staff learn the new system
  19. Annual power and real estate costs associated with EMR’s infrastructure
  20. Infrastructure needed for failover systems

By unexpectedly draining the resources of organizations, hidden costs reduce the chances that EMR solutions will deliver their intended benefits. Organizations that perform due diligence and understand the true cost of ownership right from the start are much more likely to have successful EHR implementations.


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