Inexpensive Alternatives to EHRs

First, let's define "inexpensive." According to the American Medical Association, the average cost of an EHR, per physician is $50,000. That includes hardware, software, and training, of course, but it is still a hefty investment. For small practices, that initial sum plus ongoing monthly costs may simply not be affordable. So what alternatives are out there?

It depends what you want to do. For many specialties, you may just be interested in tracking certain metrics and groups of patients - for example, diabetes or asthma patients who require timely follow-up, and those who need to have key health indicators monitored regularly. If this is the case for you, then you might consider setting up a “chronic disease registry.” These databases can be simple or complex depending on your needs, and can either be home-grown or purchased off-the-shelf and customized for your practice. These databases provide a good way to record information about your patients, and allow you to run reports to identify patients who need follow-up and track their progress. However, because this method requires both charting the note in the paper chart and then entering the same information in a database, it does little to make your office more efficient.

Using technology to improve efficiency

If you are fed up with lost or misfiled charts, drowning in a sea of paper, or simply looking to streamline patient information, then "an electronic file cabinet" solution may be the way to go for you. These systems allow you to create patient files in an electronic environment and store information such as chart notes, images, and faxes. This certainly helps to minimize paper in the patient chart, and allows staff to access patient records easily. However, these solutions are only digital files; they do not allow for the use of any data in a meaningful way, as the information resides on scanned pages rather than in data fields that can populate reports and forms.

Alternatively, you can start using separate technology solutions for tackling different issues and build gradually into a full-functioning EHR. For example, many e-prescribing systems can be used as "stand-alone" packages, allowing you to digitize patients' pharmaceutical records and achieve the benefits of improved patient safety. If you do approach technology from a component perspective, do think about where you'd like to end up and in what timeframe. It is important that you purchase components with a view to integration down the line; otherwise you may end up with data residing in several systems that cannot be successfully (or inexpensively) used to populate an EHR.

Lite EHRs

There are also EHR packages available that offer a range of features without the high price tag. These systems are usually Web-based, and typically allow you to chart electronically and store a range of data, but do not have advanced functionality such as the ability to run patient portals, link to other systems, and export data easily. However, it may make sense to start with a "lite" version and eventually phase it out to a more robust system over time. Why? Again, according to the AMA, approximately 30 percent of practices that implement an EHR later abandon it. One reason is that some practices purchase too much technology and end up overwhelmed by it. So starting small - with the economy sedan if you will - may be a better way to go for your practice.

When assessing any option, database, stand-alone e-prescribing, or lite EHR, just make sure to have the vendors answer the following questions:

• Who owns the data? You will want to be able to take it with you to another system later on.

• What happens to the data if I want to migrate to another system? Make sure that the system can export or transfer data and files to other systems.

• Is there a cost associated with exporting that data to an import-friendly format? Some vendors will allow the export of data but the format may be useless for converting the data to other systems.

• What happens if your company goes out of business or is acquired and the system is retired? Ensure that there is some provision in the contract for the data to revert to your practice immediately.

Reasonable investments in technology should not break the bank for your practice. But make sure that whatever you spend your money on will provide a reasonable return on your investment, either in office efficiency, better patient management, or improved quality of care.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.