EHR adoption and implementation costs include purchasing and installing hardware and software, converting paper charts to electronic formats, and training end-users whether physicians, Nurses, Technicians, Physical therapists and Ancillary service providers. Many studies have documented these costs in both the inpatient and outpatient settings. Evidence indicates that the cost for Inpatient adoption is immensely higher than for its outpatient use which is understandable.
However, as EHR technologies have become more commonplace over the past few years, the initial cost of systems has come down dramatically that is largely in terms of software acquisition yet the maintenance cost of an EHR remains comparatively costly. Hardware must be replaced and updated with new operating systems, newer processors and computer parts, and software must be upgraded on a regular basis to keep up with new features and clinical as well as administrative demands. In addition, providers must have ongoing training and support for the end-users of an EHR. According to one study conducted on 14 solo or small-group primary care practices, the estimated ongoing EHR maintenance costs averaged US$8412 per provider per year. A total of 91% of this cost was related to hardware replacement, vendor software maintenance and support fees, and payments for information systems staff or external contractors. Other estimates of ongoing maintenance costs for the first year after implementation was about US$17,100 per physician in a medical group of five. Not considering here to cost of hiring on-site dedicated IT Personnel! I have yet to find a study with that cost inclusion.
The costs of EHR adoption, implementation, and ongoing maintenance are compounded by the fact that many financial benefits of an EHR generally do not amass to the provider (who is required to make the initial and upfront investment) but rather to the third-party payers in the form of errors averted and improved efficiencies who is by default the Insurance Companies !, which end result is reduced claims payments. This mismanagement of incentives for health care organizations, along with the high upfront costs, creates a barrier to adoption and implementation of an EHR, especially for smaller practices. In fact, physicians frequently cite upfront costs and ongoing maintenance costs as the largest barriers to adoption and implementation of an EHR. Not that other solutions have no cost but it is a well-known fact that EHR costs the nost among Digital Health Products.
I can remember very well the Medicare and Medicaid EHR adoption incentives in the form of Bonus Payments established during President Obama Era although sounding Promising on paper but in reality only a small minority of eligible and participating practices were paid for more than the initial applicable incentive program year all of which due to the restrictive nature of eligibility criteria for these bonuses in addition to significant functional limitation of EHR when it came to analytics and data aggregation per established standards of care protocols.