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Policymakers hope that a major portion of U.S. patients will use electronic
medical records by 2014.32 That ambitious deadline was set to
make sure that usage increases enough that doctors are willing to invest
the necessary resources in digital communications and that the health care
system becomes more efficient and effective at caregiving. The public must
embrace technology if health care providers are to reap the economies of
scale possible through increased expenditures on technology.
However, cost remains a major barrier to the adoption of new technology.
According to a study of electronic medical records in primary
care, installation of electronic records cost $13,100 per provider per
year, including software, hardware, support services, and maintenance.
That would bring the total expenditure over a five-year period to
$46,400. Benefits in terms of savings on transcription, billing, and
administration were estimated at $5,700 in year 1; $24,300 in year 2;
$24,300 in year 3; $50,300 in year 4; and $50,300 in year 5, for a fiveyear
total of $154,900. That results in a net benefit of $108,500 with a
present value of $86,400.33
Training is important with these systems because surveys indicate that
initially medical professionals find them difficult to use. Most professional
systems have multiple screens, various options, and a variety of navigational
approaches.34 Learning to use these systems involves a considerable
investment of time up front, with the payoff coming several years down
the road. In an industry with extensive time and cost pressures, such barriers
make it difficult to implement this kind of improvement.
One case study of an internal medicine practice that implemented electronic
medical records found that both personal and financial costs were
quite high. The total cost of the system was $140,000. Both staff and
doctors had to undergo extensive training on data entry and system
maintenance. Midway through implementation, the system was attacked
by a virus, which led to an extensive drain on staff time. Moving to the
electronic system required a redesign of office work flow and daily routines.
Although all providers concluded that the transition was worthwhile,
the doctors felt that small medical offices would not be able to
adopt an electronic system unless financial assistance was provided. Their
view was that a subsidy of at least $12,000 per physician per year would
be required to convince recalcitrant doctors to move in this direction.