Applied Medical Informatics for the Chest Physician: Time Commitment
How much do EMRs cost? The firm First Consulting Group, based in California, said it would cost $210 million in one-time start-up expenditures for the 46 Massachusetts hospitals to install them or to update existing technology to a minimum agreed-on standard. However, the consultant predicted the hospitals would save $275 million annually because the systems reduce errors and, as a result, avoid medical care for unintentional injuries to patients.
Other than the actual cost of CPOE systems, an important consideration is where the financial incentives for adoption occur. In a one report, the Center for Information Technology Leadership estimated that 89% of the economic benefits of CPOE accrues to the holder of the financial risk for health care (ie, insurance companies). At a time when the financial value of EMRs and CPOE specifically are coming under increasing economic scrutiny, perhaps the consideration of where the financial value really exists for CPOE will be better realized and the incentives realigned appropriately. in detail
The extended length of time needed to plan, select, configure, implement, refine, and, finally, achieve effective use of an EMR remains one of the most important reasons for the limited availability of these systems for physicians in the United States. In a 2002 study, The Ohio State University reported a 7-year time period from the completion of EMR strategic planning to complete installation. Of course, this length of time may be considerably less in a smaller health-care setting; however, the importance of this report is that, irrespective of the size of the organization, the implementation of an EMR takes vision, planning, and institutional perseverance, which is a rare commodity in American health care today. By the term institutional perseverance, I mean that once organizations have decided to adopt an EMR, there must be a commitment to continued, focused, and innovative leadership in continuing the project over a period of years. The time in office of senior managers in American hospitals today, in particular the chief information officers, suggests that there may be several senior leaders within a health system before an EMR is completely implemented and effectively becomes part of the culture of an organization. However, experience has shown that expecting current leadership to be in place for the completion of an EMR project is a key element in achieving success.