Identify and discuss reasons physician practices may not adopt EHRs?
if physicians do not opt to adopt EHRs, they will be subject to a penalty. The definition of "meaningful use" should be finalized by December 2009, after which it will be open for public feedback for 60 days. [ 5
The reasons less expensive EHR alternatives are necessary
In spite of federal reimbursement for "meaningful use" of EHRs, it is likely that this will not improve the adoption rate
across the board. First, practices will need to purchase the system and long term maintenance with up front capital, which will be a challenge for many small practices. Second, clinicians who treat small numbers of Medicare and or Medicaid patients will not be eligible for reimbursement. Third, the amount of reimbursement may not be adequate in the long run if expensive commercial systems are purchased. Proprietary EHR systems are not only expensive to purchase and maintain, they may require in-house technology support. In an important study by Miller et al in 2005 of fourteen solo or small private practices using two commercial EHRs, the average cost per practitioner to purchase a client-server EHR system was $44K (range $14.4K-$66.6K) and the annual amount thereafter was $8.5 K (range $6K-$12K) for maintenance and support. In Miller’s article it was estimated that the EHR would save, on average, $32K (range $6.6K-$56.1K) per practitioner per year due to improved coding and other efficiencies. 27 It was clear from this study that practices varied tremendously, in terms of return on investment. In a second article by Miller in 2007 he estimated the value of four commercial EHRs to community health centers (CHCs) in six states. Both the initial costs and maintenance estimates were higher for the CHCs than the private practices previously reported. Unlike private practices, the financial benefits were far less due to reimbursement differences, making commercial EHRs for CHCs unsustainable. 28 In neither article did Miller mention open-source EHRs as an alternative. ]
There are no new answers.