What does it take to implement an EMR in a small office practice?

Apparently, the confidence to stick it out as the practice's staff adapts to all the positive and negative changes that electronic medical records can bring. At least that's the experience of an independent, community-based, four-internist primary-care medical practice in Philadelphia.

The physicians of Greenhouse Internists recounted their experience of implementing EMRs into their practice in Annals of Internal Medicine (8/2/05). The physicians, who admittedly were "not especially computer-literate," spent about $140,000 for the hardware, software, training, and 1 year of support for the system-an amount comparable to other reports of the cost-per-physician basis for implementing EMRs.

During the implementation, the group practice suffered numerous growing pains. For one, the staff and physicians needed training on how to use the hardware and software. For another, all of the office's work flows had to be redesigned almost simultaneously. While the system vendor encouraged the practice to develop new work flows in advance, the practice staff was ill-equipped to do so since they did not yet fully understand how the EMR system would work and the vendor did not know enough about the practice to help.

While the physicians were able to use a one-time cash surplus to finance the EMR implementation, they found that the system actually increased their annual budget for technology support: The needed support rose from $10,000 per year pre-implementation for computer maintenance and support of a limited computer system to $40,000 per year for support payments to hardware and software vendors and a local computer support vendor.

But the practice has since seen the benefit of adopting EMRs. Three months after implementation, they are able to generate prescriptions electronically, gain faster access to specialist correspondence, access a patient's medical record anywhere in the office, and see the same "chart" from multiple desktops. By the sixth month, patient waiting times and staff morale had improved. In addition, the EMR system now saves the practice $45,000 per year in eliminated transcription costs.

According to the physicians of Greenhouse Internists, "Despite the difficulties and expense of implementing the electronic health record, none of us would go back to paper."