While Medicare penalties are frequently mentioned, in fact they probably should be one of the smallest influences in the decision to acquire an EHR. Even if a practice has $100,000 in annual revenue from Medicare, the penalty will be only $1,000 a year, which pales in comparison to the other costs of an EHR.
Beyond dollars and cents, there are other factors to consider in the decision to implement an EHR when one is nearing retirement. The effect of a new system on one’s quality of life is an important consideration.
Our discussions with many physicians have convinced us that implementation of an EHR is similar to elective knee surgery: You should anticipate a great deal of initial pain, with slow and steady progress to a quality of life that is eventually better than what one had before the operation.
How painful the process of instituting an EHR will be is going to vary depending upon the individual practitioner’s facility with technology and the quality of his or her current office workflow. Many of an office’s current routines will need to change, leading to significant frustration on the part of the practice as a whole. We know many physicians who never took charts home prior to implementing an EHR, but who now find themselves spending 1-2 hours daily (including weeknights and weekends) completing notes in the EHR.
In summary, physicians retiring in the next 3 years may not find an EHR to be the wisest investment in money or in personal stress. For physicians with more than 3 years remaining in practice, however, the benefits begin to accrue. But it is important that senior partners not impede the ability of junior partners to move forward in acquiring electronic health records.
Our recommendation is that scenarios such as the one asked about in the second question above lead to an open and honest discussion of future plans, and to the development of a formula for supporting the investment in an EHR that is fair to all the providers in the group. This typically will mean that partners who plan to be a part of the practice for longer than 3 years take more financial responsibility for the EHR, and allow their retiring colleagues to bear less of the burden of the initial costs.
This column, EHR report, appears regularly in Family Practice News, a publication of Elsevier. Dr. Skolnik is associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital and professor of family and community medicine at Temple University, Philadelphia. He is also editor in chief of Redi-Reference, a software company that creates medical handheld references. Dr. Notte is in private practice in Chalfont, Pa. They are partners in EHR Practice Consultants, helping practices move to EHR systems. Contact them at info@ehrpc.com.