10 hidden costs of EHR software

When factoring the costs of selecting and implementing an EHR system into your ROI calculation, a useful strategy often lies in keeping a checklist of some of the lesser-known costs that arise. The major EHR costs such as licensing fees and hardware costs do not require elaboration since they represent the foundation of the system and the lion’s share of the costs. However, considering some of the less well-known costs relating to an EHR project can accomplish a great deal toward achieving a positive ROI.

1. Implementation assistance - Implementation assistance encompasses all technical support required to implement the EHR system. This typically involves staff outside of your organization. Potential implementation assistance costs include bringing in an outside IT contractor, assistance with chart conversion or hardware and network installation.

2. Workflow redesign - Since a new EHR is being introduced to manage your organization’s processes, workflows will need to be analyzed, adjusted and reformed in light of new EHR functionality. Associated costs can be direct, such as vendor consultation, or indirect, such as increased training or reduced productivity.

3. Training - Staff will need to be trained on the new EHR system being introduced into your organization. Training extends to physicians, nurses, and office staff. In addition to training staff, a decision regarding who will carry out the training will need to be made. Often the vendor will offer training services. However, this could be limited, requiring in-house staff to conduct training in the future.

4. Maintenance - Technology often malfunctions; this is a fact of modern life. This rule applies to a large-scale EHR system just as much as it applies to consumer technology.

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5. Reduced productivity - With a new EHR there will be a learning curve in which staff become accustomed to using the new system. This learning curve can reduce efficiency, resulting in productivity losses.

6. Security tools - HIPAA and HITECH require a high level of data security. In addition to mandated security measures, data breaches, even when your practice complies with the law, can be disastrous.

7. Customization - Out of the box EHR systems often require tweaks and adjustments to fit into the environment they are being used. This cost can be reduced if a system with a high level of user configuration is selected.

8. Upgrades and add-ons - The longer a system is in place, the lower the odds of requiring an upgrade. Particularly as meaningful use expectations of EHR functionality change, an organization can anticipate upgrades and add-ons to be required.

9. Data migration and conversion - When conducting a change of EHR systems, all of the data contained on the old system will need to be migrated to the replacement system. The scale of this cost is largely dependent on the health of your database prior to conversion.

10. Third party software - EHR systems often require third party software to improve interoperability or to facilitate tasks within the system. For example, organizations use speech to text software to facilitate dictation of notes into the EHR.

When analyzing the ROI of an EHR, all costs matter. As a result, hidden EHR costs that appear when least expected could overshadow what could have been a successful implementation. The best advice in this context is to be a pessimist and reserve budget rather than letting hidden costs poke holes in your ROI calculations when you least expect it.