Hospitals must be ready to pay the price for EHRs

Hospitals need to be better prepared to handle the full costs of implementing electronic health record (EHR) software if they want to maximize the benefits of the technology, according to research published online on 13 February in the Journal of the American Medical Informatics Association.

A team of researchers led by Dr. Sarah Slight of the University of Durham in Stockton-on-Tees, U.K., performed a qualitative study of three large EHR projects in the U.K., and found that the hospitals were not always ready to handle the full cost of implementing EHRs, including the cost of training, facilities, and infrastructure.

"With cost considered one of the most significant barriers, it is important for hospitals and governments to be clear from the outset of the major cost categories involved and the factors that may impact these costs," the authors wrote. "Failure to adequately train staff or to follow key steps in implementation has preceded many of the failures in this domain, which can create new safety hazards."

Seeking to better understand the costs incurred during EHR implementation and the factors that influence those costs, the researchers prospectively evaluated different forms of systems being installed in the U.K. as part of the country's 12.7 billion pound National Program for IT. They studied three systems (iSoft's Lorenzo Regional Care, Cerner Millennium, and CSE's RiO software) in 12 diverse healthcare organizations, which were in three different regions of the country and at different stages of implementation.

The program was fraught with difficulty and was ultimately discontinued in September 2011, the researchers said.

Between February 2009 and January 2011, the research group performed 41 semistructured interviews with 36 hospital staff, members of the local implementation team, and those involved in the implementation at a national level. From their interviews, the team identified four overarching cost categories associated with implementing an EHR:

  • Infrastructure (such as hardware and software)
  • Personnel (such as project managers and training teams)
  • Estates/facilities (furniture, fittings, and space)
  • Other (such as training materials)

The researchers determined that many factors affected these costs, as different hospitals opted for varying amounts and types of infrastructure, pursued diverse training approaches for staff, and selected different software applications. They noted that some hospitals incurred significant costs for software testing, while others spent a lot of money training clinicians and administrative staff to use the system. Training methods included either one-to-one, classroom, or mass training sessions, or different combinations of both, according to the authors.

In addition, one hospital backfilled staff to cover clinical staff that were being trained to use the EHR software, incurring a one-time cost of 750,000 pounds. Another hospital spent no money at all on providing cover, according to the team.

Overall, implementation proceeded at a much slower pace than expected, with many challenges faced along the way, according to the researchers. They found that, out of the four main categories of associated expenditures, hospitals were most likely to cut back on training and implementation costs.

"Certain factors were systematically under-appreciated in project planning, including the need to back fill staff due to lost productivity, and the need to test the system due to inadequate vendor testing," the researchers said in a statement.

The researchers said the cost categories identified in their study can assist hospitals in developing their business plans for EHRs.

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