18 hidden costs in EHR purchase and implementation

EHRs are a considerable investment in time and money, and hospitals are finding several hidden costs associated with implementation.

Several health systems this year report purchasing an EHR system has hurt their hospitals' finances, including Boston-Based Partners HealthCare, Brigham and Women's Hospital in Boston and Sutter Health in Sacramento, Calif.

Hospitals and health systems pay fees to license EHR software, with the upfront costs often between $1,200 to more than $500,000, according to Software Advice. The organization is then responsible for monthly and annual recurring costs as well as add-on and maintenance costs.

Recurring costs can be anywhere from $200 to more than $35,000 for subscriptions per provider/user fees in addition to any premium support offerings. Data migration can cost $30,000 to $50,000, according to Software Advice.

Transferring appropriate information from legacy systems to a new EHR, such as demographic data and appropriate clinical information is a key consideration when upgrading an EHR, says Nancy Fennell, Adoption Support consultant at New Hampshire Health Information Organization, a Concord-based nonprofit organization devoted to health information exchange. "Many times there is a significant cost in this, especially if you want the appropriate data elements to continue to be structured data elements in the new system."

The hidden costs, according to Ms. Fennell and Software Advice, including data management and add-on functions that may not be in the original contract include:

1. Server updates

2. Direct capabilities

3. Practice management software updates or upgrades if the new system doesn't integrate with the current practice management software

4. Patient eligibility check services

5. E-prescribing functionality

6. Revenue cycle management add-ons, such as claims management and tracking denials

7. Population health management quality reporting to payers, CDC, registries and state health departments

8. Patient portals, automated patient reminders and the ability to schedule appointments and pay bills online

9. Telehealth functionality

10. Clinical decision support tools

11. Integration engines to connect the EHR with labs and registries

12. Software updates and upgrades

13. Updates for Logical Observation Identifiers Names and Codes, ICD-10 and Systematized Nomenclature of Medicine.

14. Services for assisting with the Quality Payment Program

15. Customizations, such as note templates with custom fields and analytics capabilities

16. IT staff overtime to maintain servers

17. Extra storage for patient data

18. Initial productivity loss as providers and staff learn the new system

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