EHR: Electronic Health Records and Cost Challenges to Implementation

Dr Sarah Slight, School of Medicine Pharmacy and Health, Wolfson Research Institute University of Durham, United Interview with;
Dr Sarah Slight, School of Medicine
Pharmacy and Health, Wolfson Research Institute
University of Durham, United Kingdom. What are the main findings of the study?

Dr. Slight: Our study identified four main cost categories associated with the implementation of EHR systems, namely: infrastructure (e.g., hardware and software), personnel (e.g., project management and training teams), estates / facilities (e.g., furniture and fittings), and other (e.g., consumables and training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure, diverse training approaches for staff, and different software applications to integrate with the new system. Were any of the findings unexpected?

Dr. Slight: In this study, we sought to categorise implementation costs that have a direct implication on processes and workflow. Productivity losses were found to be very difficult to track. For example, completion of a paper order form was routinely held to be faster than the new EHR system equivalent; however comparative completion times will vary by: individual; EHR software system; clinical functionality involved; level of training; and by level of staff performing the task. No hospital in this study monitored the task completion time of its staff; however complementary time motion studies, for example, may be useful. What should clinicians and patients take away from your report?

Dr. Slight: With cost considered one of the most significant barriers to EHR adoption, it is important for hospitals and governments to be clear from the outset as to the categories of costs involved and the factors that may impact on these costs. We believe that the cost categories identified in this study can assist hospitals in the development of their business plans. What recommendations do you have for future research as a result of this study?

Dr. Slight: This study focused on the EHR systems being implemented as part of the National Care Records Service, which were all vendor-based systems. Clearly, the costs of implementing such systems may differ from those of a home-grown system, thus limiting generalizability. The unprecedented, nationally imposed system has now be superseded by locally chosen and implemented solutions, which in turn creates huge challenges around the secure exchange of confidential clinical information among disparate systems and health care settings. This is a potential area for future research.

A qualitative study identifying the cost categories associated with electronic health record
implementation in the UK
Slight SP, et al. J Am Med Inform Assoc

2014; 0:16. doi:10.1136/amiajnl-20


Last Updated on December 21, 2014 by Marie Benz MD FAAD