As basic functions like results viewing caught on, physicians started clamoring for more data and better access. "We went from docs saying they would never use a computer to saying they wanted one everywhere," Diamond says.
But even computer placement created unexpected expenses, he adds. "We put computer terminals in every patient room at UPMC," Diamond recalls. "We had the computer in a little cabinet near a ledge the docs could sit on. We didn't realize that the vent the computers used for not overheating was a place patients liked to throw coats on. We had no coat racks, and the computers began overheating." Eventually, the hospital had to modify the cabinets, directing the vented heat elsewhere.
But the cost of modifying the cabinets pales in comparison to the medical center's primary EMR dilemma: data sharing across the organization. "Once people had access to some electronic data, it became apparent what data they did not have," Diamond says. "Physicians began demanding a complete data set." UPMC was faced with pulling together data from 19 hospitals and multiple legacy systems.
The delivery system thought that by consolidating on a single vendor platform, it could solve most of its data-sharing problems. But the way the system was initially configured made that difficult, Diamond says. As a result, UPMC is embarking on a $50 million interoperability project that would pull disparate data from across all hospitals into a single view.
In addition, affiliated physicians would gain access through their own EMRs. "The assumption was that data sharing was going to be a snap," he says. "Instead it became a giant unanticipated cost."
But the cost of the interoperability project could not have been easily forestalled, cautions Diamond, who left his CMIO position to work for DB Motion, the data integrator hired by UPMC to consolidate its clinical documentation systems into a common view. When the health system first began its march toward automation, no one could have predicted the groundswell of physician support and opportunities for advanced clinical decision support. "It's like me putting in a T1 line at my practice," Diamond says. "At first I thought I would never have pictures going across the Internet, but I did."
For Schuck, the economic uncertainty suggests that physician practices should not rush headlong into adopting EMR technology. "I encourage practice managers to pick an EMR vendor simply so they can understand the hardware requirements and how the software works," she says. "But don't sign the contract right away. Step away for a year."
During that time, she advises, consider the impact on workflow and the conversion of old paper charts. Pinehurst adopted a document imaging system, scanning five years worth of paper charts and appending them to current files. The external scanning conversion costs were approximately $350,000, Shuck says. "Vendors will say they can do this, but they can't tell you the cost."
Despite the unexpected costs, neither Schuck nor Diamond would return to paper records. "It changes the way you do business," says Schuck. "But as long as you recognize the opportunities and adjust your processes to take advantage of the technology, it is worth it."
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at email@example.com.