Unwelcome Surprises

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Early adopters say clinical information technology is often worth the price, but unanticipated costs lurk in every corner.

Whenever she reads reports extolling the return on investment of clinical information technology, Phyllis Schuck shakes her head. The IT innovator has learned from hard experience that progress can be encumbered with any number of unanticipated--and sometimes exorbitant--costs. "In ROI discussions, no one mentions the new costs added," says Schuck, the chief information officer at Pinehurst (NC) Surgical Group. "Savings are not as great as reported."

Pinehurst Surgical, a 35-physician group practice, has made substantial investments in clinical hardware and software. The organization began a 16-month implementation of an electronic medical record system from Allscripts in March 2005. Since then, the practice has abandoned its paper charts, virtually eliminated its reliance on outside transcription services, and added additional physicians and mid-level providers while minimizing additional personnel overhead. But the newfound efficiency exacts its own cost, Schuck says--one that can be hard to measure. "You can easily get into unexpected costs," she says.

It's a common tale in healthcare. Once the glow of the initial deployment has worn off, clinical IT adopters find themselves staring at a new set of costs--some fixed, others temporary, and a few totally unpredictable. New servers, additional software, and better access devices can quickly clog the IT budget. Often, introducing new technology creates demand for more, as yesterday's IT skeptic becomes tomorrow's IT consumer. Formerly satisfied with paper charts, new users of EMR technology soon want additional data and increased functionality.

"A little taste of blood becomes a feeding frenzy," says Joel Diamond, MD, medical director of a five-physician group family practice in Pittsburgh that implemented EMR technology from Misys six years ago.

Pinehurst's big-ticket hidden costs were not software related, but infrastructure related. For example, the medical group deployed a wireless network to cater to its peripatetic physicians, who tote laptops and tablets into exam rooms.

"The internal wireless chips did not work well enough to cover all the movement our providers had," Schuck recalls. "So we bought external wireless cards." In addition, the practice hired consultants to analyze transmitter placement for continuous coverage. Together, the consulting tab and external cards came to $25,000, Schuck says.

But the wireless costs paled in comparison to other hardware needs Pinehurst soon encountered. "We didn't realize how quickly we would outgrow our servers," Schuck recalls. To run its technology, Pinehurst needs one dozen servers, plus a high-speed external storage disk. "We had 26 providers when we purchased the EMR and did not do a good job of putting together a long-range plan, saying that for every five or 10 doctors we add, this is what the future cost will be," she says.

To maintain uptime and store its burgeoning cache of electronic files and images, the group practice is upgrading its servers and considering adding a storage area network, or SAN. "It is in the $150,000 range," estimates Schuck.

Likewise, clinical IT in the hospital environment carries all sorts of un-anticipated costs, "from the mundane to the grandiose," says Diamond. The former chief medical information officer for St. Margaret Hospital at the University of Pittsburgh Medical Center, an integrated delivery system with 19 hospitals, Diamond helped lead the charge to an automated inpatient record, which includes computerized physician order entry.

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