Shifting to electronic health records could wreck some small medical practices.[@@]

A group of researchers led by Robert Miller, a professor of health economics at the University of California-San Francisco, comes to that conclusion in a study published in the September-October issue of Health Affairs.

Policymakers on both the left and the right have argued that storing patient records in digital form could improve the quality of care and greatly reduce the cost.

But Miller and his colleagues say their study of use of EHR systems at 14 small practices suggests that the results of a shift could be mixed, at least in the short term.

Of the 14 practices studied, “2 had severe billing problems that were at least partly EHR-related,” the researchers write. “One had no billing or revenue for 3 months; another had no revenue for 10 months and nearly went bankrupt.”

A third practice had to redo its billing for the first 6 weeks after implementation and later endured a complete system crash that resulted in a total loss of data and several weeks of providing care with computer access or paper charts, the researchers write.

The 14 primary care practices that the researchers reviewed used EHR systems from 2 vendors.

Initial costs averaged $44,000 for each full-time provider, and ongoing costs averaged $8,500 per year, the researchers write.

The average practice paid for its EHR costs in 2.5 years and profited handsomely after that, but some practices could not cover costs quickly, the researchers observe.

Costs varied dramatically between practices.

Although, for example, the average cost of setting up an EHR system was $43,826 per provider at the surveyed practices, costs ranged from $14,462 per provider at the practice with the lowest expenses up to about $63,000.

Setting up and running an EHR system seems to be cheaper for large “integrated delivery” systems that combine teaching hospitals with physician group practices, and most of the EHR studies available deal with those sorts of organizations, Miller and his colleagues write.

But, today, in the United States, the reality is that more than two-thirds of U.S. physicians are in solo or small group practices, the researchers write.