EHRs good for small practices, but quality gains only modest so far

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Physicians in solo or small group practices stand to benefit financially from purchasing and implementing electronic health record (EHR) systems, but they also should be aware of the financial risks, according to a study funded by the Commonwealth Fund and published in the current issue of Health Affairs

According to the study of 14 solo and small-group practices, the average practice paid for its EHR system in two-and-a-half years and reaped impressive profits after that. EHR systems enabled most practices to increase office efficiency and to increase reimbursement levels for office visits. Some practices, however, could not recoup their costs quickly, and three experienced serious financial problems. Meanwhile, providers achieved some improvement in quality of care through using their EHR systems, but the study researchers found that, overall, concerted efforts to improve healthcare quality were limited.

"The current reimbursement system does not reward primary care physicians for providing better care or for taking the initiative to systematically improve care," said lead study author Robert H. Miller, professor of health economics at the Institute for Health and Aging at the University of California, San Francisco.

"Instead, the system continues to reward physicians for billing certain types of visits that are perceived as having more work effort." 

Initial EHR costs averaged $44,000 per full-time provider, according to the study, while ongoing costs averaged $8,500 per provider per year. Most providers initially had to work longer hours to get up to speed, although some practices reported that, in time, the EHR systems made providers' work lives easier and more satisfying.