The incentives in the American Recovery and Reinvestment Act to expand the "meaningful use" of electronic health record systems have many health care professionals searching for information about the cost and staff resources that such systems require. We report the cost of implementing an electronic health record system in twenty-six primary care practices in a physician network in north Texas, taking into account hardware and software costs, as well as the time and effort invested in implementation. For an average five-physician practice, implementation cost an estimated $162,000, with $85,500 in maintenance expenses during the first year. We also estimate that the HealthTexas network implementation team and the practice implementation team needed 611 hours, on average, to prepare for and implement the electronic health record system, and that "end users"-physicians, other clinical staff, and nonclinical staff-needed 134 hours per physician, on average, to prepare for use of the record system in clinical encounters. 1 Potential adopters of this technology need information about the financial and other resources required to implement and maintain the systems.We quantified the costs of implementing one system-GE Healthcare's Centricity Electronic Medical Record 2 -at HealthTexas Provider Network, a large physician network in north Texas that provides fee-for-service ambulatory care. Financial costs included those pertaining to purchases of hardware and of software licenses. We also considered the maintenance costs for software licenses, hosting, and technical support for the first year following implementation.We considered nonfinancial costs to be related to the time spent by many parties to bring the system online and into full use. These parties included three groups of people.First was the HealthTexas network implementation team, which consisted of the manager for training and work flow, the senior vice president for disease management and quality, the vice presidents for informatics and for electronic health records and information technology (IT), a project manager, a process improvement consultant, and staff who conducted the workflow analyses and electronic health record training for physicians and clinic staff. This team planned and led the implementation of the system throughout the network.Second were the individual practice implementation teams, which prepared for the practice's implementation through planning, workflow reengineering, and training, and which consisted of "physician champions" chosen to spearhead the implementation at the particular practice, clinical staff "superusers," and office managers. Third were the end users-the physicians, other clinical staff, and nonclinical staff. End users had to be trained to use the electronic health record and had to prepare for its use in clinical encounters-for example, by loading information from patients' paper records.We interviewed key leaders of HealthTexas's electronic health record implementation: the vice presidents for informatics an...

Objective. To estimate a commercially available ambulatory electronic health record's (EHR's) impact on workflow and financial measures. Data Sources/Study Setting. Administrative, payroll, and billing data were collected for 26 primary care practices in a fee-for-service network that rolled out an EHR on a staggered schedule from June 2006 through December 2008. Study Design. An interrupted time series design was used. Staffing, visit intensity, productivity, volume, practice expense, payments received, and net income data were collected monthly for [2004][2005][2006][2007][2008][2009]. Changes were evaluated 1-6, 7-12, and >12 months postimplementation. Data Collection/Extraction Methods. Data were accessed through a SQLserver database, transformed into SAS â , and aggregated by practice. Practice-level data were divided by full-time physician equivalents for comparisons across practices by month. Principal Findings. Staffing and practice expenses increased following EHR implementation (3 and 6 percent after 12 months). Productivity, volume, and net income decreased initially but recovered to/close to preimplementation levels after 12 months. Visit intensity did not change significantly, and a secular trend offset the decrease in payments received. Conclusions. Expenses increased and productivity decreased following EHR implementation, but not as much or as persistently as might be expected. Longer term effects still need to be examined.

Background:The patient-centered medical home (PCMH) shows promise for improving care and reducing costs. We sought to reduce the uncertainty regarding the time and cost of PCMH transformation by quantifying the direct costs of transforming 57 practices in a medical group to National Committee for Quality Assurance (NCQA)-recognized Level III PCMHs.Methods: We conducted structured interviews with corporate leaders, and with physicians, practice administrators, and office managers from a representative sample of practices regarding time spent on PCMH transformation and NCQA application, and related purchases. We then developed and sent a survey to all primary care practices (practice-level response rate: initial recognition-44.6%, renewal-35.7%). Direct costs were estimated as time spent multiplied by average hourly wage for the relevant job category, plus observed expenditures.