This section will provide an overview of financial commitments made by the DC government, DCPCA and its members. Returns on these investments and discussions of longer-term sustainability are also summarized.
Overview of approximate costs. The table below provides a summary of estimated costs of implementation as reported by DCPCA for an implementation involving approximately 1,100 users of both practice management and EHR. Notably, the soft costs associated with planning, implementation and training constituted $3.25M of the almost $5M in initial costs. Much of this cost went to consulting and professional services provided by DCPCA, Cumberland Consulting and eCW.
(1,000-1,200 various staff)
|$250,000||DCPCA, with DC grant|
|Hardware||$1 million||DCPCA, with DC grant|
|Licensing||$650,000||DCPCA, with DC grant|
|Planning||$500,000||DCPCA, with DC grant|
|Implementation (including consultants)||$2.5 million||DCPCA, with DC grant|
|Total ongoing costs per year||$250,000||Member centers (some goes to DCPCA for ongoing support)|
Return on investment. Health center representatives explained how implementing eCW has affected their finances and the types of returns they expect on their HIT investments. Some centers pointed to the requirement that all procedures be linked to a funding source, indicating that having such a requirement has changed their center’s business model and increased third party reimbursement significantly. Some participants noted efficiencies, with one representative indicating that documentation, which previously took providers 30 minutes, takes 10 minutes under eCW.
Another participant noted that electronic billing and eRx had increased efficiency at their clinic. Other participants were less sanguine, saying that necessary interactions and exchanges with non-electronic entities had limited increases in efficiency. Some indicated that anticipated savings in staffing had not been realized, saying, “We got rid of medical records people, but there’s still a huge need… You don’t need less people; they’re just doing different things. We overtaxed staff in making those changes.” Other participants noted that expected revenue increases and savings had not materialized, but remained hopeful that given more time savings and revenues would increase. DCPCA members have also experienced increased costs after implementing eCW. Health centers reported significant decreases in provider productivity, especially during training periods. Additionally, some centers have had to increase funding for IT support staff. One participant expressed skepticism in the overall sustainability of the DCPCA plan, saying, “These are costs that didn’t exist before, there is an increased cost going forward.”
DCPCA staff predicted that, over time, increased patient throughput, not staffing reductions, would cover the costs of eCW for its members. Additionally, DCPCA hopes to expand their EHR initiative to all health centers in DC. In their view, such an expansion would help to increase economies of scale and diminish individual centers’ ongoing costs.