As a new practice is set up, an integral part of business operations may involve purchasing and implementing a computer system. Even if one is not very comfortable with computer systems, many are easy enough to use with adequate training. Consider that more and more practices are adopting EHRs and with more regulations such as Health Insurance Portability and Accountability Act (HIPAA) and electronic prescribing, a computer system is likely inevitable in the future health care system.
There are several levels of how a computer system can be integrated into the practice. The cost is determined by what level of involvement and integration is desired. If setting up a new practice, it may be easier to start with an EHR rather than trying to convert the practice at a later time. However, it is significantly more expensive and time consuming to implement an EHR system as a new practice is started. Some hospital systems are helping practices by offsetting expenses with a system that is compatible with the hospital’s system. This would be worth investigating.
How Will the System Be Used?
When looking to purchase a computer system for the practice, the first question that much be answered is, “For what will I be using the system?” The answer will determine the type of system needed, the investment that will be required, and the timeline for installation.
The simplest use of computers in an office is like what would be used at home—word processing, spreadsheets, simple accounting, and possibly Internet access.
The next level would be to use a computer system to run Practice Management software (PMS). This software typically would allow for electronic appointment scheduling, billing, and storing patient demographics.
The most complex use of computers in a pediatric office is through Electronic Health Records (EHRs). This is essentially patient charting completely on the computer.
The cost of and time for installation increases as a practice proceeds from a stand-alone computer to full-scale PMS and EHR. Sample costs are listed in the Table.
PMS and EHR|
Software cost||$500 - $1,000||$1,000 - $5,000/FT||$1,000 - $50,000?FTE|
Harware cost||$2,000 desktop||$1,000 - $2,500 per desktop/laptop/tablet|
$2,000 - $4,000 per server
Additonal for printers, scanners, modems
Implementation cost||$75 - $150 per hour of training/implementation (usually some hours included in purchase price)|
Time||2 wk - 1 mo|||||
Maintenence/Support||None - $100||$500 - $1,000/FT||$1,000 - $4,000/FTE|
Steps for Choosing a Computer System
Determine to what extent the practice would like to use computers.
Perform a financial analysis to see what is affordable and what the return on investment (ROI) would be. Investigate options such as hospital system financial support. Contact banks or lenders if financing will be needed.
Research vendors and systems.
Meet with several vendors for product demonstrations. If possible, visit pediatric practices that are currently using the system.
SOAPM and the
AAP Council on Clinical Information Technology (COCIT), and browse the
EMR Review Web site.
As the search is refined, clearly understand the initial costs of acquisition and implementation, as well as any ongoing maintenance costs. Consider hardware and software maintenance costs to keep the business running smoothly; as well as hidden expenses for upgrades, support, and additional training. Ensure these expenses are outlined in contracts.
Once a decision is made, define an implementation and transition strategy.
Information is available through the Academy to help you plan these processes.
Schedule installation of required wiring, networks, telephony, hardware, and software. This is especially important if a new office is being constructed and wiring can be installed during the building process.
Plan and carry out implementation of products with all necessary training and customization.