When health care professionals consider security they are generally thinking of their patient’s privacy, and what will happen to their sense of ownership as they move from paper charts to electronic data storage.

Although highly sensitive to the cost of transitioning to a paperless office, many physicians lack the time or inclination to focus heavily on business matters. This is especially true in primary care, where dwindling reimbursements threaten livelihood and the main factor in the success of a medical practice is volume. Docs must work at a rapid fire pace all day, every day, there is little time for much else1,2.

On the other hand, when IT professionals talk about security with their customers, they are decidedly not talking about finances, simply because they’re in business to turn a profit.  Historically, high cost of entry, ongoing maintenance costs, and hidden fees ensure that they will and that financial security for their customers is not the top priority1.

EMRs have largely failed in delivering on the promise of increased revenue, and are instead a major and disruptive investment with a shaky return. The decision-making process for small independent physicians involves the threat not only of dollars up front but an immediate loss of revenue as productivity suffers.  This results in a hit to the financial security of the practice and the physicians’ own pocketbook.

EMR ROI calculators tout both savings and increased revenue.  And, supporting anecdotal incidents exist regarding practices that were able to:

…replace the chart room with an exam room for a new    partner

…save money on error reduction and nurse time e-prescribing

…reduce headcount by automating eligibility and billing functions

But, these stories are subjective… and for every positive tale, there are numerous laments about lost time and productivity and even adding staff for IT needs where headcount reduction is not plausible or desirable.

All of this results in the fact that “primary care practices are declining in number, suffering financial strangulation and sliding into irrelevancy”. In fact, in “7 Guidelines for Saving Primary Care” four of physician and financial expert, Ken Zonies’ seven guidelines involve finances and IT 2

  1.  Increase Pay
  2.  Teach Basic Finance
  3.  Forgive Loans
  4. Reduce Bureaucratic Hassles
  5. Revise Approach to IT
  6. Tort Reform
  7.  Renew Respect

Outside the scope of medical care, when technology is done right, costs decrease.. This is due to competition and the race to develop and deliver a superior product. Doctor’s have the right to expect this of office technology as well. Therefore, financial security for physicians need not focus on some clever derivative of cost savings…it just needs to cost less. 

Financial security also means the elimination of financial risk.  Large up-front capital investments, far in advance of any real ROI do not eliminate risk.  A typical physician’s office is ill-prepared to support and maintain large scale hardware and software purchases and this lack of IT knowledge only adds risk for physicians and opportunity for IT firms.  Hiring IT support staff to run a thousand dollar investment when your business is diagnosis and treatment does not eliminate risk and may add to responsibilities outside the scope of care.

There are, however, means for physicians to reduce their financial risk in regards to practice technology:

  • o Pay for only the services you need
  • o Reuse existing PC and networking equipment
  • o Use a firm that offers monthly subscription pricing and eliminates up front investment
  • o Outsource IT management and maintenance – look for a firm that employs state-of-the-art data facilities with highly trained professionals to support your IT needs, not a half-time person fussing over a server in a closet at the back of your office.
  • o Outsource patient record storage and backup – this huge and real elimination of risk particularly in light of recent and increasingly common natural disasters.
  • o Realize economies of scale…every provider receives the exact same quality of service as the largest of groups

Finally, whether you are in primary care or specialty care, look for an IT provider that truly embodies the seventh and possibly most important tenet above.  Respect for health care providers.  In IT, service is key.


Rich Steinle, CEO  of Practice IT

Rich Steinle’s article is published in EHR Scope Spring 2008 Volume 5 publication.  To view his article and references, please visit www.ehrscope.com/magazine




1. AC Group. 2007 PMS/EHR Functionality Ratings. http://www.acgroup.org November 2007.
2. Zonies, Ken. “7 Ways to Save Primary Care”. The Physician Executive. pg 18-22, Jan/Feb 2008.