Have you ever been offered a pair of “free” tickets in exchange for subscribing to a concert series? Likely, you enjoyed the concert, but the real price tag — the entire series — was quite a bit higher than you initially wanted to pay. In the end, the concert wasn’t free at all, was it?

Something comparable happened to Sumir Saghal, an internist and geriatrician in New York City. Saghal and his two colleagues are among 200 New York physicians with large Medicaid practices who took advantage of a “free” EMR from the city’s Department of Health and Mental Hygiene. Since last December, when Saghal’s Bronx practice starting using the eClinicalWorks software, the internist has surmounted the steepest part of the EMR learning curve, and he’s proud of his now-paperless practice.

An advocate of quality improvement, he’s not concerned about the fact that he has to share his clinical data with the city, which will give him feedback and perhaps issue a public report card on his performance.

But the EMR turned out to be far from free.

Yes, the Department of Health footed the software bill of $12,000 per physician, and it’s even paying for two years of support from eClinicalWorks. But Saghal’s four-physician practice had to pay $4,000 per provider for technical assistance from the city. In addition, the group had to purchase several extra computers, including a server, as well as the services of a technical consultant to install the system.

The hardware bill alone totaled about $45,000. And the grand total invested in the “free” EMR? At least $60,000, Saghal says.

That doesn’t include the costs of lowered productivity (that can last up to six months), as well as ongoing support for the computer system.

So while the initial price of the EMR was considerably lower than what the practice would’ve had to pay on its own, all those necessary accoutrements represent a large investment. Indeed, EMR software represents only 15 percent to 25 percent of the true cost of ownership. “There’s no such thing as free,” says Erica Drazen, a health IT consultant with CSC/First Consulting Group in Boston.

But won’t practices recoup the initial outlay through increased efficiency? Maybe, maybe not. Saghal isn’t completely sure he and his colleagues will, although he’s hoping to get more pay-for-performance payments from health plans.

Perhaps you’re among the many physicians nationwide who are hoping to obtain discounted or free EMRs from the government, insurance companies, hospitals, or commercial vendors. If so, take a deep breath. Every one of these products comes with strings attached, entails major costs, and may or may not suit your practice. So if you see something out there that looks good, look again — hard — before you leap. Here’s how to see your way clearly to the real deal.

Where the deals are

The most likely source of discounted EMRs in the future may be your local hospital. As a result of several government rule changes in the past two years, hospitals are now allowed to give private-practice doctors up to 85 percent of the cost of EMR software and training, while practices must cover the costs of hardware, installation, and technical support. Depending on their interpretation of IRS regulations, hospitals may send 1099 forms, which would require physicians to pay tax on the value of the donations.

Still, the arrangement can be valuable to you in other ways, notes Laura Jantos, a principal with ECG Consulting in Seattle. Hospitals can negotiate hardware discounts, serve as intermediaries with EMR vendors, and, most importantly, help physicians navigate past the inevitable technical bumps and glitches inherent in complex system implementations. But bear these two facts in mind:

• You’re likely to get only one or two choices.

• The healthcare system donor may want to use your patient data for quality improvement.

A growing number of hospitals are in the early stages of donating EMRs to community doctors, but they’re still very rare, Drazen says. Many hospitals are preoccupied with wiring themselves or rolling out EMRs to their employed physicians, she notes.

Case in point: Community Health Network, a five-hospital system in Indianapolis, is now installing a GE Centricity EMR in the offices of its 175 employed primary-care physicians. But, except for some private practices managed by its management services organization, says Community Health Network’s CEO William Corley, the system won’t donate EMRs to any area doctors until after it installs a new enterprise EMR in its hospitals in 2009. In the interim, he notes, the hospital plans to provide a Centricity “EMR lite” to nonemployed specialists so they can receive lab results and communicate online with the employed doctors.