Remember Opportunity Cost When Taking the EHR Plunge

The physicians I know personally are intensely interested in the welfare of their patients. Each, however, has a different personality: There are optimists, pessimists, skeptics and activists. Some are instinctive while others are quantitative and analytical. Some are builders; others are buyers. 

Personally, I'm an optimistic skeptical analytical activist builder. I've been working in medically-related computer science and engineering (44 years) longer than I've been a doctor (36 years). I do my doctoring in a facility that inflicts an absolutely ghastly hodge-podge of systems on its practitioners. One way I look out for the welfare of patients is to study the theory and principles of medical computing (medical informatics) and work to improve clinical computing, especially electronic medical records.

It's part of my personality to get upset when I see practitioner's time being wasted doing clerical work, when I see systems that interfere with the delivery of care instead of helping, or when I see organizations wasting precious resources on obsolete, poorly designed systems. Sometimes my reaction makes me seem like a curmudgeon, so if you detect a bit of grumpiness in my commentary from time to time, remember that it stems from my impatience with the pace of progress in the area of electronic records.

So, let's begin by considering opportunity cost. Imagine you have a dollar. You have it until you spend it. You have options. You can save it, invest it anticipating a return, purchase a consumable or you can make a purchase that commits you to additional (perhaps unexpected) costs in the future. Once spent, the dollar is not available if a better opportunity comes along and you may end up paying child-support for years.

There have been "sweet spots" in the technology sphere over the years. Organizations that made technology purchases when it was new got more years of use before obsolescence set in. Organizations that buy products that are near the end of, or past, their useful life get to experience the meaning of opportunity cost first-hand.

The technology cycle heralded by the Internet has profound implications for how systems can, and perhaps should, be designed. It began more than 20 years ago. One can see indications that the next cycle is on the horizon. For the most part the largest, best-selling and most entrenched healthcare systems are based on technologies that emerged from cycles that pre-date the Internet.

Purchases made today to qualify for federal incentive money are likely to embody technology that is already out of date if not downright obsolete. If that's true, then systems purchased in a hurry now will probably have to be replaced in hurry before too long. Will the incentive payment mitigate the future expenses (that can be anticipated even now) or the work flow inefficiencies that are inherent in many "mature" products?

Regardless of whether you are optimistic or pessimistic, trusting or skeptical, you owe it to yourself to consider opportunity cost along with the usual list of criteria when and if you decide to take the plunge into EHRs.

Daniel Essin, MA, MD, FAAP, FCCP, will be a regular contributor to the Practice Notes Blog. He has been a programmer since 1967 and earned his MD in 1974. He has worked at the Los Angeles County and USC Medical Center where he developed a number of internal systems, chaired the Medical Records Committee, and served as the director of medical informatics. His main research interests are electronic medical records, systems architecture, software engineering, database theory and inferential methods of achieving security and confidentiality in healthcare systems.