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H H S Department of Health and Human Services
U.S. Department of Health and Human Services
Health Information Technology

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What Are Some of the Less Obvious Costs, Including Software?

As noted above, there are various costs associated with the adoption of health IT into a practice.  These include the costs associated with acquiring a new system, as well as the less obvious costs that will continue throughout the lifespan of the system.  The total cost of ownership can depend upon certain characteristics of your practice, including practice size, hospital associations, type of clinic, and the particular system adopted.  Also, it is important to realize that you may need to customize the EHR/health IT systems to fit the particular needs of your practice and HIV/AIDS population.  This could require the expertise of either in-house IT staff or outside consultants.  

Medicare providers who do not begin participation in the EHR Incentive Program (also called “Meaningful Use”) by 2014 and Medicaid providers who do not begin participation by 2016 will miss out on these payment incentives.  For those practices, the forfeiture of meaningful use incentive payments is actually lost revenue.  Thus, if you are eligible to receive these incentive payments, you should ensure that your EHR technology has been certified as having the required capabilities, related standards, and implementation specifications to support the achievement of meaningful use Stage 1.  You may be eligible to receive Medicaid EHR Incentive Program payments if at least 30 percent of your patients are Medicaid recipients, or if you work in an FQHC or Rural Health Clinic, at least 30 percent of your patients are “needy individuals.”  Individuals considered “needy” include those receiving assistance from Medicaid or the Children’s Health Insurance Program (CHIP), those receiving uncompensated care, or those receiving care at no cost or reduced cost based on an income-based sliding scale.  If you are a Medicare fee-for-Service provider and do not demonstrate meaningful use, you will have a payment reduction in your Medicare reimbursement starting in 2015. 

Even with incentive payments from the EHR Incentive Program, purchasing and utilizing a vendor-based EHR represents a significant cost to clinics and practices.  Nevertheless, it may less than you would expect.  A 2005 survey conducted by the American Academy of Family Physicians (AAFP) revealed that the total cost of ownership for an integrated vendor-based EHR is less than $8,000 per physician per year over a three year period (assuming a three-physician practice).  This cost includes the initial price of the software as well as ongoing costs for hardware, third-party licenses, and annual upgrade or maintenance costs.  

Besides purchasing a vendor-based EHR, another option for you to consider is utilizing open source EHR software, which is often available for free.  Several open source EHR products already exist specifically for care of HIV/AIDS patients, though these products have been implemented mainly in developing countries. These EHRs include OpenMRS go to exit disclaimer, Fuchia, Smartcare, and WorldVISTA products.  Each has a supportive community with descriptions and documentation available online.  Also, HRSA provides grantees under the Ryan White Program with free access and technical assistance to the CAREWare Software.  It also allows you to quickly produce a completed Ryan White HIV/AIDS Program Annual Data Report (RDR) and Ryan White HIV/AIDS Program Services Report (RSR).  However, CAREWare is not an EHR solution that meets Stage 1 Meaningful Use certification requirements.

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