How to Evaluate the Real Cost of an Electronic Health Record System?


moneyclock:dropcap_open:I:dropcap_close:f you are shopping for an Electronic Health Record system, chances are you will follow this path: You will choose to call 4 or 5 companies you have heard the most from other fellow chiropractors, or you have seen in chiropractic seminars or magazines. At this point, they are all the same for you. They all claim they have the best service, the best system and the lowest cost. So, you will ask for a demo, online or live at the seminar. As a bonus, you just find out the system is free and in the process to become certified for the Stimulus incentive package. So, you automatically become eligible to receive 44,000 dollars from the government. Wow, what a deal! That was easy…. You are almost ready to make your final decision. Let’s go fast because the government may have given all his Stimulus dollars to the fastest decision maker and maybe there will not be any dollars left for you. Hurry up; let’s buy some computers and go for it! Decision made…done deal!

Stop! No…don’t do that; it will not happen like this. The real cost of an EHR system has to be established with a lot of diligence. Let’s rewind the tape for a moment and proceed much differently. Let’s take the business approach instead of emotion. Choosing the automated EHR system you will be using for approximately 2,000 hours per year needs a serious analysis. Your analysis needs to be well structured with priorities well defined. Act as a good business person.

Free or Not Free

I will start this discussion with a big statement: “Nothing is free in life.”  It is not any different for chiropractic EHR software. “Free” will cost you a lot of money. You need to find what’s under the hood. In every software category, EHR or not, free is to get you aboard with something that does the very minimum and, most of times, less. Then they sell you applications (apps) or modules. You need to find out what will be the cost of these applications. What will be the cost for the service on these paid apps afterwards? Free or not free, you have to make a good evaluation of how much it will cost to maintain your EHR software over a 5-year period minimum. You may also hear, “Expand your EHR as you grow.” The word “expand” simply means spend more money on other applications later on. Some other providers will have specific functions and tools to help you grow, which is a much different and interesting approach. Do not hesitate to ask an EHR provider, “Please show me how I can grow my practice with your system,” or “Show me how your system will save my staff time and how it will make my life better.”

Hardware Cost

Computer prices have gone low. This is good news. You may think, since you will be using 5 or 6 computers in your practice, you need a strong dedicated server. If you use a dedicated server and it fails, you have no more access to any data file and cannot work anymore. These servers can cost up to $2,500 and are not necessarily needed for all EHR software. You can save a substantial amount of money with an EHR system that does not require a dedicated server. Since these systems can use just about any computer in your office to act as a file server, you may use any other computer as an emergency file server and get the system back in 5 minutes or so. This can be the difference between closing your office for the day or remaining open and treating every patient for that day.

:dropcap_open:Choosing the automated EHR system you will be using for approximately 2,000 hours per year needs a serious analysis.:quoteleft_close:

Time Savings

Do you agree that “Time is money”? Then you can make good money by saving time and using this precious time at your discretion. All systems are about the same speed on an online demo. They run on a single computer with near empty databases. The real speed test comes when you have 7 computers networked together, with 5,000 patients, 100,000 appointments and 200,000 transactions. It can be very slow, if your data is stored on internet somewhere. It is well known that internet is the slowest network, while a local network is so much faster. Make your own calculation: If, because you have a fast EHR system, you save 2 minutes per patient/visit and you see 200 patients per week, you will save over 333 hours per year, which represents more than 8 weeks of free time. Have you ever realized this amazing statistic? How much money this time saver is worth to you? The 2 minutes is not achieved only on hardware speed but also on how the information is accessible on one screen, how the system can automate all the billing, manage care plans, if you have any, etc.

Cost of Service

You will also have to pay for service because, like in any other business, help agents and trainers do not work for free. How much, in terms of money and quality, will you get back from that service contract? Will they answer your calls instantly when you need help or will you need to wait for a call back? Will they support you if you have some hardware issues? Do they have an emergency plan for you to make sure you can keep adjusting your patients if your server fails? If you are storing your patient data on internet and internet gets down on you, what is the plan if it takes 24 hours before you get it back? It can be very costly, if you have to cancel all your patients for a day or two. If you do have some insurance claims rejected, the money recuperation obtained from efficient software provider assistance can be huge at the end of the year.

The Stimulus Package

If you put the $44,000 Stimulus in the equation to do your EHR final choice, you will probably have to redo your budget at some later time. First and most importantly, no chiropractic software is fully certified for all the required meaningful use. Installing partially certified software will not make you eligible for one single penny from the stimulus. You would have to buy one or multiple other software to meet all the requirements. This would be a financial disaster for you. Be very careful about the stimulus package before you include it as criteria for your cost.

As a business person, the goal is to turn the EHR overall expenses into an investment. The return on your investment will be in office growth, time savings, better collection, and better overall control with less or no downtime at all. The real cost of an EHR software is much more than the acquisition and the monthly service fee and your investment return will make the entire difference between failure or success.

Fortunately, 99% of chiropractors I have personally seen installing an Electronic Health Record system has turned it to a great investment. Over the years, out of thousands of doctors I have witnessed installing such a system, I can recall only one who has returned to paper operation. This amazing statistic explains why EHR systems are so popular these days.

Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 17 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions, please email to [email protected].

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