To the Editor:

I am one of the physicians still very uncertain as to the value of EHR's. Our 50-partner multispecialty group is beginning to look at it. I'm not on the committee, but I have read at least 10 articles on the subject. I'm sure there have been hundreds more that I've missed. Like the other articles I've read, Dr. Kenneth Adler's “Why It's Time to Purchase an Electronic Health Record System,” [November/December 2004, page 43] does not specifically discuss the cost of the project.

I don't question the eventual savings – we have three staff who now spend about 20 percent of their time looking for paper charts – but how much physician productivity was lost during the transition? If for a year I see 20 people a day rather than 30, that's a lot of lost income. I'd be interested in seeing the revenue, total expenses, salary costs and personal income for the year before and first three years after the installation.

Author's response:

I would like to see that data too. In fact we are collecting it for our group, but we haven't been using our EHR for three years yet, so I can't provide it at this time.

When we implemented our EHR, we lightened our schedule for the first week and a half after implementation. After that we returned to normal schedules. We were able to maintain our productivity, but we ended up working longer hours the first several months as we converted our patient data from paper to electronic format.

So yes, adopting an EHR requires a definite investment of time and money. The payoff, however, is much more than financial. Among other advantages, EHRs allow you to easily monitor and measure what you do.

A maxim in management is that you can't improve what you can't measure. I believe that improving care is the primary promise of electronic health record systems. The purpose of my article was to show that you can accomplish that noble goal without having to sacrifice your paycheck.