title: Productivity and cost implications of implementing electronic medical records into an ambulatory surgical subspecialty clinic.
abstract: OBJECTIVE
  Electronic medical records (EMRs) have been proposed as technology through which the quality of healthcare could be improved. We present an analysis of the cost and productivity implications associated with the transition from transcription to an EMR system in an ambulatory setting.
  
  
  METHODS
  Data were collected from eight consecutive fiscal years from 1998 to 2005. Transcription was used in the first 4-year period, and EMR was implemented and used in the later 4-year period. Productivity was defined as ambulatory revenue and the number of patient encounters. All costs related to transcription and EMR implementation were calculated. All data were adjusted for inflation.
  
  
  RESULTS
  Within the transcription era, the transcription costs were $395,404, total revenue was $18,137,945, and patient encounters numbered 52,027. The average transcription cost per encounter was $7.60, average revenue per encounter was $348.63, and average revenue per provider was $505,615. Within the EMR era, the EMR-related costs were $293,406, total revenue was $30,370,647 and patient encounters numbered 65,102. The average documentation cost per encounter was $4.51, average revenue per encounter was $466.51, and average revenue per provider was $690,242. The startup costs of initial EMR implementation were $10,329 per physician provider.
  
  
  CONCLUSIONS
  The results of our study have shown that the implementation of an EMR system when an economy of scale exists coincides with an increase in the revenue per encounter and per provider compared with transcription. The advantage of the fixed costs of an EMR system compared with the variable costs of a transcription-based system is the allowance of cash savings in an ambulatory surgical subspecialty practice.
authors.affiliation: Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Mukul
authors.initials: M
authors.lastname: Patil
authors.forename: Lalit
authors.initials: L
authors.lastname: Puri
authors.forename: Chris M
authors.initials: CM
authors.lastname: Gonzalez
mesh_terms: D000554:Ambulatory Care Facilities; D000556:Ambulatory Surgical Procedures; D002641:Chicago; D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000191:economics*