Electronic Medical Record Adoption


A money-losing proposition for most practices.

The big question has finally been answered; is an investment in electronic medical record (EMR, also referred to as an electronic health record or EHR) worthwhile for physicians in private practice? Researchers Julia Adler-Milstein (University of Michigan in Ann Arbor), Carol Green (medical student at the University of Rochester), and safety expert David Bates (Brigham and Harvard) surveyed 49 practices in a large EHR pilot program. The Massachusetts eHealth Collaborative (MEC), which was organized by the American College of Physicians and the Massachusetts Medical Society, paid for the EHRs and the consultants who helped the practices implement the technology from March 2006 through December 2007. The study accounted for one-time costs of the pilot (e.g. EHR cost) and on-going costs (e.g. personnel salaries). The costs were compared with the benefits of EHR adoption (e.g. increased revenue) and avoided costs (e.g. cost of maintaining paper medical records).

Adopting an EHR system is a money-losing proposition for most physicians, even with the availability of federal bonuses for meaningful use of the technology. The average physician was calculated to lose $43,743 over 5 years of practice. Only 27% of all practices were able to achieve a positive return on investment. The percentage of profitable practices would have increased to 41% if they had received $44,000 in meaningful-use incentive payments over 5 years (federal incentive payments for meaningful use of EHRs began in 2011). The financial hit was not as bad for physicians in primary care, who lost $29,349 compared with $50,722 for specialists. Groups with 6 or more physicians posted a positive return on their investment; however, it was only $2205.

Interestingly, nearly half of the practices kept their paper charts even after they implemented EHR systems. Practices with positive returns on their investment saved an average of $8245 on paper charts compared with $3898 for practices who had negative returns. The difference was even greater for practices that used dictation services ($52,782 versus $8345) and support staff to file and maintain paper charts ($41,983 versus $5038). The authors concluded that current meaningful use incentives alone may not ensure that most practices, particularly smaller ones, achieve a positive return on investment from EHR adoption.


Adler-Milstein J, Green CE, Bates DW. A survey analysis suggests that electronic health records will yield revenue gains for some practices and losses for many. Health Affairs. 2013; 32 (3): 562-570.

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