The Virtual Care Insider

Virtual Care and the EMR: The High Cost of Free

in Strategy

Jon Pearce

Jon Pearce
CEO
October 11, 2017

Do you remember the healthcare world pre-EMR? Healthcare organizations from large IDNs to individual practices were swamped by stacks of paper. There were rooms filled with files, cabinets bursting with the medical histories of every patient that sought care at a given clinic.

Pre-EMR medical files

Then came computers and along with them, electronic medical record systems (aka, the EMR). And everything changed. Digitized patient records didn’t take up any space. Health systems, physician groups, and clinics were freed from the morass of paper they’d been buried in for years. And over time, the EMR evolved to be more than just a digital record storage solution. From patient portals to revenue cycle support and scheduling, EMR vendors expanded their offerings to support a wide variety of health system needs.

It’s no wonder then, that when health systems begin looking at a virtual care solution, the telemedicine module/functionality in their EMRs is often the first place they look. Many EMRs automatically include this online care delivery with the software. In fact, the main argument in favor of health systems using their EMR’s virtual care solution is that they’re already paying for the technology, so adding virtual care would essentially be free. But is it really?

Imagine this: Your health system is moving forward with launching virtual care. After reviewing your options, your team decided to build within your EMR. Like most health systems, you want to maximize your EMR investment – plus the promise of “free” virtual care technology is too good to pass up. Then you get started…

What Does “Free” Cost?

Technology

Turning on the telemedicine module in your EMR to offer virtual care is much more complicated than just flipping a switch. You will need to dedicate time and personnel to creating your virtual care service: developing the user experience and interface, creating and mapping the appropriate fields in your EMR, and ensuring the necessary integrations with scheduling, billing, etc. are in place and working properly. This means either diverting resources from other projects, adding to your technology team’s workload, or hiring – on contract or full-time.

The Cost:

  • Simply adding development to your technology team’s workload is the most cost-effective option, but it does cost the organization. Pushing off other projects incurs costs, and adding to the workload can stress employees causing an increase in absenteeism and even turnover.
  • Contracting with a certified consultant can run to hundreds per hour, and you may still need to dedicate person-hours toward development.
  • Hiring – whether contract or full-time – incurs costs in recruitment, training, and compensation.

Clinical Content

The technology side is just the first cost hurdle. Your virtual care service also needs high-quality clinical content, including patient-facing questions, algorithms, and clinical decision support – none of which is included in the EMR’s technology. Same as the technology, you have three choices for creating your clinical content: dedicate internal resources, purchase the clinical content, or hire a clinical informatics specialist – either on contract or full-time.

The Cost:

  • Even if you have a clinician with a background in informatics, finding internal resources means diverting clinical expertise away from patients. The cost of inexperience in this area could be even higher, with poorly-constructed algorithms producing the potential for quality concerns.
  • Purchasing content will, of course, incur the cost of the content, but it may also require additional time and energy from your technology and clinical team to customize it to your unique needs.
  • Hiring, again, means recruitment, training, and compensation costs.

Ongoing Investments

Building internally through your EMR means an ongoing resource commitment. You will need to regularly allocate resources for:

  • Technical support
  • Managing software updates
  • Clinical content management and updates
  • Service and technology enhancements (e.g., additional conditions, specialties, and services)

Opportunity Cost

Right now, health systems across the country – and likely in your market – are launching virtual care. According to a recent KaufmanHall study, 56% of health systems stated that developing virtual access points is a high priority, and 23% have a virtual care solution in place today. On top of which, telemedicine companies are growing their service capabilities and becoming more like complete online health systems than one-off urgent care centers. While you’re finding an EMR vendor-certified consultant, hiring IT and clinical staff to support virtual care, and actually building out all the individual, customized components of your service, these competitors are already marketing to and perhaps serving your patients.

Protecting patient relationships and retaining patients isn’t the only consideration. On the flip side, with virtual care proven to add patients to health systems, the time spent in building virtual care internally means the potential for losing new revenue. A recent white paper by Kurt Waltenbaugh, CEO of Carrot Health (and yours truly) found that approximately 25% of new patients from virtual care went on to have in-person care appointments within a health system. With the average annual revenue per new patient close to $3,000, this can add up to significant lost opportunity.

Finally, building your virtual care service within your EMR makes it much more difficult to change EMR vendors. You may not want to consider it right now, but if something occurs that causes you to change EMRs and you’ve built your virtual care, you lose your virtual care service, and all the time and money invested in building it.

Adding it all up

Back to our imaginary scenario: You’ve gone through your technology build, and you begin adding up Money growing – see your ROI increase with Zipnosisall the costs associated with creating your virtual care service. All told, your free virtual care technology ended up taking more than a year and costing several hundred thousand dollars to build. During that time, your two biggest competitors launched online care services, and now have contracts with the major health plans and employers in your area. What’s more, your urgent care centers and clinics have seen a decrease in patients, as those services siphon visits away from your health system.

Having spent the past decade supporting health systems, I understand the temptation of the word “free.” Healthcare organizations are consistently asked to do more with fewer resources, and budgets are under heightened scrutiny. But look closely at any option billed as “free” – it may end up costing you more in the long run.

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