Keeping it real--building an ROI model for an ambulatory EMR initiative that the physician practices espouse

The ambulatory electronic medical record initiative at Magic Valley Regional Medical Center (MVRMC) in South Central Idaho underwent a rigorous product evaluation process that resulted in one of the market-leading EMR products being selected for implementation. MVRMC includes four business entities, including a 213-bed regional hospital and a 19-practice management services organization. Early in the process, the organization viewed buy-in from its physicians as a critical success factor. The physicians had been integral to product selection, and it was equally important for them to trust the economic model for its acquisition-especially because it was likely that they would be asked to put "some skin in the game." To make this initiative economically feasible, MVRMC received a grant from Agency for Healthcare Research and Quality based on the potential impact of the endeavor on healthcare delivery in the region. However, because the functional analysis did not result in the selection of the least expensive product, the AHRQ grant would only help defray the startup expenses, but not ongoing support and maintenance expenses after implementation; these costs would be borne by anticipated increases in the practice's revenue or reduction in its operating expenses. The ROI model would need to explain how each practice, from the single physician specialist to an almost 20-physician family practice, could pay for the desirable outcomes discussed during the selection phase of the project. The physicians, who had participated in technology initiatives in the past, were skeptical that cost-justifying an IT system was realistic, even though they recognized the potential benefits it could have on the quality and consistency of the care. Because some process standardization within and between practices would be needed to use electronic charting effectively, it was important that the ROI model did not outweigh the benefits of an as-yet untested operational workflow that leveraged interoperability. In addition, one of the key benefits of the initiative was the integration of ambulatory and inpatient information into a common patient-centric view of care. This outcome needed to be appropriately considered in the determination of the value of the initiative. To make the ROI model real, the physicians needed to be willing to take on the responsibility of delivering on the benefits. This report highlights the key aspects of using an ROI model in support of an electronic medical system implementation emphasizing improvements in intra-practice efficiencies, interoperability between multi-specialty practices and ambulatory and inpatient care events for a patient while ensuring that all stakeholders consider its mathematical estimates as accurate and achievable in the real world.