SAN FRANCISCO – Community health centers can gain significant quality benefits from the use of electronic health records, but these benefits do not cover the costs of going paperless, reported a study in the January/February issue of Health Affairs.
Robert Miller, a professor of health economics at the University of California, San Francisco, and UCSF graduate student Chris West conducted retrospective case studies of six community centers with EHRs in six states to determine the cost-benefit balance of transitioning from paper to electronic health records.
“Making the initial financial investment in an EHR is very difficult for CHCs, as is recouping that investment,” said Miller, a scholar at UCSF’s Institute for Health and Aging. “But the long-term benefit comes from improved efficiency.”
Community health centers are unique in the ambulatory care field, in that they provide primary medical care for disadvantaged patients – most of whom are uninsured, or underinsured, individuals living below the poverty line. The bulk of the centers’ revenues come from Medicaid reimbursements and grants.
“Because CHCs are paid differently than most other practices, they really can’t use the EHR as a tool for revenue enhancement,” Miller said. “In the CHC world, it is flat-rate payments from Medicaid, and lump sum payments from the Bureau of Primary Health Care.”
Miller and West concluded that the revenue enhancement benefits of the EHRs were negligible. All but one center incurred ongoing, substantial net financial losses as a result of the EHR investment.
Miller suggested that in some cases quality improvements may justify incurring short-term financial losses, but only if a center rapidly and extensively uses the EHR to improve quality outcomes.