I have always liked those optical illusions where, depending on how you look at the picture, you can see two different things.Maybe it was my simple mind being entertained by flipping back and forth between the two images.

How you look at things matter, doesn't it?

Which brings me to several recent discussions that I have had with physicians about EMRs.  (The fact that I connected optical illusions and EMRs was a bad Freudian slip.)

As you might guess, we're having lots of discussions with practices considering the EMR.  We're in the middle of a lot of implementations.  And we have a lot of clients through the process and operating their practice on the system.  It is something we talk about a lot around here.

What has dawned on me is that physicians and practice administrators think about the cost of the EMR in one of two ways.  It all depends on how you look at it.

One group looks at the EMR decision as an operating expense.  The other look at it as an investment.  One sees a white candlestick and the other sees two faces.

And that difference is absolutely huge because it tells you a lot about how the practice will approach the EMR, and thus what benefits will be gained.

One camp views every dollar of cost the same - a dollar no longer in my pocket - and make no distinction about the type of expenditure it is.  That is a problem.

Some costs are what we call 'operating expenses.  These costs, be they big or small, are the cost of running the business every day.  Payroll, the electric bill, your rent, your malpractice insurance.  All operating expenses.  They are necessary for running a business and when they are spent, they are spent.

But other costs are investments, outlays of money that could bear future value.  Some investments are to maintain the value of existing assets.  Upgrades to technology, building maintenance, and continuing medical education fit in this category.

And some investments build new value.  Recruiting a new physician, adding an ancillary revenue stream, expanding to more patient rooms, rethinking practice operations to increase productivity and charges through the better use of mid-level providers are all examples of expenditures, the use of cash, that are investments in the future.

What about an EMR?

It would seem the answer is obvious, but my recent experience says maybe not.

Spending to implement an EMR doesn't seem like an operating expense because it is not part of running the practice today.  It doesn't seem like a maintenance investment, because you don't have it to maintain yet.  So it has to be an investment in new value, right?

But far too many practices are approaching this decision with an 'operating expense' mindset, which is likely to lead them to a bad decision.

With operating expenses, you have necessary costs for running the business.  You want your costs to be as efficient as possible.  That is, you do not want to pay more than necessary to get the job done.  You don't think a lot about the potential for new value creation.

And that is how the EMR decision is being approached by many.  How can I get this for the lowest possible cost?

Well, I'll tell you a few ways...

• Buy a low quality software package from a vendor that is not likely to survive the industry consolidation.
• Reduce your upfront service fees by thinking that training alone is all you need, and ignore what it takes to get the system fully implemented. (Here is a hint.  Training will likely be only 35-45% of your total service costs if you successfully implement an EMR.)
• Better yet, just skip the training entirely and learn it all on your own.
• Don't work on the work flow changes that the technology can enable.  Just keep doing things as you are now.
• Don't upgrade your office technology (PCs, network) to what is really required to make your EMR perform as it should.

Unfortunately, there are more than enough EMR vendors and sales reps out there more than willing to tell a story to practices with the 'low cost/operating expense' mindset.

Implementing an EMR is one of the biggest investments you will ever make in your practice.  It is not about reducing transcription costs (though it should).  It is not about eliminating the chart chase (though it will).  It is not about making you marginally more productive (though it could).

It is about recreating your practice for the future.

It is about getting you ready to operate in a highly interconnected healthcare system where everyone will exchange data with everyone else.

It is about connecting with your patients electronically, which is how they connect with all of the rest of the businesses that provide services to them.

It is about using data to improve the quality of the care that you deliver.

It is about your being able to participate in emerging models of care such as medical homes and accountable care organizations.

It is about your being successful new reimbursement systems that will be the difference between your making it as an independent practice and your having to give up to go be someone's employee.

Physicians who approach this decision as an investment in their future ask better questions.  They evaluate potential systems and partners in a different light.  They look at costs through a different lens.

Remember, cheap is not always the least expensive option.

It all depends on how you look at it.