Primary care practices with six or more physicians generally were more likely to see a profit with their EHRs than were smaller physician groups or specialists. This was more likely when the new technology was used to add more patients to the daily schedule and to improve billing processes so that accurate codes were used and fewer claims were rejected.
"It seemed like with primary care there was more opportunity to reduce costs," Adler-Milstein says. "There were more of them that saw savings in dictation compared with specialty practices. It may suggest that dictation is in wider use in primary care and there could be more potential savings in practices are able to eliminate dictation costs."
About 55% of the practices saw a reduction in the cost of paper medical records. However, nearly half of the practices saw no savings there because they continued to use paper records even after switching to EHR.
"As we were in these practices collecting data, some said that for malpractice protection they perceived that they needed to keep paper-based documentation," Adler-Milstein says.
"Oftentimes they would create things in the electronic system but also print them out and store them. They were oftentimes documenting on paper or they weren't able to make the full switchover and become completely paperless. You say EHR and the assumption is paperless, but the reality is there are a lot of things that are still hard to do in EHR."
Adler-Milstein says the study suggests that federal meaningful use incentives alone are not adequate to ensure that the vast majority of practices don't lose money on EHR.
"You are going to have to make a lot of other changes to figure out how to realize cost savings. That is a clear message for practices: You have to figure out other opportunities to save money if you want to come out ahead," she says.