How much does it cost to switch EHRs?

EHR switching cost has three layers. The first is what you pay to get live: licenses, implementation services, data migration, interfaces to labs and billing, hardware and training. Quotes vary with how much history you migrate and how many interfaces you need, and the most detailed published cost study is older and covers first-time implementation: across 26 primary care practices in a north Texas physician network, implementation cost an estimated $162,000 for an average five-physician practice, plus $85,500 of maintenance in the first year, and end users needed 134 hours per physician to prepare (Fleming et al., Health Affairs, 2011). That is about $32,400 of implementation and $17,100 of first-year maintenance per physician ($162,000 ÷ 5; $85,500 ÷ 5). The second layer is lost productivity, and the measured drops are moderate rather than catastrophic. Five otolaryngologists at UC Irvine averaged 121 clinic visits and 284 work RVUs a month in the 12 months after moving to a new EHR, against 132 and 334 before, about 8% and 15% lower. Two oculoplastic surgeons at UC San Diego saw 27.7 patients per half-day clinic against 31.8 before, about 13% fewer. The third layer is time. At a Duke orthopaedic clinic, labor cost per visit rose from $36.88 to $46.04 two months after go-live and was back to $38.75 at six months, so budget for a learning period of about six months, with slower billing and more denials while the new claim workflows settle. To size your own exposure, multiply the visits you expect to lose by your revenue per visit. Worked example: a clinician seeing 400 visits a month who loses 10% for six months gives up 240 visits; at Concentra's reported $147.42 of revenue per visit, that is about $35,400 (240 × $147.42 = $35,381).