Miller RH et al. 2005 "The value of electronic health records in solo or small group practices."

Miller RH, West C, Brown TM, et al. The value of electronic health records in solo or small group practices. Health Aff 2005;24(5):1127.
"We conducted case studies of fourteen solo or small-group primary care practices using electronic health record (EHR) software from two vendors. Initial EHR costs averaged $44,000 per full-time-equivalent (FTE) provider, and ongoing costs averaged $8,500 per provider per year. The average practice paid for its EHR costs in 2.5 years and profited handsomely after that; however, some practices could not cover costs quickly, most providers spent more time at work initially, and some practices experienced substantial financial risks. Policies should be designed to provide incentives and support services to help practices improve the quality of their care by using EHRs."

To describe the implementation of an electronic health record in "early adopter" solo and small group primary care practices.

Type Clinic
Primary care
Small and/or medium
Other Information
"The fourteen practices averaged 3.3 FTE billing providers, ranging from one to six FTEs. They averaged 2.5 FTE physicians and 0.8 FTE mid-level billing providers," such as nurse practitioners or physician assistants.
Type of Health IT
Electronic health records (EHR)
Type of Health IT Functions
"Eleven practices had tightly integrated their EHRs into their practice management systems, which handled practice billing and patient scheduling; demographic data flowed from this system to the EHR, and clinical data for billing flowed from the EHR to the management system. Three practices had no such data exchange ... Virtually all providers used the EHR for most common tasks, including prescribing, documenting, viewing, and within practice messaging, and almost all used it to assist in billing. Providers typically used templates (electronic forms) to document activities; they also used electronic forms to generate prescription and lab orders that were printed out for patients. Transcription was rare, and ten practices no longer routinely pulled paper charts. Few practices used the EHR for reporting (patient lists or provider performance), patient-provider communication, or communication from providers in the practice to those outside it."
Workflow-Related Findings
"Three practices that saw the same number of patients in less time took the gain as more personal time, rather than seeing more patients."
"Providers in most practices particularly liked accessing records from home, which enabled some of them to go home earlier, spend time with family, and then work later in the evening. They also liked being able to immediately access records when on call."
"Although twelve practices reported using some form of computerized reminders beyond drug-related alerts, only five had reminders, set by the practice, for at least one type of chronic care patient (rather than having physicians set reminders for specific patients).... Four practices created lists of at least some patients requiring needed services-for example, diabetics overdue for a glycosylated hemoglobin test-or had a routine way of following up with patients on lists for needing services. Finally, only two practices generated reports on provider performance-both belong to external QI collaboratives."
"Interviewees reported that providers worked longer hours for an average of four months (ranging from one to twelve months), mostly because of the need to enter clinical data during the patient's initial visit after implementation and to become familiar with using the software. EHR physician champions had especially heavy time costs, as they made complementary process changes to improve efficiency and quality-for example, they altered exam room/office procedures, revised templates (forms) to capture needed data, and resolved or prevented some technical difficulties."
Study Design
Only postintervention (no control group)
Study Participants
Physicians and office managers of the 14 solo and small group practices participated.