Forgetting about planning and budgeting for the hardware components of an EMR implementation is a little like forgetting to put tires on a $20 Million Race Car. Your car may have the fastest motor, but you won’t get anywhere.
Whether your organization is small or large, before setting the budget for an EMR implementation there are “hidden costs” that need to be included to make sure your organization’s end user computing environment is ready for an EMR.
1) So you want a computer in every patient or exam room. Will they all be “net new”? If so, pay particular attention to Tips #3 through #6. Budget for the new computers you’ll need in non-patient room areas, too.
2) Are you looking at portable “workstations on wheels” in patient rooms or wall mounted computers? If wall mounts will be used, you’ll need to plan for additional costs to install the mounts and move obstacles like glove dispensers and sharps containers, and potentially backer board to protect the drywall in some areas. Don’t forget you’ll need to close the patient rooms while the work is happening.
3) What about the existing devices? Do they meet specs or not? You may need to replace more than you think you do. See Tips #3 and #11.
4) Outside of the patient rooms, count the number of devices you think you’ll need on every shift then add at least 10% more. They’ll break when you are at maximum patient census.
5) Speaking of devices, do you have somewhere to plug them in? Is there available power? Can you add more outlets to the existing panel or is an additional power panel needed? In how many areas? Remember that one available outlet in a patient room might not be enough. Patients like to plug in their cell phones, tablets, and eReaders, so looking at an empty room might not give you the right perspective.
6) What about network jacks? Unless you are going with wireless devices, you may need more data ports. That means installation and cabling costs.
7) Then you’ll need somewhere to plug the devices into in your data closet. Do you have available ports on the switch? If not, you’ll need more switches.
8) Are you going with portable equipment? You’ll need spare batteries. Physicians don’t like dead laptops.
9) Portable equipment is usually wireless. Is your wireless network up to snuff? Coverage and strength OK for all the wireless devices you might be adding to it?
10) If your document scanners are older models, chances are they won’t work with a new EMR system. The front desk area and HIM areas will probably need new scanners at a cost of $1000 each.
11) The goal of an EMR is to have an electronic, not paper, system, but clinicians and other staff will still be printing plenty of documents. Budget for your printer replacements. Most EMRs don’t play well with multi-function devices, so be sure to consider those too, even if they are newer.
12) Dictation is a function related to your EMR, but not usually included with it. Are you going with Dragon or another electronic dictation system? You’ll need microphones or headsets for the physicians. They’ll lose some, so get extras. Make sure the computers you are planning to install meet the specs for the ancillary applications that will be on the devices.
13) However many network cables, power cables, USB cables, and cable extenders you have, there won’t be enough. It may seem like small change, but it adds up over time.
14) Are you doing barcode medication administration? Great! The scanners are way cool. How are you going to keep them on the portable computer carts or wall mounted computers? They don’t usually come with a holder or mount. Be sure to include those in your planning
15) Who is going to do all this work for you? Your in-house desktop support and networking teams are likely already busy supporting the day-to-day operations of your clinic or hospital. You’ll need at least one Project Manager, depending on the size of your organization, and a team of technicians to either do the device deployment and related work or to backfill for your existing techs.
Without considering your core desktop and network environments you might be over budget before any of your clinicians ever enter a single patient order.