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Unhappy Camper (Vol. 1, Issue 7)

Guess what, current EMR users?  It’s time to pay, and pay a lot, for the very necessary upgrades of your computers to Windows 7.  Of course you’ll have to check with your EMR vendor first to ensure they’re ready for it, and also because there’s a checklist the length of Idaho of things to be done.  And be careful, medical equipment interfaces to some EMRs are still having teething problems with the upgrade. But the sooner these items are accomplished the more reliable and more protected your precious EMR data will be. 

Microsoft advertises all sorts of improvements to make the average consumer think about switching over, but few of the improvements in the standard version are enough to impress the medical office.  But there is one feature in the, albeit more expensive, Windows 7 Ultimate Edition that should make the decision a slam dunk for EMR users; that being BitLocker with advanced encryption technology.  As I’ve stated in previous columns (see http://www.docehrtalk.org/messageboard/2010/07/30/hie-and-data-security-... ), we currently have no good protection from disastrous financial consequences of a data breach of our patient records.  To force the issue of upgrading, it is rumored that Microsoft will cease support of the Windows XP operating system in the future.  That means no more security patches and bug  fixes for those who remain behind.  Windows 7 Ultimate Edition BitLocker promises to make EMR systems much more secure, even if still vulnerable to some extent (See http://en.wikipedia.org/wiki/BitLocker_Drive_Encryption )

At $319.99 for a new Windows 7 Ultimate Edition the software is a bit pricey.  The Upgrade version from the Windows XP or Vista is $219.99 provided you a verifiably licensed copy on your machine.  Street prices might be a little less expensive. That price, of course, must be multiplied by as many machines as you utilize for EMR purposes in your office and from home (possibly excepting the faxserver and the server itself if you have these).  For my 1 and ½ physician office with 4 support staff that’s $2,000 for software alone.  And upgrades to hardware are also on the bill.  Windows 7 requires 1 GB RAM and at least a 1 GHz processor.  Medical offices should not strive for the bare minimum and require more robust performance from their computers. Most IT people will tell you that RAM upgrades are a must before thinking about these upgrades.  For the typical tablets such as my 3 year old Fujitsu Lifebook machines, that’s about $278 per unit.  IT support will also be a cost in all these items, and is actually quite labor intensive (you do have an IT support contract, don’t you?).  For current Windows XP users there is no direct upgrade path into Windows 7.  Everything on the XP side must be taken off then reinstalled after Windows 7 is done.  That software reinstallation usually includes your EMR software as well, with those attendant costs directly from your EMR vendor.  While you’re at it, don’t forget new batteries at about $120 per tablet or notebook and new styluses (styli?) for those with pen-enabled tablets at $50 per unit. Vista platforms are an easier, progressive upgrade, but from what I’ve seen, EMR vendors tended to avoid that somewhat clunky operating system in the first place.

Of course one has another option to sell the old computers and buy all new ones.  While processor costs come down and capabilities go up over time as per Moore’s Law, one has to figure in the costs of the new computers themselves, the reinstall of the EMR program, and the additional license costs of upgrading from the Standard Windows 7 that comes with the machine to Windows 7 Ultimate Edition. These costs to be borne by the small medical practice can easily top $20000.  Don’t forget to have those old hard drives wiped clean to military standards before donating your old computers out to nonprofit groups or to loyal employees for home use.

So this necessary upgrade will be taking a big chunk out of your anticipated EMR ‘Meaningful Use’ incentive bonus.  I guess that it’s some consolation that the costs of all of these upgrades are taken off the front end as a business expense.  But on the flip side, don’t forget to account to the IRS for any of those EMR incentive payments.  CMS and their toadies will be issuing 1099s for all such payments made, and the Feds will be just waiting for anyone not to declare that money on their tax returns.

This article has been checked for offesive material, excepting people from Idaho, of course.