To the Editor:

As the office administrator for the practice my wife shares with a part-time midlevel provider, I read your article “How Much Will That EMR System Really Cost?” [April 2002, page 57] with considerable shock and dismay. The figures used to exemplify electronic medical records system (EMR) costs are vastly out of line and, for most small family physician practices, unreachable.

I understand that the spreadsheet is a tool physicians, their staff and consultants can use to evaluate their own planned purchases and that the numbers they enter are expected to vary. In that way, the spreadsheet is an excellent and instructive tool.

I do have considerable reservations about using such high costs to illustrate usage of the spreadsheet. Those figures are more likely to deter than encourage physicians to get started with EMR systems. It can be done for much less than the example suggests. In my wife's office, we have a network, a server, eight desktop computers, a laptop computer, a networked laser printer, a networked inkjet printer, a DSL connection, a modem, a scanner and considerably more software functionality (including an EMR system) than itemized in the spreadsheet. We set this up almost two years ago for a total initial cost of $17,000, a first-year annual cost of $950 and second-year cost of $1,100. About one third of these costs were for increasing functionality rather than maintenance or upgrades. Hardware prices, in particular, are lower today.

It's easy to spend the amounts suggested by Mr. Valancy in the article, and when practice management software is added, it's easy to spend much more. But it's not necessary, and for most small practices, it's not sensible.