Standards and Guidelines for Electronic Medical Record Systems in ...

System Costs, Ownership and Sustainability
Requirements
1. Health Managers (such as the DHMT) should be involved in EMR system
implementations to promote ownership.
2. EMR systems should be developed in a manner as to minimize the Total Cost of
Ownership (TCO) while meeting minimum functional and operational standards.
3. EMR system implementation should adopt an open source software where possible,
to reduce on the costs of licensing and encourage the EMR community to contribute
towards system development.
4. EMR system implementers should consider the resource constrained setting and
minimize the resource requirements such as additional commodities that cannot be
sustained by public health facilities.
Total cost of ownership (TCO) is a financial estimate of both the monetary impact and human
resource impact of acquiring, deploying, and retiring an information technology system over the life
cycle of the product. It is comprised of a number of factors that can be grouped within three main
categories – acquisition (one time) expenses, operational (ongoing) expenses, and long term
expenses. The overall goal is to select technology that minimizes TCO while meeting minimum
functional and operational standards.
When evaluating the total cost of ownership (TCO), the following factors are to be considered:
1. Acquisition Expenses
a. Software licensing
b. Hardware (server, client workstations)
c. Infrastructure (networking hardware and software)
d. Technical support for installation and configuration costs
2. Operational (Ongoing) expenses
a. Hardware support
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