Pediatric Informatics: Computer Applications in Child Health (Health ...

228 M.M. Simonian
low or no cost to providers for participation. The Agency for Healthcare Research
and Quality (AHRQ) Web site has many grants for individuals interested in applying
technology to their practice. Most involve studies using technology for certain
clinical conditions. Others involve large organizations evaluating the effectiveness
of technology to solve particular problems. 13
16.4.4.5 Network Membership Benefit
Practices associated with multiple hospital systems often see value in using practice
management and electronic health record systems that are compatible or interoperable
with the systems used by those institutions. Mutual benefits between hospitals
and office-based practices include sharing of demographic, billing and payment
data and easier tracking of referrals and more accurate billing. After the initial costs
of development by hospitals, technology becomes a marketing tool that can be used
to build loyalty at low cost to private practices.
An issue that should be considered is the effect of Stark (or “anti-kickback”)
legislation 14 on adoption. Stark legislation had hindered growth of technology in
practices that do not have the financial resources to invest. This is of significance in
IT obtained as a network membership benefit. Again, legal counsel may be helpful
in navigating these issues.
16.4.5 Expenses – Ongoing and Operational
16.4.5.1 Software Licenses
Software licenses are certificates, sometimes linked to access and services that
allow practices to use purchased software (such as practice management and electronic
health record systems, clinical decision support, periodicals, clinical journals,
or diagnostic services). Group licenses (such as through professional associations
or community practice consortia (IPAs) for a shared or commonly used application
may reduce individual costs at a bulk rate.
16.4.5.2 Training and Technical Support
Training staff to use applications properly can be an additional expense if it is not
included as part of the purchase price. Training costs may exceed the software costs
when travel, housing, and consultation are included, but may be mitigated if online
training is available.
Technical support should be considered in terms of how and when service is
scheduled (Telephone? Online? 24/7/365? Workdays only? Immediate response?
Can maintenance or repairs be handled online (onsite repair costs may be higher)?).