Cost analysis of an Electronic Medical Record System at an urban clinic in Kampala, Uganda - an organizational perspective

Abstract

Electronic medical record systems (EMRS) are increasingly being adopted worldwide. While their benefits are well known, the costs of implementing and maintaining such EMRs in resource constrained settings are not well documented. Establishing such costs is crucial to enable policy and fiscal planners make sound decisions in allocation of scarce resources across multiple areas of need. Objective: To conduct a comprehensive cost analysis for developing, implementing and maintaining an EMRS specifically looking at the direct costs for the development and implementation, the cost implications with use of an EMR as compared to paper based medical record system as well as a trend analysis of the cost of an EMR in resource limited settings. Methods: This study was conducted at the Infectious Diseases Institute (IDI), a public HIV/AIDS care clinic situated in Kampala, Uganda an implementer of a custom-made EMRS. A comprehensive direct cost analysis was conducted using an organizational perspective. Elements for cost at pre-implementation, implementation and maintenance phases were identified based on industry-accepted cost metrics. Cost units were determined based on data from primary sources. A cost inventory was developed and used to extract data from the market survey findings, original receipts and invoices for associated products. Costs with a lifetime of greater than one year were annuitized and a standard-recommended Uganda government depreciation rate of 40% was applied. The costs were converted to their equivalent dollar value using the government of Uganda dollar rates and the total costs are reported. Sensitivity analysis was conducted to account for uncertainty. Results: The total calculated cost of the IDI EMRS, since its inception in January 2009 until December 2016, was USD 1,066,965 while an opensource instance would cost just over USD 800,000. The annuitized total cost was USD 1,084,498. Maintaining a paper based medical record system over the same time would have cost almost half the cost of the EMR (USD 544,159). Salaries and wages contributed 70% (USD 757,332) and 81% (USD 438,842) of costs in the EMRS and paper-based system, respectively. Other cost drivers included software and licensing (20%, USD 258,341) in the EMRS and stationery (17%, USD 90,854) in the paper system. The sensitivity analysis model with open source architecture resulted in a 20% reduction in the total cost of the EMRS. Inclusion of public service rates to the model led to a further 25% reduction in the total cost of the EMRS. The costs expended showed a gradual decrease with time. Conclusion: EMRS have higher costs as compared to paper-based medical record systems. However, expenditure on the system reduces with time. Salaries and wages are the largest contributors to the cost burden. Opensource systems have a potential to lower costs. Recommendations: There is need to utilize open opensource systems to minimize costs as well as devise means of lowering personnel costs.