In this article I discussed the network costs of an EMR implementation. I would like to drill down further to discuss the broadband and wide area network (WAN) costs of a network for midsize and large medical practices. The definition of midsize and large medical practices is vague but for illustration let’s assume a midsize medical practice has 4 or more physicians and 2 or more locations (offices). For a large practice, let’s assume 10 or more physicians and 4 or more locations.
A typical EMR implementation in a practice with multiple locations has the EMR Server(s) in a central location in one of the offices. The other offices access the EMR across the WAN. For those that are not familiar with the terminology for WAN, it is simply the network that ties together each of the offices and make all the offices appear like they are on the same network. Most carriers (Verizon, AT&T, Qwest, etc.) will implement a WAN with an MPLS network. For simplicity lets say a MPLS network is a private network that no one else but the practice can access and allows 2 or more offices to communicate with each other. The advantage of an MPLS network is that a 3rd office can be added and then all 3 offices can communicate with each other.
In a minimal MPLS network implementation with 2 offices, both offices are connected to each other with 1.5 Mbps of bandwidth (the speed of a T-1). For redundancy, each site has a DSL circuit that functions as a backup in case the primary MPLS circuit goes down. Let’s take a rough look at the cost for this implementation. I am only going to discuss the reoccurring monthly costs and not address the setup or equipment costs.
- 1.5 Mbps MPLS at office #1 (central office with the EMR) – $500-$600/mo
- 1.5 Mbps MPLS at office #2 – $500-$600/mo
- 1.5 Mbps DSL at office #1 – $75/mo
- 1.5 Mbps DSL at office #2 – $75/mo
All together, a practice is looking at approximately $1,250 per month ($15,000 annually) just for the network connectivity between the offices.
Before we move on to the cost of a large practice, let’s take the above example and add a 3rd office to the practice. When you add a 3rd office you add not only another connection to the MPLS network but you add additional traffic on the MPLS network from the 3rd site. So now you have 2 offices that are accessing the EMR over the MPLS network. When I say accessing the EMR I am also referring to scanning images (insurance cards, paper referrals, driver’s licenses, etc.), printing, sending electronic faxes (if implemented), etc. In this case the requirements for the network start to increase. A typical implementation would put more bandwidth at the central office with the EMR to accommodate the increased network traffic created by the 3rd office.
- 3.0 Mbps MPLS at office #1 (central office with the EMR) – $1,000/mo
- 1.5 Mbps MPLS at office #2 – $500-$600/mo
- 1.5 Mbps MPLS at office #3 – $500-$600/mo
- 1.5 Mbps DSL at office #1 – $75/mo
- 1.5 Mbps DSL at office #2 – $75/mo
- 1.5 Mbps DSL at office #3 – $75/mo
The monthly cost is now approximately $2,150 per month ($25,800 per year). Again, this doesn’t include any equipment or setup costs.
For the costs of a large practice let’s make the following assumptions: we have 4 offices and we need 6.0 Mbps at the central office with the EMR and 3.0Mbps at each of the other offices.
- 6.0 Mbps MPLS at office #1 (central office with the EMR) – $3,000/mo
- 3.0 Mbps MPLS at office #2 – $1,000/mo
- 3.0 Mbps MPLS at office #3 – $1,000/mo
- 3.0 Mbps MPLS at office #4 – $1,000/mo
- 1.5 Mbps DSL at office #1 – $75/mo
- 1.5 Mbps DSL at office #2 – $75/mo
- 1.5 Mbps DSL at office #3 – $75/mo
- 1.5 Mbps DSL at office #3 – $75/mo
The total monthly cost is $6,300/month ($75,600/year).
The network communications costs to tie each of the offices together for an EMR implementation can add up quickly. I want to clarify this article by saying that what was discussed is only one way of implementing the network. There are many other ways and if you discuss these with the carriers you will hear terminology such as point to point T1’s, site to site VPN, etc. The backup circuits could be DSL, Cable Modem, T1, 3G wireless, etc. The bandwidth and associated costs are estimates as well. Additionally, it should be noted that different EMR systems may have different bandwidth requirements.
For a multi-office practice, WAN costs can be the first financial hurdle a practice will encounter when planning an EMR implementation. The WAN is the foundation of every multi-office computer network. Costs can be substantial, but practices should not take the WAN planning lightly or attempt to cut corners. A poorly implemented WAN, can lead to a failed EMR implementation. Would you build your home on top of a cracked foundation and expect it to stand the test of time?
Related posts:
