Vendors use different standards to determine exact pricing: the number of physicians, concurrent users, or computers that will have the software installed, for example. A thorough needs assessment before you start shopping — who will use the system, and how — can make for smoother negotiation. See what other BuyerZone users paid for their Electronic Medical Records solution.

Desktop EMR pricing starts at $2,000 to $3,000 and range up to $10,000 or $15,000 per user. A medium sized practice can easily spend $50,000 on the hardware and software to install a comprehensive EMR system including PDAs or tablet PCs. Many vendors can set up leases or extended payment schedules, turning a hefty purchase into a more palatable monthly fee.

Online or ASP software pricing usually includes setup fees of less than $1,000 and monthly fees ranging from $50 to $300 or more. Some ASPs charge for actual usage: $0.50 per updated chart, $0.80 for each new record, etc. Often, they have monthly minimums no matter how little you actually use the software. Note that these usage-based pricing arrangements are generally fair — typically totaling $60 to $200 per month in fees for a small practice — but they require you to estimate your average usage before you can compute the total cost.

There are a large number of additional fees to be aware of for both types of systems. Some providers may include these as part of their monthly fees, and some may bill each item separately. As long as you know exactly what fees you will be expected to pay, you will be able to compare vendors accurately.

• Data transfer fees — when you import existing data, vendors will often charge you for an extra step of cleaning, de-duping, and preparing the data for the new system.

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• Exit fees — when you leave the service, this fee covers the expense of exporting your data so you can move it to a new system.
• Support fees — basic support is often included for six months or a year with the purchase of a desktop system and is usually included in an ASP's monthly fee. However, you may encounter long hold times on the phone unless you upgrade to the "gold" or "premier" support package, which will cost extra.
• Training — As with support, basic training is often included, although it's usually computer-based training. If you need extra administrator training, or on-site classroom training, you can expect to pay extra for those as well.

Upgrade pricing can also vary. ASPs will usually upgrade their software without charge to you, but desktop vendors may charge an upgrade fee because they have to help install the new software. Check your contract to see how often upgrades will occur and how much they will cost.