I think one of the issues most providers are grappling with in regard to HIT and EMRs in their office is not only the initial investment of capital, but the ongoing "relationship" between the practice and the vendor(s). Will you have a "tiger by the tail?"
The daily operation of the practice will be entirely dependent upon your PMS and/or EMR system. Witness the recent "crash" of the entire West Coast VA CPRS system. A recent iHealthbeat article quoted that it was the worst incident effecting quality and safety of care in the VA system.
The vendors have their "business model" for profitability, and they are not about to let providers interfere with that fact.
Keep in mind we are in the early phase of EMR and HIT "buildout"
There will initially be a "bubble" as providers invest in EHRs, RHIOS, etc Eventually the acquisition rate will flatten out. With diminishing returns will the vendors jack up maintenance contracts and costs for updates.
About 18 months ago Allscripts began offering a "free eRx system which operates as a portal application. It is necessary to enter patient information in the system the first time it is used for a new patient. Allscripts now offers "a bridge" to connect it to your PMS. They don't say much about interfaces for EMRs. Most of the interfaces cost about 300 dollars initially and 240 dollars each year afterward. One interface was quoted at 695 dollars. There are many with "custom" as the interface quote. Now I can see an upfront charge for an interface, but an annual charge is something else, unless there are some other changes in software after the initial installation. (sounds like Microsoft)...Windows "Live". I wonder what the rest of you thinks about this?