In an article published in the ICD10 monitor, Shannon DeConda, the founder and president of the National Alliance of Medical Auditing Specialists (NAMAS), compares the financial burdens brought on by EHR and ICD-10. In preparation for the ICD-10 implementation, hospital systems and larger health care facilities have large budgets planned for 2015, and many have already invested a significant outlay of money in education and training to meet the fall 2014 deadline. There also is the risk that unpracticed ICD-10 coding skills could diminish over the next 18 months.

While smaller practices seem to be relieved by the ICD-10 implementation postponement, those same practices were quick to jump onto the EHR bandwagon. DeConda suggests that adoption was driven by the financial incentive promised in conjunction with making the EHR investment, despite the sometimes ill-suited definitions of meaningful use. Regardless of the substantial nature of the financial incentives tied to EHR, which can range from $44,000 to $63,000 per provider, the costs of EHR implementation have been high, with decreased patient volumes and costly medical necessity audits producing enhanced scrutiny of higher levels of service. DeConda states that the financial investment in EHR in most cases has far exceeded the bonus incentives. In the article, she reviews a Healthit.gov report on the average five-year total cost of ownership of EHR software, which far exceeds the incentive bonus.