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Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies

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Abstract

In the current paper, we describe the challenges in measuring return on investment (ROI) and review published ROI studies on health IT. In addition, given the absence of a robust ROI literature base, we review the general benefits and potential costs of various health IT applications including electronic health records (EHRs), computerized physicians order entry (CPOE) systems, and clinical decision support systems (CDSS). We conclude that articles examining these benefits are much more common than studies examining ROI itself. This trend suggests the early stage of this knowledge base. Additional research utilizing broader perspectives and multidisciplinary techniques will be needed before a better understanding of ROI from health IT is achieved.

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References

  1. Bergeron, B., and Bergeron, R., The return on investment for information technology. J. Med. Pract. Manage. 14(1):43–50, 1998.

    Google Scholar 

  2. Sendi, P., Al, M., and Zimmermann, H., A risk-adjusted approach to comparing the return on investment in health care programs. Int. J. Health Care Finance Econ. 4(3):199–210, 2004.

    Article  Google Scholar 

  3. IOM. Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine, Washington, DC, 2001.

  4. Leatherman, S., Berwick, D., Iles, D., Lewin, L.S., Davidoff, F., Nolan, T., and Bisognano, M., The business case for quality: Case studies and an analysis. Health Aff. 22(2):17–30, 2003.

    Article  Google Scholar 

  5. Middleton, B., Hammond, W. E., Brennan, P. F., and Cooper, G. F., Accelerating US EHR adoption: How to get there from here, recommendations based on the 2004 ACMI retreat. J. Am. Med. Inform. Assoc. (1), 13–19, 2004.

  6. Wachter, R. M., The end of the beginning: Patient safety five years after ’to err is human’. Health Aff. (Millwood), Supply Wed Exclusives (W4), 535–545, 2004.

  7. Ash, J. S., and Bates, D. W., Factors and forces impacting EHR system adoption: Report of a 2004 ACMI discussion. J. Am. Med. Inf. Assoc. 12(1):8–12, 2004.

    Google Scholar 

  8. Johnston, D., Pan, E., Middleton, B., Walker, J., and Bates, D. W., The Value of Computerized Provider Order Entry in Ambulatory Settings, Center for Informaion Technology Leadership, Boston, MA, 2003.

  9. Wang, S. J., Middleton, B., Prosser, L. A., Bardon, C. G., Spurr C. D., Carchidi, P. J., Kittler, A. F., Goldszer, R. C., Fairchild, D. G., Sussman, A. J., Kuperman, G. J., and Bates, D. W., A cost-benefit analysis of electronic medical records in primary care. Am. J. Med. 114(5):397–403, 2003.

    Article  Google Scholar 

  10. Barlow, S., Johnson, J., and Steck, J., The economic effect of implementing an EMR in an outpatient clinical setting. J. Healthc. Inform. Manage. 18(1):46–51, 2004.

    Google Scholar 

  11. Cooper, J., Organization, management, implementation and value of EHR implementation in a solo pediatric practice. J. Healthc. Inform. Manage. 18(3):51–55, 2004.

    Google Scholar 

  12. MTC, NEHI., Treatment Plan: High Tech Transfusion. Case Statement for Implementation of CPOE in All Massachusetts Hospitals, Boston: Massachusetts Technology Collaborative in Partnership with New England Healthcare Institute, 2004.

  13. Ohsfeldt, R. L., Ward, M. M., Schneider, J. E. Jaana, M., Miller, T. R., Lei, Y., and Wakefield, D. S., Implementation of hospital computerized physician order entry systems in a rural state: Feasibility and financial impact. J. Am. Med. Inform. Assoc. 12(1):20–27, 2005.

    Article  Google Scholar 

  14. Schmitt, K. F., and Wofford, D. A., Financial analysis projects clear returns from electronic medical records. Healthc. Finance Manage. 56(1):52–57, 2002.

    Google Scholar 

  15. Agrawal, A., Return on investment analysis for a computer-based patient record in the outpatient clinic setting. J. Assoc. Acad. Minor. Phys. 13(3):61–65, 2002.

    Google Scholar 

  16. Carter, J., Electronic Health Records: A guide for Clinicians and Administrators, Philadelphia, PA, American College of Physicians, 2001.

  17. Chambliss, M., Rasco, T., Clark, R., and Gardner, J., The mini electronic medical record: A low-cost, low-risk partial solution. J. Fam. Pract. 50(12):1063–1065, 2001.

    Google Scholar 

  18. Miller, R. H., and Sim, I., Physicians’ use of electronic medical records: Barriers and solutions. Health Aff. 23(2):116–126, 2004.

    Article  Google Scholar 

  19. Williams, B., How to do an ROI (return on investment). Healthc. Inform. 7(2):30–32, Feb 1990.

    Google Scholar 

  20. Mildon, J., and Cohen, T., Drivers in the electronic medical records market. Health Manage. Technol. 22:14–16, 18, 2001.

    Google Scholar 

  21. Erstad, T. L., Analyzing computer based patient records: A review of literature. J. Healthc. Inform. Manage. 17(4):51–57, 2003.

    Google Scholar 

  22. Sandrick, K., Calculating ROI for CPRs. Health Manage. Technol. 19(6):16–20, 1998.

    Google Scholar 

  23. Ewing, T., and Cusick, D., Knowing what to measure. Healthc. Finance Manage. 58(6):60–63, 2004.

    Google Scholar 

  24. Essex, D., The many layers of workflow automation. Healthc. Inf. 17:124–130, 2000.

    Google Scholar 

  25. Dick, R., Steen, E., and Detmer, D., The Computer-Based Patient Record: An Essential Technology for Health Care. IOM National Academies Press, Washington, DC, 1991.

  26. Renner, K., Electronic medical records in the outpatient setting. Med. Group Manage. J. 43:52, 54, 56–57, 74, 1996.

    Google Scholar 

  27. Bednash, G., The decreasing supply of registered nurses (commentary). JAMA 283(22):2985–2987, 2000.

    Article  Google Scholar 

  28. Gattis, W. A., Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team. Arch. Intern. Med. 159(16):1939–1945, 1999.

    Article  Google Scholar 

  29. Chaiken, B. P., Clinical ROI: not just costs versus benefits. J. Healthc. Inform. Manage. 17(4):36–41, 2003.

    Google Scholar 

  30. Fitzmaurice, J. M., Adams, K., and Eisenberg, J. M., Three decades of research on computer applications in health care: Medical informatics support at the Agency for Healthcare Research and Quality. J. Am. Med. Inform. Assoc. 9(2):144–160, 2002.

    Article  Google Scholar 

  31. Teich, J. M., Merchia, P. R., Schmiz, J. L., Kuperman, G. J., Spurr, C. D., and Bates, D. W., Effects of computerized physician order entry on prescribing practices. Arch. Intern. Med. 160(18):2741–2747, 2000.

    Article  Google Scholar 

  32. Bates, D. W., Leape, L. L., Cullen, D. J., Laird, N. M., Petersen, L. A., Teich, J. M., Burdick, E., Hickey, M., Kleefield, S., Shea, B. F., Vander Vliet M., and Seger, D. L., Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 280(15):1311–1316, 1998.

    Article  Google Scholar 

  33. Bates, D. W., Evans, R. S., Murff, H., Stetson, P. D., Pizziferri, L., and Hripcsak, G., Detecting adverse events using information technology. J. Am. Med. Inform. Assoc. 10(2):115–128, 2003.

    Article  Google Scholar 

  34. Jain, A., Atreja, A., Harris, C. M., Lehmann, M., Burns, J., and Young, J., Responding to the rofecoxib withdrawal crisis: A new model for notifying patients at risk and their health care providers. Ann. Intern. Med. 142(3):182–186, 2005.

    Google Scholar 

  35. Burton, L., Anderson, G., and Kues, I., Using electronic health records to help coordinate care. Milbank Q. 82(3):457–481, 2004.

    Article  Google Scholar 

  36. Epping-Jordan, J. E., Pruitt, S. D., Bengoa, R., and Wagner, E. H., Improving the quality of health care for chronic conditions. Qual. Saf. Health Care. 13(4):299–305, 2004.

    Article  Google Scholar 

  37. Bodenheimer, T., Wagner, E. H., and Grumbach, K., Improving primary care for patients with chronic illness. JAMA 288(14):1775–1779, 2002.

    Article  Google Scholar 

  38. Chaiken, B. P., Clinical technology: Are you getting your money’s worth? Healthc Finance Manage. 57(2):66–69, 2003.

    Google Scholar 

  39. Aspden, P., Corrigan, J. M., Wolcott, J., and Erickson, S. M., Patient Safety: Achieving a New Standard for Care, National Academies Press, Washington, DC, 2003.

  40. Kinninger, T., and Reeder, L., The business case for medication safety. Healthc. Finance Manage. 57(2):46–51, 2003.

    Google Scholar 

  41. Bates, D. W., Using information technology to reduce rates of medication errors in hospitals. BMJ 320(7237):788–791, 2000.

    Article  Google Scholar 

  42. Kohn, L. T., and Corrigan, J. M., To Err is Human: Building a Safer Health System, National Academy Press, Washington DC, 2000.

  43. Lesar, T. S., Briceland, L., and Stein, D. S., Factors related to errors in medication prescribing. JAMA 277(4):312–317, 22–29, 1997.

    Article  Google Scholar 

  44. Phillips, J., Beam, S., and Brinker, A., Retrospective analysis of mortalities associated with medication errors. Am. J. Health-Syst. Pharm. 58:1835–1841, 2001.

    Google Scholar 

  45. Classen, D. C., Pestotnik, S. L., Evans, R. S., Lloyd, J. F., and Burke, J. P., Adverse drug events in hospitalized patients. JAMA 227(4):301–306, 1997.

    Article  Google Scholar 

  46. Rothschild, J. M., Federico, F. A., Gandhi, T. K., Kaushal, R., Williams, D. H., and Bates, D. W., Analysis of medication-related malpractice claims: Causes, preventability, and costs. Arch. Intern. Med. 162(21):2414–2420, 2002.

    Article  Google Scholar 

  47. Kuperman, G. J., and Gibson, R., Computer Physician Order Entry: Benefits, Costs, and Issues. Ann. Intern. Med. 139:31–39, 2003.

    Google Scholar 

  48. FirstConsultingGroup, Computerized Physician Order Entry: Cost, Benefits, and Challenges—A case study approach, Long Beach, CA, First Consulting Group, 2003.

  49. Kaushal, R., Shojania, K., and Bates, D. W., Effects of computerized physician order entry and clinical decision support systems on medication safety. Arch. Intern. Med. 163:1409–1416, 2003.

    Article  Google Scholar 

  50. Ash, J. S., Gorman, P. N., Lavelle, M., Payne, T. H., Massaro, T. A., Frantz, G. L., and Lyman, J. A., et al., A cross-site qualitative study of physician order entry. J. Am. Med. Inform. Assoc. 10(2):188–200, 2003.

    Article  Google Scholar 

  51. Metzger, J., and Turisco, F., Computerized Order Entry: A Look at the Vendor Marketplace and Getting Started. California healthcare foundation and first consulting group, Oakland, CA, 2001.

  52. Teich, J. M., Glaser, J. P., Beckley, R. F., Aranow, M., Bates, D. W., Kuperman, G. J., Ward, M. E., and Spurr, C. D., The Brigham integrated computer system (BICS): Advanced clinical systems in an academic hospital environment. Int. J. Med. Inform. 54(3):197–208, 1999.

    Article  Google Scholar 

  53. Koppel, R., Metlay, J. P., Cohen, A., Abaluck, B., Localio, A. R., Kimmel, S. E., and Strom, B. L., Role of computerized physician order entry systems in facilitating medication errors. JAMA 293(10):1197–1203, 2005.

    Article  Google Scholar 

  54. King, W. J., Paice, N., Rangrej, J., Forestell, G. J., and Swartz, R., The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients. Pediatrics 112(3 Pt 1):506–509, 2003.

    Article  Google Scholar 

  55. Bates, D. W., Teich, J. M., Lee, J., Seger, D., Kuperman, G. J., Ma’Luf, N., Boyle, D., and Leape, L., The impact of computerized physician order entry on medication error prevention. J. Am. Med. Inform. Assoc. 6(4):313–321, 1999.

    Google Scholar 

  56. Bates, D. W., Spell, N., Cullen, D. J., Burdick, E., Laird, N., Petersen, L. A., Small, S. D., Sweitzer, B. J., and Leape, L. L., The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 277(4):307–311, 1997.

    Article  Google Scholar 

  57. Lipton, H. L., Miller, R. H., and Wimbush, J. J., Electronic prescribing: Ready for prime time? J. Healthc. Inf. Manag. 17(4):72–79, 2003.

    Google Scholar 

  58. Dexter, P. R., Perkins, S., Overhage, J. M., Maharry, K., Kohler, R. B., and McDonald, C. J., A computerized reminder system to increase the use of preventive care for hospitalized patients. N. Engl. J. Med. 345(13):965–970, 2001.

    Article  Google Scholar 

  59. Krohn, R., In search of the ROI from CPOE. J. Healthc. Inf. Manag. 17(4):6–9, Fall 2003.

    Google Scholar 

  60. Tierney, W. M., Miller, M. E., Overhage, J. M., and McDonald, C. J., Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 269(3):379–383, 1993.

    Article  Google Scholar 

  61. Mekhjian, H. S., Kumar, R. R., Kuehn, L., Bentley, T. D., Teater, P., Thomas, A., Payne, B., and Ahmad, A., Immediate benefits rea-lized following implementation of physician order entry at an academic medical center. J. Am. Med. Inf. Assoc. 9(5):529–539, 2002.

    Article  Google Scholar 

  62. Newell, L. M., and Christensen, D., Who’s counting now? ROI for patient safety IT initiatives. J. Healthc. Inf. Manag. 17(4):29–35, 2003.

    Google Scholar 

  63. Weiner, M., Gress, T., Thiemann, D. R., Jenckes, M., Reel, S. L., Mandell, S. F., and Bass, E. B., Contrasting views of physicians and nurses about an inpatient computer-based provider order-entry system. J. Am. Med. Inf. Assoc. 6(3):234–244, 1999.

    Google Scholar 

  64. Lee, F., Teich, J. M., Spurr, C. D., and Bates, D. W., Implementation of physician order entry: User satisfaction and self-reported usage patterns. J. Am. Med. Inf. Assoc. 3(1):42–55, 1996.

    Google Scholar 

  65. Hunt, D. L., Haynes, R. B., Hanna, S. E., and Smith, K., Effects of computer-based clinical decision support systems on physician performance and patient outcomes: A systematic review. JAMA 280(15):1339–1346, 1998.

    Article  Google Scholar 

  66. Krohn, R., JHIM Quick Study: Clinical Decision Support Systems. J. Healthc. Inf. Manage. 18(4):10–12, 2004.

    Google Scholar 

  67. Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., Sheridan, T., Reducing the frequency of errors in medicine using information technology. J. Am. Med. Inf. Assoc. 8(4):299–308, 2001.

    Google Scholar 

  68. Rosenstein, A. H., Measuring the benefits of clinical decision support: Return on investment. Health Care Manage. Rev. 24(2):32–43, 1999.

    Google Scholar 

  69. Shea, S., DuMouchel, W., and Bahamonde, L., A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J. Am. Med. Inf. Assoc. 3(6):399–409, 1996.

    Google Scholar 

  70. McMullin, S., Longergan, T., Rynearson, C., Doerr, T., Veregge, P., and Scanlan, E., Impact of an evidence-based computerized decision support system on primary care prescription costs. Ann. Fam. Med. 2(5):494–498, 2004.

    Article  Google Scholar 

  71. Raschke, R. A., Gollihare, B., Wunderlich, T. A., Guidry, J. R., Leibowitz, A. I., Peirce, J. C., Lemelson, L., Heisler, M. A., and Susong, C., A computer alert system to prevent injury from adverse drug events: Development and Evaluation in a Community Teaching Hospital. JAMA 280(15):1317–1320, 1998.

    Article  Google Scholar 

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Menachemi, N., Brooks, R.G. Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies. J Med Syst 30, 159–168 (2006). https://doi.org/10.1007/s10916-005-7988-x

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