1.  Return on Investment for a Computerized Physician Order Entry System

Author(s): Kaushal R, Jha AK, Franz C, Glaser J, Shetty KD, Jaggi T, Middleton B, Kuperman GJ, Khorasani R, Tanasijevic M, Bates DW; Brigham and Women's Hospital CPOE Working Group

Source: Journal of the American Medical Informatics Assocation (JAMIA). 2006 May-Jun;13(3):261-266 Epub 2006 Feb 24.

Summary: Although computerized physician order entry (CPOE) may decrease errors and improve quality, hospital adoption has been slow. The high costs and limited data on financial benefits of CPOE systems are a major barrier to adoption. The authors assessed the costs and financial benefits of the CPOE system at Brigham and Women's Hospital (BWH), a 720-adult bed, tertiary care, academic hospital in Boston, over 10 years. Benefits were determined from published studies of the BWH CPOE system, interviews with hospital experts, and relevant internal documents. The culture at BWH is very supportive of informatics. Over 10 years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million, given the institutional 80% prospective reimbursement rate. The CPOE system at BWH has resulted in substantial savings, including operating budget savings, to the institution over 10 years. Other hospitals may be able to save money and improve patient safety by investing in CPOE systems.

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2.  The Value of Health Care Information Exchange and Interoperability

Author(s): Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B

Source: Health Affairs (Millwood--Spring Hope). 2005 Jan-Jun, Suppl Web Exclusives;(NULL)((NULL)):W5-10-W5-18.

Summary: This paper assesses the value of electronic health care information exchange and interoperability (HIEI) among providers (hospitals and medical group practices) and independent laboratories, radiology centers, pharmacies, payers, public health departments, and other providers. The authors created an HIEI taxonomy and combined published evidence with expert opinion in a cost-benefit model. Fully standardized HIEI could yield a net value of dollar 77.8 billion per year once fully implemented. Nonstandardized HIEI offers smaller positive financial returns. The clinical impact of HIEI for which quantitative estimates cannot yet be made would likely add further value. A compelling business case exists for national implementation of fully standardized HIEI. Much of the data, assumptions, and conclusions in this article are based on expert panels and opinion, rather than data on health outcomes. The models and arguments are well-presented, but the issues of validity and reliability of the data should be considered.

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3.  A Cost-Benefit Analysis of Electronic Medical Records in Primary Care

Author(s): Wang SJ, Middleton B, Prosser LA, Bardon CG, Spurr CD, Carchidi PJ, Kittler AF, Goldszer RC, Fairchild DG, Sussman AJ, Kuperman GJ, Bates DW

Source: The American Journal of Medicine. 2003 Apr 1;114(5):397-403.

Summary: The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care. Much of the data and conclusions are based on expert opinion and assumptions, with a minority of data from actual studies.  We performed a cost-benefit study to analyze the financial effects of electronic medical record systems in ambulatory primary care settings from the perspective of the health care organization. The reference strategy for comparisons was the traditional paper-based medical record. The estimated net benefit from using an electronic medical record for a five-year period was 86,400 US dollars per provider. Benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors. Implementation of an electronic medical record system in primary care can result in a positive financial return on investment to the health care organization.

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4.  The Value of Electronic Health Records in Solo or Small Group Practices

Author(s): Miller RH, West C, Brown TM, Sim I, Ganchoff C

Source: Health Affairs (Millwood--Spring Hope). 2005 Sep-Oct;24(5):1127-1137.

Summary: We conducted case studies of 14 solo or small-group primary care practices using electronic health record (EHR) software from two vendors. Initial EHR costs averaged $44,000 per full-time-equivalent (FTE) provider, and ongoing costs averaged $8,500 per provider per year. The average practice paid for its EHR costs in 2.5 years and profited handsomely after that; however, some practices could not cover costs quickly, most providers spent more time at work initially, and some practices experienced substantial financial risks. Policies should be designed to provide incentives and support services to help practices improve the quality of their care by using EHRs.  This article provides useful information for clinicians interested in purchasing and implementing an EHR, and for provider organizations and policy makers who may be involved in making decisions about EHR adoption.  While only focusing on two EHR vendor systems is a limitation of this study, the numbers are consistent with other cost data from similar studies.

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5.  The Costs of a National Health Information Network

Author(s): Kaushal R, Blumenthal D, Poon EG, Jha AK, Franz C, Middleton B, Glaser J, Kuperman G, Christino M, Fernandopulle R, Newhouse JP, Bates DW, Cost of National Health Information Network Working Group

Source: Annals of Internal Medicine. 2005 Aug 2;143(3):165-173.

Summary: While the use of information technology may result in a safer and more efficient health care system, there is no consensus about the structure or costs of a national health information network (NHIN).  An expert panel estimated that to achieve an NHIN in five years given the current state of information technology infrastructure would cost $156 billion in capital investment over five years and $48 billion in annual operating costs.  Approximately two-thirds of the capital costs would be required for acquiring functionalities and one third for interoperability. Ongoing costs would be more evenly divided between functionality and interoperability. If the current trajectory continues, the health care system will spend $24 billion on functionalities over the next five years or about one-quarter of the cost for functionalities of a model NHIN.  Assessments such as this one may assist policymakers in determining the level of investment that the United States should make in an NHIN.

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6.  Use of Information Technology to Improve the Quality of Health Care in the United States

Author(s): Ortiz E, CM Clancey

Source: Health Services Research. 2003 Apr;38(2):xi-xxii.

Summary: Since 1969, the Agency for Healthcare Research and Quality (AHRQ) has continued to support research and development in the use of information technology (IT). This article provides a brief overview of IT initiatives sponsored by the Agency. The Clinical Informatics to Promote Patient Safety (CLIPS) portfolio focused on the use of IT to reduce medical errors. The Small Business Innovative Research (SBIR) program helped small businesses develop innovative technology that will lead to improvements in health care. The Integrated Delivery System Research Network (IDSRN) studied various ways that IT can improve the quality of health care in diverse settings. Additionally, important health care outcomes research is conducted through Primary Care Practice-Based Research Networks (PBRN)s. The Translating Research into Practice (TRIP) program funded projects that help narrow the gap between knowledge and practice to improve the quality of the nation's care. The Agency's bioterrorism efforts have focused on developing evidence-based information to improve heath care quality.