The studies referenced here were reported in peer-reviewed publications as systematic reviews, hypothesis tests, or predictive analyses. Although the results are valid for the institutions they represent, they may not be valid for other organizations with different technical capacities, project management expertise, organizational culture, or human and economic resources - all of which may affect cost. More

Using the criteria of electronic health record and cost effectiveness and cost benefit we get the following:

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The first article provides the following summary data for a small (three-physician) practice:

Improved productivity	Workload	Illustrated benefits of AEHR
Elimination of chart pulls	120 chart pull/day, each taking 5 minutes (1,000 hours of work annually)	1000 hr/yr * $17/hr = $17,000/yr
Reduction/elimination of transcription costs	12000 visits/yr * 40 lines of transcription * $0.11/line	$52,800 yearly savings minus increased provider time for documentation = $42,680/yr net savings
Automatic documentation of diagnostic codes	12000 visits/yr * 2 codes/visit *15% manually researched * 5 minutes/code = 300 hours coding time	CPR can virtually eliminate the cost of coding time, resulting in a saving of $5100/yr

This can be used to make a case to management for implementation of an EHR. The second article (although in Sweden) also provides perspective on EHR implementation in the outpatient setting but breaks down the cost by category:

Category	Description	Monetary value (in SEK, 1995 dollars)
Direct costs	Training	54,000
	Hardware and software (NPV)	1,471,700
	Project manager system supplier	6700
	Maintenance	109700
	Total direct costs	1,642,100
Unexpected costs	Self-training during working hours	109,100
	Loss of normal activities in leisure hours	69,100
	Increase in administrative work load	192,000
	Extra service	3,300
	Summarizing medical records	77,400
	Total unexpected costs	450,900

The fifth article provides summary data for a small independent family physician clinc:

• Settings: Hypothetical small independent family physician clinic.
• Evaluation Method: Present an Excel-based spreadsheet tool designed to help family physicians compare the initial purchase price and the annual and five-year operating costs of EHR systems. Gave an example from a hypothetical scenario. A web link to the tool was provided.
• Health IT System: Hypothetical electronic health records (EHR) systems for outpatient clinical settings.
• Costs: In the example, the author estimated that an EHR system with one-server and six desktop- computers would cost $71, 020 initially (assuming purchased in Jan. 2002), $7,283 for first year, and $11, 984 for years two to five respectively. Description and comments of the cost items (e.g., type of printers) were provided.

The studies referenced here were reported in peer-reviewed publications as systematic reviews, hypothesis tests, or predictive analyses. Although the results are valid for the institutions they represent, they may not be valid for other organizations with different technical capacities, project management expertise, organizational culture, or human and economic resources - all of which may affect cost. In addition, these studies may not contain the full technical details of how health information technology was implemented or how it operates. Thus, these results are best used as general guidelines for determining costs and benefits rather than as absolutes, because they may not hold true for all organizations. Please refer to Chapter 4 of "Costs and Benefits of Health Information Technology," AHRQ Publication No. 06-E006, for additional information on the limitations and conclusions of the studies included in the evidence report.