Justifying the cost of a computer-based patient record

• HIT Description: Hypothetical electronic health record (EHR) system for clinical and financial information management in a large academic medical center. More info...
  
• Purpose of Study: Project long-term costs and benefits of implementing an EHR system.
  
• Years of study: 1994-Not available
  
• Study Design: Case-based predictive cost-benefit analysis
  
• Outcomes: Predicted costs and benefits of HIT. Benefits include both quantifiable and nonquantifiable ones in data capture and access, decision support, clinical practice optimization, business management, and streamlining patient flow.
  

Summary:

• Settings: A large academic cancer center that has a staff of about 8,000 and includes a hospital, outpatient clinic, and remote patient care sties.
• Evaluation Method: A predictive cost-benefit analysis with support from top management. Inputs and data were obtained from various stakeholders that would be affected by an EHR (e.g., medical staff, nursing, front office, and collections departments), literature review, by surveying 10 institutions that were implementing an EHR system, and by interviewing EHR vendors and through process mapping sessions.
• HIT System: Hypothetical electronic health record (EHR) system for clinical and financial information management in a large academic medical center.
• Costs: The projected costs over the 10 years are listed below.
• Benefits: Under several key assumptions, the projected quantifiable benefits over 10 years are listed in the table below. The benefits are expected to begin in the third year after implementation. Nonquantifiable benefits and the human element of benefit estimates (such as staff reduction) are also discussed.

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� � Costs � �	� � Time periods when the costs� � occurred � �	� � Total monetary value (in millions� � of dollars) � �
� � Hardware/software � �	� � Year 1 to 5 � �	� � 12.53 � �
� � Integration � �	� � Year 1 to 3 � �	� � 0.68 � �
� � Network infrastructure � �	� � Year 4 � �	� � 0.15 � �
� � Vertical integration � �	� � Year 2 to 3 � �	� � 0.05 � �
� � I/S infrastructure � �	� � Year 1 to 10 � �	� � 40.09 � �
� � Institutional issues � �	� � Year 1 to 2 � �	� � 1.00 � �
� � Total � �	� �   � �	� � 54.49 � �

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� � Benefits � �	� � % of total institution expenses,� � excluding noncontrollable and capital costs � �	� � Total monetary value (in millions� � of dollars) � �
� � Data capture and access � �	� � 2.7% � �	� � 56.75 � �
� � Decision support � �	� � 3.4% � �	� � 81.24 � �
� � Business management � �	� � 2.2% � �	� � 13.92 � �
� � Streamlining patient flow � �	� � 0.43% � �	� � 10.20 � �
� � Total � �	� �   � �	� � 162.11 � �

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