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 forall 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.
- I am in a four-person practice. What will the cost of an electronic medical record (EMR) implementation be for me?
- We are a small practice being asked to participate in a regional health information exchange. What are the pros and cons of doing this? What workflow and productivity changes can we expect?
- I want to implement computerized physician order entry (CPOE) in my hospital. What is the cost? What are the caveats?
- We are a small practice interested in improving care effectiveness by implementing an electronic health record (EHR) system. What does the research tell us on whether and how we can succeed?
- We've been asked to implement a computerized physician order entry (CPOE) CPOE system as part of a patient safety initiative. What can we really expect in terms of health benefits from CPOE?
Question 1. I am in a four-person practice. What will the cost of an electronic medical record (EMR) implementation be for me?
Using the criteria of electronic health record and cost effectiveness and cost benefit we get the following:
NOTE: Below is an example screenshot of the search criteria you can use. Perform a search on the database.
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)|
|Hardware and software (NPV)||1,471,700|
|Project manager system supplier||6,700|
|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|
|Summarizing medical records||77,400|
|Total unexpected costs||450,900|
The sixth article provides summary data for a small independent family physician clinic:
- 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.