Effect of Electronic Health Records on Health Care Costs: Longitudinal Comparative Evidence From Community Practices | Annals of Internal Medicine

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Abstract
Chinese translation Background: The United States is aiming to achieve nationwide adoption of electronic health records (EHRs) but lacks robust empirical evidence to anticipate the effect on health care costs. Objective: To assess short-term cost savings from community-wide adoption of ambulatory EHRs. Design: Longitudinal trial with parallel control group. Setting: Natural experiment in which 806 ambulatory clinicians across 3 Massachusetts communities adopted subsidized EHRs. Six matched control communities applied but were not selected to participate. Patients: 47 979 intervention patients and 130 603 control patients. Measurements: Monthly standardized health care costs from commercial claims data from January 2005 to June 2009, including total cost, inpatient cost, and ambulatory cost and its subtypes (pharmacy, laboratory, and radiology). Projected savings per member per month (PMPM), excluding EHR adoption costs. Results: Ambulatory EHR adoption did not impact total cost (pre- to postimplementation difference in monthly trend change, −0.30 percentage point; P = 0.135), but the results favored savings (95% CI, $21.95 PMPM in savings to $1.53 PMPM in higher costs). It slowed ambulatory cost growth (difference in monthly trend change, −0.35 percentage point; P = 0.012); projected ambulatory savings were $4.69 PMPM (CI, $8.45 to $1.09 PMPM) (3.10% of total PMPM cost). Ambulatory radiology costs decreased (difference in monthly trend change, −1.61 percentage points; P < 0.001), with projected savings of $1.61 PMPM (1.07% of total PMPM cost). Limitations: Intervention communities were not randomly selected and received implementation support, suggesting that results may represent a best-case scenario. Confounding is possible. Conclusion: Using commercially available EHRs in community practices seems to modestly slow ambulatory cost growth. Broader changes in the organization and payment of care may prompt clinicians to use EHRs in ways that result in more substantial savings. Primary Funding Source: Massachusetts eHealth Collaborative.
Reference Key
 adler-milsteinannalseffect Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Julia  Adler-Milstein;Claudia  Salzberg;Calvin  Franz;E. John  Orav;Joseph P.  Newhouse;David W.  Bates;
Journal annals of internal medicine
Year Year not found
DOI
1709804
URL
https://dx.doi.org/10.7326/0003-4819-159-2-201307160-00004##main_botton_nav
Keywords
telemedicine motivation quality improvement medicare legislation patients health information technology surveys inpatients outpatients population statistics electronic medical records adverse reactions health care providers computers diagnostic radiology pilot studies linear regression analysis research laboratories electrode recording

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