Study of the Cost-Benefit Analysis of Electronic Medical Record Systems in General Hospital in China

Electronic medical record (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medical record systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medical record. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medical record creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medical record creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors.

[1]  Ping Li,et al.  Impact of the Japanese Diagnosis Procedure Combination-based Payment System in Japan , 2010, Journal of Medical Systems.

[2]  J Mildon,et al.  Drivers in the electronic medical records market. , 2001, Health management technology.

[3]  Rawitz Jg,et al.  Justifying costs of computer software purchases. , 1990 .

[4]  Minal Thakkar,et al.  Risks, barriers, and benefits of EHR systems: a comparative study based on size of hospital. , 2006, Perspectives in health information management.

[5]  Davis Mw,et al.  Reaping the benefits of electronic medical record systems. , 1993 .

[6]  Anne F. Kittler,et al.  A cost-benefit analysis of electronic medical records in primary care. , 2003, The American journal of medicine.

[7]  Stephen H. Cohen,et al.  A pilot study to document the return on investment for implementing an ambulatory electronic health record at an academic medical center. , 2007, Journal of the American College of Surgeons.

[8]  D. Blumenthal,et al.  Health Information Technology in the United States: The Information Base for Progress , 2006 .

[9]  P. Shekelle,et al.  Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care , 2006, Annals of Internal Medicine.

[10]  D. Bates,et al.  patient safety Improving Safety with Information Technology , 2003 .

[11]  L A Kian,et al.  Justifying the cost of a computer-based patient record. , 1995, Healthcare financial management : journal of the Healthcare Financial Management Association.

[12]  C. McDonald,et al.  Reminders to physicians from an introspective computer medical record. A two-year randomized trial. , 1984, Annals of internal medicine.

[13]  Cheryl Bagley Thompson,et al.  Comparison of mailed vs. Internet applications of the Delphi technique in clinical informatics research , 2000, AMIA.

[14]  Jonathan M. Teich,et al.  The impact of computerized physician order entry on medication error prevention. , 1999, Journal of the American Medical Informatics Association : JAMIA.

[15]  A Bingham,et al.  Computerized patient records benefit physician offices. , 1997, Healthcare financial management : journal of the Healthcare Financial Management Association.

[16]  G W Keever,et al.  EMR to the rescue. An ambulatory care pilot project shows that data sharing equals cost shaving. , 2001, Healthcare informatics : the business magazine for information and communication systems.

[17]  D P Connelly,et al.  Computerized patient records in primary care. Their role in mediating guideline-driven physician behavior change. , 1995, Archives of family medicine.

[18]  K Renner,et al.  Cost-justifying electronic medical records. , 1996, Healthcare financial management : journal of the Healthcare Financial Management Association.

[19]  E. Keeler,et al.  Costs and benefits of health information technology. , 2006, Evidence report/technology assessment.

[20]  et al.,et al.  The Regenstrief Medical Record System: a quarter century experience , 1999, Int. J. Medical Informatics.

[21]  Nava Pliskin,et al.  Spreadsheet evaluation of computerized medical records: The impact on quality, time, and money , 1996, Journal of Medical Systems.

[22]  George Hripcsak,et al.  Review Paper: Detecting Adverse Events Using Information Technology , 2003, J. Am. Medical Informatics Assoc..

[23]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[24]  Roger Taylor,et al.  The State and Pattern of Health Information Technology Adoption , 2005 .

[25]  Mohr Dn Benefits of an electronic clinical information system. , 1997 .

[26]  K Sandrick,et al.  Calculating ROI for CPRs. , 1998, Health management technology.

[27]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[28]  R Nelson Computerized patient records improve practice efficiency and patient care. , 1998, Healthcare financial management : journal of the Healthcare Financial Management Association.

[29]  David W. Bates,et al.  Reducing the frequency of errors in medicine using information technology. , 2001, Journal of the American Medical Informatics Association : JAMIA.

[30]  D. Bates Using information technology to reduce rates of medication errors in hospitals , 2000, BMJ : British Medical Journal.

[31]  D Essex Skip the song & dance. , 1999, Healthcare informatics : the business magazine for information and communication systems.

[32]  J G Rawitz,et al.  Justifying costs of computer software purchases. , 1990, Healthcare financial management : journal of the Healthcare Financial Management Association.

[33]  C. A. King,et al.  A provider-interactive medical record system can favorably influence costs and quality of medical care. , 1990, Computers in biology and medicine.

[34]  A. Khoury,et al.  Finding value in EMRs (electronic medical records). , 1997, Health management technology.

[35]  K Renner,et al.  Electronic medical records in the outpatient setting (Part 2). , 1996, Medical group management journal.

[36]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[37]  Robin C. Meili,et al.  Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. , 2005, Health affairs.

[38]  D. Bates Physicians and ambulatory electronic health records. , 2005, Health affairs.

[39]  Sara Rosenbaum,et al.  How common are electronic health records in the United States? A summary of the evidence. , 2006, Health affairs.

[40]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[41]  M. J. Hall,et al.  Use of electronic medical records by ambulatory care providers: United States, 2006. , 2010, National health statistics reports.

[42]  T. Clemmer,et al.  A computer-assisted management program for antibiotics and other antiinfective agents. , 1998, The New England journal of medicine.

[43]  K Renner,et al.  Electronic medical records in the outpatient setting (Part 1). , 1996, Medical group management journal.

[44]  David Blumenthal,et al.  Improving Preventive Care by Prompting Physicians , 2001 .

[45]  Shinji Naganawa,et al.  Impact of adjustment measures on reducing outpatient waiting time in a community hospital: application of a computer simulation. , 2010, Chinese medical journal.

[46]  William DuMouchel,et al.  A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. , 1996, Journal of the American Medical Informatics Association : JAMIA.