Electronic Health Records in Four Community Physician Practices: Impact on Quality and Cost of Care
- Affiliations of the authors: UnitedHealthcare, (DB, KR, LGS), Edina, MN; Center for Health Care Policy and Evaluation/Ingenix (YB, WPW, RH), Edina, MN; The Lewin Group (WPW), Falls Church, VA; Duval County (FL) Health Department (RH), Jacksonville, FL
- Correspondence and reprints: Dawn Bazarko, RN, MPH, UnitedHealthcare, 5901 Lincoln Drive, Edina, MN 55346 e-mail: <dawn_m_bazarko{at}uhc.com>
- Received 12 April 2006
- Accepted 9 February 2007
Introduction
Health information technology (HIT) is widely seen as a way to increase the quality and lower the cost of care. Advocates for HIT suggest technology (particularly clinical decision support) increases guideline adherence in practice, which improves health status, which lowers utilization and cost, especially over the long term.
Electronic health (or medical) records (EHRs) may be the most frequently discussed form of HIT. The term “EHR” is used to include a wide range of functionalities in some discussions and a much narrower range in others. The Institute of Medicine (IOM) described eight “core” functionalities.1 Prominent among these are
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health information and data storage,
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management of results from laboratory and imaging tests,
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electronic ordering (e.g., prescription drugs and referrals),
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clinical decision support (e.g., guideline reminders),
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interoperability, and
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administrative processes such as billing.
HIT adoption and diffusion have garnered proponents across the political spectrum, most notably Republican Newt Gingrich and Democrat Hillary Clinton, and the Bush Administration appointed a National HIT Coordinator to promote HIT.
Nonetheless, few studies have systematically analyzed the costs and benefits of HIT, and even fewer empirical studies of HIT adoption have been published in the peer-reviewed literature. The cost and quality impact of HIT adoption is unclear. Hillestad et al2 estimated that EHRs could save the country approximately $40 billion a year during the adoption period, through reduced hospitalization rates and length of stay, as well as more appropriate pharmaceutical utilization and care for chronic illness. Conversely, given the significant underuse of effective care,3 EHRs could also increase costs (particularly in the short term) by identifying and ensuring delivery of effective preventive and chronic care services, or by addressing long-standing workflow issues. One recent notable study reported an increase in mortality associated with Computerized Physician Order Entry (CPOE) in pediatric hospitals.4
Moreover, the …
