review paper published by the Journal of the American Medical Informatics Association. But the authors caution that the conclusions cannot necessarily be generalized across healthcare organizations.
The 33 studies reviewed looked at several different types of health IT, including primary care electronic health records (7), computerized provider entry systems (6), medication management systems (5), immunization information systems (5), institutional information systems (4), disease management systems (3), clinical documentation systems (2) and one health information exchange network.
In terms of value for money, 23 papers reported positive findings, eight were inconclusive and two were negative. Most of the papers on EHRs, medication management and disease management systems had positive findings, while the CPOE, immunization and documentation studies' findings were mixed.
"As the HIS [health information systems] become more complicated, as in CPOE and clinical documentation and immunization systems where there are multiple objectives, target audiences and performance variations, there may be diminishing returns in having to manage the increased complexities, needed coordination and stakeholder expectations," the study said.
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Of the CPOE papers, three reported positive economic results, two were inconclusive and one was negative. One paper found that CPOE saved $12,700 per adverse drug event (ADE) prevented, but the effect was dependent on the ADE rate, the physician and system cost, and the system's ability to reduce ADEs. Another study found that after hospitals implemented CPOE, their operating margins declined for two years, especially in rural and critical access hospitals. "They concluded that CPOE cost was likely not financially feasible for small hospitals," the review paper said.
Five of the seven EHR studies showed positive economic results over time periods ranging from six months to eight years. One study found that over a five-year period, an ambulatory care clinic had a net benefit of $86,400 per provider. Another paper showed that, at an average cost saving of about $3 per encounter, an ambulatory surgery clinic saved $184,627 per provider over four years, given an EHR startup cost of $10,329 per provider.
Some of these studies factored in initial losses of provider productivity as part of implementation costs, said Francis Lau, one of the review paper's authors and a professor of health information science at the University of Victoria in Canada, in an interview with InformationWeek Healthcare. "Longitudinal studies demonstrate that even with the initial decrease in productivity, the savings go back up once the system gets stabilized," he said.
The papers on institutional systems showed higher costs related to electronic documentation, but none tried to link those systems to the value of patient safety or quality, Lau said. "The reason for the increase in documentation costs -- which is consistent with other studies -- is that it takes a lot of time to document electronically. The clinical documentation did improve in accuracy and completeness. But that's hard to translate into dollar terms."
Regarding the inconsistent results with regard to electronic medication administration and clinical decision support systems, he said, "if you can demonstrate avoidance of a patient safety event, it's a little easier to show the savings. But it's difficult to show an improvement in quality of care due to a particular information system because there are so many factors that influence care."
Noting that 30% of the papers did not find any economic benefit related to health IT, Lau said that one reason might be because of how the systems were implemented. "There's a gross undertraining in the healthcare informatics field for people who can implement these systems and train clinicians. If you're going to rely on clinicians to learn all the advanced features of these systems, that's not going to happen, because that's not their role. So we have a void, not in the systems, but in the people who are implementing the systems."
Another recent study in Health Affairs supports this thesis, showing that physicians who used EHRs were more likely to improve the quality of care when they received more technical assistance.