Can electronic medical record systems transform health care? Potential health benefits, savings, and costs

Health Affairs

Volumn 24, Issue 5, 2005, Pages 1103-1117

  Hillestad, Richard ^a   Bigelow, James ^a   Bower, Anthony ^d   Girosi, Federico ^d   Meili, Robin ^d   Scoville, Richard ^b   Taylor, Roger ^b,c  

^a RAND CORPORATION   (United States)

^b RAND Health Scoville   (United States)

^c RAND Health Scoville   (United States)

^d NONE

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; COST CONTROL; ECONOMICS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH CARE QUALITY; HUMAN; MASS COMMUNICATION; MEDICAL RECORD; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; UNITED STATES;

AGED; COST CONTROL; DELIVERY OF HEALTH CARE; DIFFUSION OF INNOVATION; EFFICIENCY, ORGANIZATIONAL; HEALTH EXPENDITURES; HUMANS; MEDICAL RECORDS SYSTEMS, COMPUTERIZED; MIDDLE AGED; QUALITY OF HEALTH CARE; UNITED STATES;

EID: 27644565865     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.24.5.1103     Document Type: Article

References (43)

1. Organization for Economic Cooperation and Development, "Health at a Glance - OECD Indicators 2003," 17 September 2003, www.oecd.org/document/ 11/0,2340,en_2649_201185_16502667_1_1_1_1,00.html (20 July 2005).
2. The term EMR systems as used here includes the electronic medical record (EMR), containing current and historical patient information; clinical decision support (CDS), which provides reminders and best-practice guidance for treatment; and a central data repository (CDR), for the information. It also includes IT-enabled functions, such as computerized physician order entry (CPOE). We use the terms health information technology (HIT) and EMR systems interchangeably.
3. H. Taylor and R. Leitman, "European Physicians, Especially in Sweden, Netherlands, and Denmark, Lead U.S. in Use of Electronic Medical Records," Harris Interactive 2, no. 16 (8 August 2002), www.harrisinteractive.com/news/newsletters_healthcare.asp (20 July 2005).
4. K. Fonkych and R. Taylor, The State and Pattern of Health Information Technology Adoption (Santa Monica, Calif.: RAND, 2005).
5. R. Taylor et al., "Promoting Health Information Technology: Is There a Case for More-Aggressive Government Action?" Health Affairs 24, no. 5 (2005): 1234-1245.
6. The online supplement is available at content.healthaffairs.org/cgi/ content/full/24/5/1103/DC1. The RAND Web site provides a comprehensive description of our methods, data, and models. See www.rand.org/publications/MG/ MG408; MG409; and MG410.
7. HIMSS AnalyticsSM Database (formerly the Dorenfest IHDS+TM Database), second release, 2004.
8. See J.H. Bigelow, K. Fonkych, and F. Girosi, Technical Executive Summary in Support of "Can Electronic Medical Record Systems Transform Healthcare?" This online summary of our methods includes a table listing the most important literature findings and some measures of their quality; see Note 6.
9. See K.C. Voelker, "Electronic Medical Record (EMR) Comparisons by Physicians for Physicians," www.elmr-electronic-medical-records-emr.com (26 May 2005).
10. In R. Koppel et al., "Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors," Journal of the American Medical Association 293, no. 10 (2005): 1197-1203, it was reported that the medication error rate actually increased because of computer- and interface-induced errors. We have assumed that this is not the case for a carefully redesigned medication process supported by modern CPOE.
11. See Agency for Healthcare Research and Quality (AHRQ), Medical Expenditure Panel Survey (MEPS) (multiple years of data and documentation), at www.meps.ahrq.gov (24 February 2005);
12. American Hospital Association, AHA Annual Survey Database (a survey conducted since 1946; data must be purchased); and AHRQ, Nationwide Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP), at www.hcup-us.ahrq.gov/nisoverview.jsp (24 February 2005).
13. National Center for Health Statistics, National Ambulatory Medical Care Survey (NAMCS) - multiple years of data and documentation available at www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm (24 February 2005).
14. A. Bower, The Diffusion and Value of Healthcare Information Technology, Pub. no. MG-272-HLTH (Santa Monica, Calif.: RAND, 2005).
15. Recently, Jan Walker and colleagues quantified the value of full adoption of interoperable EMR systems. J. Walker et al., "The Value of Health Care Information Exchange and Interoperability," Health Affairs, 19 January 2005, content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.10 (2 May 2005).
16. Laurence Baker argued that these savings were overestimated. L.C. Baker, "Benefits of Interoperability: A Closer Look at the Estimates," Health Affairs, 19 January 2005, content.healthaffairs.org.cgi/content/abstract/ hlthaff.w5.22 (26 May 2005).
17. F. Girosi et al., Extrapolating Evidence of Health Information Technology Savings and Costs, Pub. no. MG-410 (Santa Monica, Calif.: RAND, 2005).
18. Other factors and savings, mentioned in the Study Data and Methods section, could increase this total potential.
19. D.W. Bates et al., "Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors," Journal of the American Medical Association 280, no. 15 (1999): 1311-1316.
20. Koppel et al., "Role of Computerized Physician Order Entry Systems."
21. D. Johnston et al., Patient Safety in the Physician's Office: Assessing the Value of Ambulatory CPOE, April 2004, www.chcf.org/topics/view.cfm?itemID= 101965 (26 May 2005).
22. J.H. Bigelow et al., Analysis of Healthcare Interventions That Change Patient Trajectories (Santa Monica, Calif.: RAND, 2005).
23. S.J. Wang et al., "A Cost-Benefit Analysis of Electronic Medical Records in Primary Care," American Journal of Medicine 114, no. 5 (2003): 397-403.
24. E.A. McGlynn et al., "The Quality of Health Care Delivered to Adults in the United States," New England Journal of Medicine 348, no. 26 (2003): 2635-2645;
25. and Centers for Disease Control and Prevention, "Chronic Disease Overview," 15 October 2004, www.cdc.gov/nccdphp/overview.htm (26 May 2005).
26. See, for example, Institute for Healthcare Improvement, "My Shared Care Plan," www.ihi.org/IHI/topics/chronicconditions/diabetes/tools/ my+shared+care+plan.htm (26 May 2005).
27. R.C. Burack and P.A. Gimotty, "Promoting Screening Mammography in Inner-City Settings: The Sustained Effectiveness of Computerized Reminders in a Randomized Controlled Trial," Medical Care 35, no. 9 (1997): 921-931.
28. B. Kaplan, "Evaluating Informatics Applications - Clinic Decision Support Systems Literature Review," International Journal ofMedical Informatics 64, no. 1 (2001): 15-37.
29. Bigelow et al., Analysis ofHealthcare Interventions.
30. We make the 100 percent assumption to provide an upper bound on the net costs and the health effects of their service. We do not suggest that 100 percent participation can be realized in practice.
31. K.E. Thorpe, C.S. Florence, and P. Joski, "Which Medical Conditions Account for the Rise in Health Care Spending?" HealthAffairs, 25 August 2004, content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.437 (26 May 2005).
32. Bigelow et al., Analysis of Healthcare Interventions.
33. This is less than the direct sum, because reduced incidence implies a lesser requirement for disease management.
34. R.B. Haynes, H.P. McDonald, and A.X. Garg, "Helping Patients Follow Prescribed Treatment: Clinical Applications," Journal of the American Medical Association 288, no. 22 (2002): 2880-2883.
35. D.L. Roter et al., "Effectiveness of Interventions to Improve Patient Compliance: A Meta-Analysis," Medical Care 36, no. 8 (1998): 1138-1161.
36. Bigelow et al., Analysis of Healthcare Interventions.
37. Wang et al., "A Cost-Benefit Analysis."
38. Walker et al., "The Value of Health Care Information Exchange."
39. Because there is not much experience with regional connectivity, cost estimates fall within a wide range. Our own scaling of data provided by the Santa Barbara Care Data Exchange indicates $2.4 billion for a non-standards-based system.
40. Girosi et al., Extrapolating Evidence.
41. R. Miller and I. Sim, "Physicians' Use of Electronic Medical Records: Barriers and Solutions," Health Affairs 23, no. 2 (2004): 116-126;
42. and D.W. Bates et al., "A Proposal for Electronic Medical Records in U.S. Primary Care," Journal of the American Medical Informatics Association 10, no. 1 (2003): 1-10.
43. Taylor et al., "Promoting Health Information Technology."