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Effect of Electronic Health Records on Health Care Costs: Longitudinal Comparative Evidence From Community Practices

Julia Adler-Milstein, PhD; Claudia Salzberg, MSc; Calvin Franz, PhD; E. John Orav, PhD; Joseph P. Newhouse, PhD; and David W. Bates, MD, MSc
[+] Article, Author, and Disclosure Information

From University of Michigan, Ann Arbor, Michigan; Brigham and Women's Hospital and Harvard Medical School and Harvard School of Public Health, Boston, Massachusetts; Eastern Research Group, Lexington, Massachusetts; and Harvard Kennedy School, Cambridge, Massachusetts.

Acknowledgment: The authors acknowledge Dr. Ariel Linden for his feedback on earlier drafts of the manuscript.

Grant Support: By the Massachusetts eHealth Collaborative.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2546.

Reproducible Research Statement: Study protocol and data set: Not available. Statistical code: Parts available from Dr. Adler-Milstein (e-mail, juliaam@umich.edu).

Requests for Single Reprints: Julia Adler-Milstein, PhD, University of Michigan, School of Information, 4376 North Quad, 105 South State Street, Ann Arbor, MI 48109; e-mail, juliaam@umich.edu.

Current Author Addresses: Dr. Adler-Milstein: University of Michigan, School of Information, 4376 North Quad, 105 South State Street, Ann Arbor, MI 48109.

Ms. Salzberg and Drs. Orav and Bates: Brigham and Women's Hospital, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, OBC-3, Boston, MA 02120.

Dr. Franz: Eastern Research Group, Inc., 110 Hartwell Avenue, Lexington, MA 02421-3136.

Dr. Newhouse: Harvard Medical School, Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115.

Author Contributions: Conception and design: J. Adler-Milstein, C. Franz, J.P. Newhouse, D.W. Bates.

Analysis and interpretation of the data: J. Adler-Milstein, C. Salzberg, C. Franz, E.J. Orav, J.P. Newhouse.

Drafting of the article: J. Adler-Milstein, C. Salzberg, E.J. Orav.

Critical revision of the article for important intellectual content: J. Adler-Milstein, C. Franz, E.J. Orav, J.P. Newhouse, D.W. Bates.

Final approval of the article: J. Adler-Milstein, E.J. Orav, J.P. Newhouse, D.W. Bates.

Statistical expertise: J. Adler-Milstein, E.J. Orav.

Obtaining of funding: J. Adler-Milstein, D.W. Bates.

Administrative, technical, or logistic support: J. Adler-Milstein, D.W. Bates.

Collection and assembly of data: J. Adler-Milstein, C. Salzberg.

Ann Intern Med. 2013;159(2):97-104. doi:10.7326/0003-4819-159-2-201307160-00004
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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.





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