Hospitals with advanced EHRs are able to reduce costs compared to those hospitals without advanced EHRs, according to a study published online June 27 in the American Journal of Managed Care.
While EHRs are supposed to help improve the overall quality of healthcare, and there are predictions that they can save the healthcare system billions of dollars through safety improvement and more efficient care, “little is known about their impact on hospital cost,” the authors wrote.
“There are those who think that we will save money [with EHRs],” said lead author Abby Swanson Kazley, PhD, assistant professor at the Medical University of South Carolina in Charleston. “But there are others who think we won’t realize those savings until we have an interoperable system, and we aren’t quite there yet. We wanted to take this intermediate step to see whether hospitals that are using these systems—that in all likelihood have applied for, are applying for or meet the criteria for Meaningful Use [MU]—are realizing gains.”
The researchers used data obtained from the National Inpatient Sample (NIS) 2009 and the Health Information Management Systems Society (HIMSS) in 2009. The information from NIS includes discharge data from more than 1,000 hospitals in 45 states, while the HIMSS 2009 data were used to measure hospital EHR use and represents "a broad canvassing of acute care hospitals, chronic care facilities, ambulatory practices on their adoption and plans to adopt various HIT components." The researchers said they wanted to evaluate systems with capabilities that are consistent with MU criteria—systems with advanced features such as clinical decision support and computerized physician order entry.
According to Kazley, the researchers looked at total costs per patient admission, with the total charges reported multiplied by the hospital-specific cost-to-charge ratio for 2009.
Their analysis included over 5 million individual patient cases—about 30 percent of which occurred in hospitals that use advanced EHRs. The researchers determined that the mean overall total cost per admission was $7,938 at hospitals without advanced EHRs compared to a mean cost per patient admission of $7,207 at hospitals with advanced EHRs—a difference of $731 (slightly less than 10 percent).
Despite the costs involved in adopting, implementing and maintaining EHRs, the study "supports the business case for the costly implementation and maintenance of an EHR system,” the authors wrote.
The authors further concluded that cost savings might not be realized until multiple advanced features, including CPOE and CDS, are included in and implemented in an EHR. “Since EHR systems are complex and costly to implement, it is often a multistage process to adopt and use EHRs,” Kazley and her colleagues wrote. “Thus, hospitals must anticipate that the financial savings may not exist until advanced, 'meaningful' use is attained. The majority of hospitals have yet to reach the stage of implementation where cost savings are possible, since they are not using advanced EHRs.”
In the meantime, “what this tells us is that there are savings for third-party payers and patients, and they may want to shop and find hospitals where they may want to have a procedure done that has an advanced EHR if they believe it will help them receive high quality care and save a few dollars here and there,” Kazley said. “And I think it’s worth the investment for the hospital.”