Journal:Return on investment in electronic health records in primary care practices: A mixed-methods study
| Full article title | Return on investment in electronic health records in primary care practices: A mixed-methods study |
|---|---|
| Journal | JMIR Medical Informatics |
| Author(s) | Jang, Yeona; Lortie, Michel A.; Sanche, Steven |
| Author affiliation(s) | McGill University, Desautels Faculty of Management; St Mary's Research Centre, Montreal |
| Primary contact | Email: yeona.jang@mcgill.ca; Phone: 1.514.398.8489 |
| Year published | 2014 |
| Volume and issue | 2 (2) |
| Page(s) | e25 |
| DOI | 10.2196/medinform.3631 |
| ISSN | 2291-9694 |
| Distribution license | Creative Commons Attribution 2.0 |
| Website | http://medinform.jmir.org/2014/2/e25/ |
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Abstract
Background: The use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices.
Objective: Guided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment.
Methods: Given the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems.
Results: We collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months.
Conclusions: We found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices.
Keywords: return on investment in electronic health records; cost recovery from EHR implementation; ROI indicator; physician satisfaction with EHR; primary care practices
Introduction
Context
The use of electronic health records (EHR) in clinical settings is widely recommended as an innovation enabler with potential benefits of reducing health care costs, while improving quality and safety, and is considered central to achieving patient-centered health care.[1][2][3][4] As a wide array of EHR projects have been implemented within various health care settings, the health care field is rich with volumes of work examining the benefits of EHR. However, the existing literature reports mixed results in benefits realized from EHR implementation.[5][6] Such mixed results suggest that the implementation of EHR systems does not automatically guarantee the conversion of potential benefits into realized benefits.
The implementation of EHR systems within primary care practices is seen as particularly complex[7][8][9][10], with physicians and other staff in primary care practices citing obstacles such as difficulty in adapting to the significant changes in workflow and the time commitment required to learn to use the new software while prioritizing patient care [11-14]. While there is a growing body of evidence that EHR can be a valuable tool for improving quality of care and patient safety with relatively positive perceptions about EHR benefits [15-17], uncertainty about cost recovery of an EHR investment remains a significant concern in primary care practices [7,8,18,19]. Various studies on EHR impact and adoption also raise the need for cost-benefit analysis of EHR investments [5,20]. Thus, this study seeks to assess the return on investment (ROI) from an EHR implementation in primary care settings, aiming to complement the current insights on cost recovery concerns in existing literature.
References
- ↑ Hillestad, R.; Bigelow, J.; Bower, A.; Girosi, F.; Meili, R.; Scoville, R.; Taylor, R. (2005). "Can electronic medical record systems transform health care? Potential health benefits, savings, and costs". Heath Affairs 24 (5): 1103-1117. doi:10.1377/hlthaff.24.5.1103. PMID 16162551.
- ↑ Blumenthal, D. (2009). "Stimulating the adoption of health information technology". The New England Journal of Medicine 360 (15): 1477-1479. doi:10.1056/NEJMp0901592. PMID 19321856.
- ↑ Bates, D.W. (2010). "Getting in step: electronic health records and their role in care coordination". Journal of General Internal Medicine 25 (3): 174-176. doi:10.1007/s11606-010-1252-x. PMC PMC2839327. PMID 20127195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2839327.
- ↑ Saleem, J.J.; Flanagan, M.E.; Wilck, N.R.; Demetriades, J.; Doebbeling, B.N. (2013). "The next-generation electronic health record: perspectives of key leaders from the US Department of Veterans Affairs". Journal of the American Medical Informatics Association 20 (e1): e175-e177. doi:10.1136/amiajnl-2013-001748. PMC PMC3715365. PMID 23599227. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715365.
- ↑ Black, A.D.; Car, J.; Pagliari, C.; Anandan, C.; Cresswell, K. Bokun, T.; NcKinstry, B.; Procter, R.; Majeed, A.; Sheikh, A. (2013). "The impact of eHealth on the Quality and Safety of Health Care: a Systematic Overview". PLoS Medicine 8 (1). doi:10.1371/journal.pmed.1000387. PMC PMC3022523. PMID 21267058. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022523.
- ↑ Holroyd-Leduc, J.M.; Lorenzetti, D.; Straus, S.E.; Sykes, L.; Quan, H. (2011). "The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence". Journal of the American Medical Informatics Association 18 (6). doi:10.1136/amiajnl-2010-000019. PMC PMC3197985. PMID 21659445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197985.
- ↑ Gans, D.; Kralewski, J.; Hammons, T.; Dowd, B. (2005). "Medical groups' adoption of electronic health records and information systems". Health Affairs 24 (5): 1323-1333. doi:10.1377/hlthaff.24.5.1323. PMC PMC3197985. PMID 21659445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197985.
- ↑ DesRoches, C.M.; Campbell, E.G.; Rao, S.R.; Donelan, K.; Ferris, T.G.; Jha, A.; et al. (2008). "Electronic health records in ambulatory care — a national survey of physicians". The New England Journal of Medicine 359 (1): 50-60. doi:10.1056/NEJMsa0802005. PMID 18565855.
- ↑ El-Kareh, R.; Gandhi, T.K.; Poon, E.G.; Newmark, L.P.; Ungar, J.; Lipsitz, S.; et al. (2009). "Trends in primary care clinician perceptions of a new electronic health record". Journal of General Internal Medicine 24 (4): 464-468. doi:10.1007/s11606-009-0906-z. PMC PMC2659149. PMID 19156468. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659149.
- ↑ Bassi, J.; Lau, F.; Lesperance, M. (2012). "Perceived impact of electronic medical records in physician office practices: a review of survey-based research". Interactive Journal of Medical Research 1 (2): e3. doi:10.2196/ijmr.2113. PMC PMC3626136. PMID 23611832. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626136.
Notes
This presentation is faithful to the original, with only a few minor changes to presentation. The PubMed ID has been added when missing to make the references more useful.
Per the distribution agreement, the following copyright information is also being added:
©Yeona Jang, Michel A Lortie, Steven Sanche. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 29.09.2014.
