Measuring Return on Investment: Comparing Apples to Oranges or at least Macintosh to Granny Smith

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Measuring Return on InvestmentComparing Apples
to Oranges(or at least Macintosh to Granny Smith)

• Yael Harris, PhD, MHS
• Senior Policy Analyst
• Office of the National Coordinator for Health
  Information Technology

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A Quick Review of the Literature

• 339,662 total annual savings in practice of 28
  MDs using EHRs- Grieger, Cohen, Krusch, 2007
  
• Estimated net benefit of using EMR over 5 year
  period 86,400 per physician- Wang, Middleton,
  Prosser, et. al., 2003
  
• Nationwide savings of 21.3 billion within 5
  years of 90 adoption- Hillestad, Bigelow, Bower
  et. al. 2005
  
• Use of EMRs can result in poorer quality (and
  possibly higher overall costs as a result)-
  Linder et. al. 2007

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What are we measuring?

• Electronic Administrative Record?
• Computerized Physician Order Entering?
• E-labs?
• Medication Management?
• Clinical Decision Support?

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A Plea for a Standardized Definition

• ONC funded study by George Washington /Harvard
• What constitutes an Electronic Health Record
  (EHR)
  
• How to measure adoption

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Results

• 4 Functionalities
• Electronic notes
• Electronic ordering of lab tests
• Electronic receipt of lab results
• Electronic ordering of medications

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So, What is Current Adoption Rate?

• 9.2 for physician offices
• Rate much lower for small and solo practices
• Rate lower in rural areas
• Highest rates in New England

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Ongoing Measurement

• 2007 Comprehensive survey of adoption
• Identify types of practices that have adopted
• Identify practices planning to adopt
• Identify barriers
• Identify cost tradeoffs
• 2008 going forward- National Ambulatory Medical
  Care Survey (NAMC)

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So, is there a return on investment?

• Technology type
• Adoption of EHR
• Practice size
• Time since implementation
• Start up costs

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Questions?

• Yael Harris
• 202-205-3628
• Yael.harris_at_hhs.gov