An electronic health record (EHR), or electronic medical record (EMR), refers to the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.[2]
EHS systems are designed to store data accurately and to capture the state of a patient across time. It eliminates the need to track down a patient’s previous paper medical records and assists in ensuring data is accurate and legible. It can reduce risk of data replication as there is only one modifiable file, which means the file is more likely up to date, and decreases risk of lost paperwork. Due to the digital information being searchable and in a single file, EMR’s armore effective when extracting medical data for the examination of possible trends and long term changes in a patient. Population-based studies of medical records may also be facilitated by the widespread adoption of EHR’s and EMR’s.
Cost-Benefit Analysis (CBA) estimates and totals up the equivalent money value of the benefits and costs to the community of projects to establish whether they are worthwhile. These projects may be dams and highways or can be training programs and health care systems. Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness.
Electronic Medical Record (EMR) systems have numerous benefits, such as improvement in the quality of care, medical error prevention, and reduction of unnecessary care costs. However, one major barrier to the adoption of EMR systems is the cost issue. As a result of searching on PubMed, papers related to the economic evaluation of the EMR were identified. Wang et al. performed a cost-benefit analysis (CBA) of EMR with a computerized physician order entry system (CPOE). The result was a positive return on investment (ROI), and the benefits were mainly from savings in drug expenditures, radiology tests, billing errors, etc. Barlow et al. assessed the effects of EMR assuming 5 years based on 1 year experience. The maintenance of paper-charts decreased and the reimbursement process was improved. Hillestad et al. reported more than $81 billion in savings annually after the adoption of EMR. The potential savings and costs were based on a broad literature survey. Kaushal et al. analyzed the effects of CPOE systems based on published studies, interviews with experts, and internal documents. The major cumulative savings were from renal dosing guidance, nursing time utilization, specific drug guidance, and adverse drug event prevention.
A performance measure used to evaluate the efficiency of an investment or to compare the efficiency of a number of different investments. To calculate ROI, the benefit (return) of an investment is divided by the cost of the investment; the result is expressed as a percentage or a ratio.
The return on investment formula:

In the above formula “gains from investment”, refers to the proceeds obtained from selling the investment of interest. Return on investment is a very popular metric because of its versatility and simplicity. That is, if an investment does not have a positive ROI, or if there are other opportunities with a higher ROI, then the investment should be not be undertaken.
The first steps to success in an EHR implementation project are defining the project goals, and calculating the return on investment and a budget based on those goals. In the strictest sense: ROI = gain from investment – cost of investment) / cost of investment. There are many factors to consider when calculating the ROI of an EHR system, as it is not all financial. It is important to look at all the costs and benefits; the quantifiable (measured in dollars) as well as qualifiable (measured in units other than dollars) factors that will influence the EHR project and the ongoing post go-live support needs.
In the first table below, there are two lists of items to be measured when calculating the true outlay for an EHR project. Here, costs are the direct expenses incurred before, during, and post implementation. Returns are the items that could influence cost savings (gains).
Costs Returns
• Contracted or hired IT support hours, before, during, and post EHR implementation
• Project Manager for the ASC side of the project (could be the ASC Administrator, DON, or a computer literate, organized, clinician who can hold people to task)
• EHR Selection Committee members hours needed pre-implementation
• EHR Implementation Team hours needed before, during, and immediate post implementation
• Power-user training hours (using a train the trainer approach)
• End-user training hours, including practice hours
• Additional staffing required during first three weeks of go-live, giving extra time to adapt to new system • Weekly EHR maintenance hours post go-live • Medical Record staff decrease in hours (usually at least one FTE can be eliminated)
• Chart audit hours saved (nursing and medical record staff)
• Report generation hours saved
• Chart assembly hours saved
• Staff training on manual documentation hours saved
• Medical Coding staff decrease in hours (depends on configuration of EHR system)
• Nursing worked hours saved on documentation
• Front office hours saved on documentation during chart initialization
• Staff hours saved from not having to do redundant documentation in multiple systems (i.e. paper medical record and business software)
• EHR Servers (production, back-up)
• End-user Laptops, PCs, or Tablets
• Mobile computer carts
• Computer monitors
• Printers
• Network hardware
• Fax Server
• Signature Pads
• Cables (connecting to patient monitors, printers, etc)
• Vendor EHR application software (software and license costs need to be calculated)
• Operating Systems for user devices
• Misc. Software (i.e. Adobe Acrobat, Excel, Oracle, etc.)
• Interfaces (i.e. Patient Demographics, Surgery scheduling, Pathology. Consider bi-directional)
• EHR Vendor Implementation Costs
• EHR vendor annual service contract costs
• EHR software update costs
• IT support contract costs – specific to EHR system • Elimination of dictation system
• Paper medical record forms printing and binder costs savings
• Faxing or mailing patient discharge summaries, operative reports, etc. to physicians eliminated with auto-faxing from EHR system
• Coding costs saved (with optional EHR auto-coding- depends on EHR selection)
• Medical records for return patients are auto-populated with historical information from previous visit – nursing and front office staff hours saved
• Server storage room; physical space, AC, power, fire suppression
• Wiring and/or wireless network access points
• Electrical outlets for hardware
• Phone line(s) • Costs for secure space and shelving for onsite medical record storage eliminated
• Costs for long-term storage of medical records eliminated
In this table, the deterrents’ column is a list of factors that work against the success of an EHR project and the satisfiers’ column is a list of factors that add to the value of an EHR system. Some of these items could be translated into actual dollars with some extrapolation.

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. Demonstrating a return on investment from an EHR implementation is oftentimes challenging and may be even more difficult for smaller practices. In addition to the costs directly associated with the EHR, such as purchasing and licensing fees, there are also costs that may not be as easy to recognize and calculate. These costs reflect the effect of the EHR implementation upon productivity, especially the initial changes in the practice including change management, transitions in workflow, and other time constraints associated with electronic versus paper records.

• Gunter, Tracy D; Terry, Nicolas P (2005). “The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions”. Journal of Medical Internet Research 7 (1): e3. doi:10.2196/jmir.7.1.e3. PMC 1550638. PMID 15829475.
• • “Mobile Tech Contributions to Healthcare and Patient Experience”. Top Mobile Trends. Retrieved 29 May 2014.
• • Habib, J. L. (2010). “EHRs, meaningful use, and a model EMR”. Drug Benefit Trends 22 (4): 99–101.
• • Kierkegaard, Patrick (2011). “Electronic health record: Wiring Europe’s healthcare”. Computer Law & Security Review 27 (5): 503–515. doi:10.1016/j.clsr.2011.07.013. ISSN 0267-3649.
• • “Electronic Health Records Overview” (PDF).
• • “What is a personal health record?”. HealthIT.gov. Office of the National Coordinator for Health IT. Retrieved 2015-07-24.
• • U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule
• • Evans, Dwight C.; Nichol, W. Paul; Perlin, Jonathan B. (2006). “Effect of the implementation of an enterprise-wide Electronic Health Record on productivity in the Veterans Health Administration”. Health Economics, Policy and Law 1 (2): 163–9. doi:10.1017/S1744133105001210. PMID 18634688.
• “VistA:Winner of the 2006 Innovations in American Government Award” (PDF). The Ash Institute for Democratic Governance and Innovation at Harvard University’s John F. Kennedy School of Government.

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