EMR Benefits: Financial
The implementation of an EMR has financial effects: positive, negative, and neutral.
- 1 Financial benefits
- 2 Implementation of EHR in Independent practices
- 3 Implementation of EHR in Hospital owned practices
- 4 Implementation of EHR in Ambulatory Practices
- 5 Various approaches to ROI
- 6 Evaluation of Low Value Services
- 7 Incentive Programs
- 8 National and international effects
- 9 Add in later elsewhere
- 10 Sources of Funding
- 11 Alternative View
- 12 References
Implementing and using an EMR brings significant costs and challenges. These must be carefully considered and overcome in order to entirely realize the potential benefits of an EMR. 
By consolidating information across the entire spectrum of clinical operations, from admission to treatment to labs and beyond, EMR allows for:
- Increase in the pace of information flow including service delivery.
- Coding/billing accuracy.
- Better capture of charges.
- Better documentation of patient encounters.
- Reduction in overall administrative and maintenance costs of healthcare institutions.
- Reduction in costs for the patient.
- Reduction in transcription costs .
- Decrease in malpractice insurance premiums.
- Decrease in paper consumption has the potential to lead to yearly estimated savings of $1.3 billion in the U.S. 
- Reduction in overtime expenses.
Today's health care system is a business in which it has become increasingly difficult for providers to remain profitable. Reimbursement is based on correct coding, which relies on accurate, timely and comprehensive discharge summaries. EMR provides a reliable, rapid and reproducible solution, and may more than pay for the initial investment. 
Implementation of EHR in Independent practices
Those practices not owned by a hospital or integrated delivery system reported an increase on average of $49,916 in total net medical revenue when compared to physicians or independent facilities still using paper records.
Implementation of EHR in Hospital owned practices
Practices owned by hospitals or integrated delivery systems implementing EHR reported an operating margin that was $42,042 greater than the margin reported when compared with those practices still implementing paper records.
General cost savings
Savings are attributed to automating various paper-driven and time-consuming tasks such as the following:
- Reduced transcription costs
- Reduced chart pull, storage, and re-filing costs
- Reduced medical errors
- Improved patient health/quality of care through better disease management and patient education. 
Many health care providers have found that electronic health records (EHRs) help improve medical practice management by increasing practice efficiencies and cost savings.
A national survey of doctors1 who are ready for meaningful use offers important evidence:
- 79% of providers report that with an EHR, their practice functions more efficiently
- 82% report that sending prescriptions electronically (e-prescribing) saves time
- 68% of providers see their EHR as an asset with recruiting physicians
- 75% receive lab results faster
- 70% report enhances in data confidentiality
Based on the size of a health system and the scope of their implementation, benefits for large hospitals can range from $37M to $59M over a five-year period in addition to incentive payments. 
The use of EMRs can reduce administrative and other related costs for physicians. Storage space dedicated to paper charts can essentially be eliminated once the transition to an EMR system is complete. Likewise, staffing for filing and retrieval for a patient files and the need to purchase paper based supplies is substantially reduced or eliminated. 
Efficiency of transactions
The efficiency of increased information flow and documentation allow for measurable time and cost savings. The amount of time support staff save during patient encounters has been directly demonstrated in a clinical setting . Furthermore, the integration of EMR systems enables for a more consistent application of medical protocols, such as those that provide guidance on the use of specific or expensive drugs. As a result, the availability of information 24 hours a day, 7 days a week, helps to contribute significantly to reduced errors, better decision-making, improved outcomes, and lower malpractice risk. In a study done by Harvard researchers, 6.1% of physicians with electronic records had malpractice settlements, compared to 10.8% without electronic records 
Another feature of EMR is the capability to eliminate paper-based informed consents. Paper consents get lost or misplaced very easily and this problem contributes $3.3 billion to the cost of health care in the U.S. due to resulting operating room delays for example. Electronic informed consents also help better reducing liability risk .
One financial benefit of improving care through the use of Health IT might be to lower malpractice insurance costs for providers. A number of firms that sell liability insurance for physicians are offering discounted premiums to practices that use EHRs.(Congress of the United States Congressional Budget Office. (2008). Evidence on the costs & benefits of health information technology (). Washington, DC: Government Printing Office.) P. 13
Financial benefits include averted costs and increased revenues, which can be divided into three categories: payer-independent benefits, benefits under capitated reimbursement, and benefits under fee-for-service reimbursement .
In 2009, the Medical Group Management Association(MGMA) reported the results from surveying 1,324 primary care and specialty practice members. These results found that independent practices reported a median of $49,916 more revenue per full-time physician than paper-based practices. In addition, hospital-owned multi-specialty facilities reported a median of $42,042 more than their paper-based counterparts.
Cannon & Lucci note that suggest that many practices may be unable to completely eliminate transcription and its associated costs by switching to structured templates for clinical documentation. A number of practices have opted to take a blended approach, implementing templates but retaining transcription or implementing voice recognition software in its place.
Voice recognition saves physicians time in their clinical practices by allowing them to dictate notes for transcription either by software or by a human transcriber. In this manner, physicians are able to document accurately in free-text, individual descriptions of clinical conditions, histories, physical exams and plans. Additionally, the traditional discrete text fields of SOAP can be filled out with a greater level of efficiency while maintaining, if not improving, noting quality.
EMR can help hospitals or patients to reduce some redundant tests. For example, EMR could reduce the number of tests conducted at KCH by 7% according estimate by Julia Driessen’s report. A 1998 study at Brigham and Women's Hospital concluded that 8.6% of the tests sampled were redundant, and if those tests were not performed, charges would be reduced by $930,000 annually. (30) A review of studies looking at possible benefits of CPOE found significant evidence of reduced laboratory test ordering in multiples studies . The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study.
Another study targeted at reduction of unneccesary or redundant testing focused specifically on the monitoring of therapeutic levels of antiepileptic drugs (AED). AED tend to have narrow therapeutic windows and as such, blood levels of the drug are monitored closely with frequent, costly, lab tests. A clinical decision support intervention at point of care during CPOE for lab orders reduced AED testing volume by 19.5% in one study. 
Also, by SWOT analysis performed by Sameer Kumar. He said that nationally applied EMR can reduce paper to maintain medical records about 1.3 billion with a cumulative savings over 15 years of $19.9 billion.
Kuperman et al. (2003) upon reviewing the benefits of CPOE said that a reduction in medication errors would increase hospital savings. They found two studies showing that half of all of medication errors were due to ordering of a drug for which the patient had an allergy and the other half were because of incorrect drug and incorrect dose. (11) During physician order entries standardized computer order sets can assist physicians to select disease-sensitive drug and patient-specific dosing. Computer applications can also send alerts about patient allergies, drug interactions and monitoring of drug levels.
In addition to reducing medication errors, EMRs may drive hospital savings on total drug costs up to 15% annually by means of clinical decision support recommending alternative drugs or alternative dosing regimens.. Wang et al's analysis suggests that EMR implementation can result in an estimated drug savings of $16,400 annually per provider. Kaushal et al showed that interventions to switch twice-daily dosing of ceftriaxone to once-daily dosing at Brigham and Women's Hospital resulted in $175,094 in annual cost savings.
Over a 5-year period and determined by the overall size of the particular health system and scope of the EMR implementation, large hospitals can potentially save between $37M and $59M. 
In 2012, at the Children’s Hospital in Boston, medical waste in general was reduced by 30% resulting in approximately $1.6 M savings per year .
At the Eden Park Pediatric Associates in Lancaster, Pennsylvania, a five-physician practice saved $114,000, which was more than ten perfect of its budget after implementing an EMR. 
Another potential benefit from an EMR implementation is the increase in available operating budget. Reduce in staff expenses or lower drug and maintenance costs, for example, could significantly impact a hospital or clinic operating budget (Kaushal at al, 2006).
The meaningful use of certified EHR technology is a core requirement for healthcare providers looking to qualify for the incentive payments. In July 2010, the CMS issued the final rules, setting criteria that providers need to meet, and the schedule to meet them, to qualify for the subsidies. (15)
Management Risk Disposition
The following tenets are the willingness to invest in experimental efforts.
- Provide users with real time knowledge
- Reduce non-clinical time
- Increase patient doctor time
- Investment Motivation
To reduce cost, position for capitation/managed care, and gain market share. To enable providers to take advantage of financial incentives, the Health Information Technology for Economic and Clinical Health Act (HITECH) lists related criteria related to "Meaningful Use of EHR technology".  In addition, the Centers for Medicare & Medicaid Services, along with the Office of the National Coordinator for Health IT requires that an EHR technology are constituted of the following five pillars as health outcome policy priorities (67):
- Improving quality, safety, efficiency, and reducing health disparities.
- Engaging patients and families in their health.
- Improving care coordination.
- Improving population and public health.
- Ensuring adequate privacy and security protection for personal health information.
Total benefits per year are known as the annual inflow (or cash-in). If Anytown Hospital can save $2,500 from chart pull and $2,000 from transportation in the year after implementation, inflow will be $4,500 in the first year. An EHR will bring more benefits to the healthcare organization as the staff becomes familiar with the system and eliminates the initial productivity loss in the following years.
The sum of the annual outflow and inflow is the net cash flow per year.
For example, Anytown Hospital will not realize a financial benefit in the initial year of implementation. The net cash flow in the initial year is -$12,500 ($0 inflow + -$12,500 outflow). 
EHRs can reduce the cost associated with "defensive medicine." By using CDS support and integrated reference materials if available, physicians can reduce cost by determining if a treatment or procedure is truly needed.
Incorporating decision support within a CPOE not only assists a physician in practicing evidence-based medicine, it has also been demonstrated to reduce cost. Specifically, renal dosing guidance, specific drug guidance and adverse drug prevention have contributed to a net operating budget savings of $9.5 million at Brigham and Women's Hospital . The average savings computed from the study indicated a 6-month savings of $3,450 per clinician. This is just one example of a study result measuring the impact of a specific CDSS in a specific EHR system in a singular clinic setting.
Integrating EHR-stored data into the decision-making process can decrease ordering unnecessary diagnostic tests and hence, reduce healthcare expenditures. For instance, providing physicians with estimated procedure costs, past abnormal test results, and pretest abnormal probabilities can increase underused testing and decrease in the number of overused procedures. 
EHR with fully integrated CDSS will help to reduce antimicrobial expenditures of healthcare organization.Extensive uses of unnecessary antibiotic prescription will lead to unwarranted increase in hospitals antibiotic expenditures as well as It reduces drug efficacy due to drug resistance.Many large healthcare organizations have their own antimicrobial management teams(AMT).They help to improve standards of antimicrobial use including supporting staff education,clinical governance and policy development.A randomized control trial was done among the AMTs with CDS as intervention group and AMT without CDS in control group to evaluate the effectiveness and cost-effectiveness of CDS system for the management of antibiotic utilization.Result of the study was suggestive that AMT with CDS group able to reduce 23% of hospital’s expenditures on antibiotic..
CDSS can also reduce healthcare costs through the presence of alerts regarding the compliance with prescription of formulary medications. The process of drug substitution has been reported to be time-intensive and prone to inaccuracies . CDSS linked to pharmacy and insurance formularies can result in error free substitutions resulting in improved patient outcomes through the prevention of ADEs. 
Increased practice efficiencies, cost savings, and reimbursement
EMRs help improve medical practice management by increasing practice efficiencies and cost savings. A practice can be made more efficient by using integrated EMR systems that can be used for scheduling, automated coding, and managing claims which save time as well. As one example, a clinic or physician practice can expect to increase revenue and decrease costs by converting the encounter form to digital format to reduce billing errors and revenue loss. Prompts for fields that need to be completed will reduce errors by an average of 78% according to one study . Communication is enhanced among clinicians, labs and health plans as information can be accessed from anywhere. EMRs save money by reducing redundancies in medical care, by eliminating costly tasks of creating paper charts and labor intensive management of paper charts. Very simply, the EHR eliminates paper chart pulls and staffing expenses can be reduced as a result. One study estimated that an average of $5 per pull would be saved considering the time and cost of medical records staff to retrieve and then re-file the paper chart. The clinic studied expected it would reduce paper chart pulls by approximately 600 annually and transcription costs would be reduced by 28% .
There is significant evidence to show that while initial costs remain an issue, switching from paper records to EHR systems will ultimately reduce overall health care expenses. Documenting electronically is much less time consuming than documenting on paper allowing physicians more time with their patients and the ability to see more patients.  Historically, it has been difficult to identify and achieve a solid, measurable Return on Investment (ROI) following Electronic Health Records (EHR) or other clinical system implementation initiatives. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has motivated system implementations, and the associated incentive dollars have offered a simple measure of ROI on the revenue side of the ledger, but this represents only one aspect of the substantial benefits clinical systems can yield. A proper optimization program, with broader consideration for the projects comprising it, can bring a truly positive ROI to healthcare organizations over a 10-15 year period if properly considered and executed. (Cumberland Consulting Group, 2013) Research indicates that Medicare and private payers could save tens of billions of dollars every year. To incentivize EMR adoption, the federal government has established a plan to provide $44.7 billion during 2010-2019 to financially assist health care providers in the EMR implementation process . However according to Himmelstein, Wright & Woolhandler, as currently implemented, the use of Electronic Medical Records could moderately advance metrics related to quality measures, it does however not reduce the cost of administration of ‘overall’ costs. “Hospitals on the ‘Most Wired’ list performed no better than others on quality, costs, or administrative costs” (Himmelstein, Wright & Woolhandler, 2009). Forecasts of potential improvements in efficiency and cost-savings from implementation of computerized health care and the use of Electronic Medical Records seem premature at the time the authors published their data in 2009 . According to DRCRHONO, physicians qualify to get $24,000 or more as part of the economic stimulus incentive offered by the HITECH act if they adopt a certified EMR. Incentives are given to providers who qualify. The stimulus includes $24,000 in Medicare Incentives or $63,750 in Medicaid Incentives. The government is putting in $19.2 billion dollars to help move all doctors off paper records onto electronic systems .
A scheduling/practice management system in an ambulatory care setting can improve efficiency by reducing the no-show rate. One study demonstrated a reduction from 19% to 10% in a practice that used generated reminder postcards for appointments. Each $1 spend on reminders generated $7.50 revenue. 
EMR implementations could affect physician and health system reimbursement in a number of ways. Some have argued that increased clinical documentation as a result of using an EMR will lead to increased billing and therefore reimbursement. Having an electronic health record can mean less time with filing claims or searching for documentation. If a physician works in many different locations accessing a patients electronic record from a different location is very easy.  An increase in emergency department billing among Medicare patients has been attributed to more complete documentation that allows for higher levels of billing . However, given the pay-for-service model present in many facets of the American healthcare system, some of the cost savings possibly generated by the introduction of an EMR – such as eliminating unnecessary and duplicated tests and ineffective procedures – could lead to decreased reimbursement for the physicians and health systems.
According to a survey performed by the National Center for Health Statistics, in collaboration with the Office of the National Coordinator for HIT, it was found that 82% of providers report time savings when sending prescriptions electronically and that 79% of providers see increased efficiency when using an electronic health record. 
Implementation of EHR in Ambulatory Practices
"Implementation of an EHR was associated with increased revenues but also sustained losses of productivity in ambulatory practices for at least 2 years. Practices were able to maintain reimbursements by billing more ancillary procedures such as immunizations, venepuncture and EKGs in the primary practices." 
Various approaches to ROI
Cost benefit analysis is categorized into 3 fields :
Direct, one-time costs
- Hardware & Peripherals
- Packaged and customized software
- Network, peripherals, supplies, equipment
- Initial data collection and conversion of archival data
- Facilities upgrades, including site preparation and renovation
- End-user project management
- Project planning, contract negotiation, procurement
- Application development and deployment
- Configuration management
- Office accommodations, furniture, related items
- Initial user training
- Workforce adjustment for affected employees
- Transition costs (parallel systems, converting legacy systems)
- Quality assurance and post implementation reviews
Direct, ongoing costs
- Salaries for IT and assigned end user staff
- Software maintenance, subscriptions, upgrades,
- Equipment leases
- Facilities rental and utilities
- Professional services, Ongoing training and
- Reviews and audits
Indirect, ongoing costs
- Data integrity
- IT policy management
- Help Desk
The financial commitment of implementing a CPOE system varies amongst facilities and depends on the facility's current hardware and software systems. The institution's current system needs to have a strong infrastructure in order to be able to enhance it's capabilities. The license for the software is but a small portion of the total cost. The larger expenses incurred will be a result of training healthcare professionals and support activities. Customer service and technical support should be available everyday 24 hours a day.
For more information, see EMR Cost Categories.
The typical pattern of determining ROI is as follows:
- Organizations implement the electronic health records(EHRs), then optimize.
- The chief medical information officer (CMIO) is charged with making the EHR work.
- ROI is too difficult to calculate and too time-consuming to determine
- Success is measured by whether the project is "on-time" and "on-budget"
Next-Generation Value Realization
- Organizations seek to optimize business and clinical result through value realization.
- Physician leader, such as the chief medical officer and the chief transformation officer, work with the CMIO to be accountable for value.
- "On-value" and "speed-to-value" will be critical measures of success.
- Lean will be combined with other methodologies to drive breakthrough innovation, performance improvement, and change.
- Financial, clinical, business strategy, and IT leaders will work together to create an organization value management strategy and approach. 
- Arlotto (2014) defends the right that EHRs are able to provide organizations the greatest value in the future of healthcare. She argues that this can be accomplished through the involvement of business, clinical, and financial platforms within an organization. As the healthcare industry is transitioning from volume to value based payment, organizations are increasingly depending on IT applications to facilitate the progress. She explains that our current healthcare practices use EHRs as an entity that simply automates the paper record and measure value based on direct cost-benefit analysis, rather than ensuring value realized over the lifetime of the investment. Five commonly mistaken truths are further discussed in order to facilitate the transition for more efficient use of EHR. 
How to achieve a positive ROI
A key to achieving a positive return on investment (ROI) when implementing an EHR system is using it for more than meeting meaningful use requirements. A 2013 study conducted by Harvard University researchers showed that many practices that implemented EHRs showed a negative 5 year ROI. Citing only 27 percent of practices which adopted EHRs would show a positive ROI. The reason for this according to their research was that many practices were not using their EHR systems effectively. The practices which showed a positive ROI were able to use their EHR in a way that increased the number of patients they were able to see in a day as well as improving their billing to reduce rejected claims. The practices which showed a negative ROI were mostly still using paper charts heavily even after implementing the EHR system. This resulted in decreased productivity on top of the expense of the system. The most important step practices must take to see a positive ROI on EHRs is to take the time to optimize their use so they can improve efficiency and reduce costs. Since the roll out of meaningful use many organizations and providers are still asking themselves if the use of this technology has improved the delivery and quality of patient care. Value can be defined in many ways and be difficult to measure. With that said organizations need to be fully committed to implementing the technology and follow up with post implementation optimization. 
Challenges to identifying a ROI
Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications . For organizational stakeholders to embrace EHR adoption, they need assurance that adopting an EHR system would positively impact business performance .
Additional barriers include:
- Vendor supplied benefits data may not be objective
- Few vendors maintain a structured database of benefits information (see EMR Benefits: Benefits Database)
- Peer reviewed studies are difficult to compare due to the complexity of health services delivery and variety of provider settings.
- Differences in system architecture
- Trade journals tend to focus on anecdotal evidence rather then empirical evidence
- No standardized domain method exists to measure the ROI of electronic health records
- Lack of information regarding maintenance and optimization costs 
Factors that contribute to calculation of ROI, such as increased revenue, decreased expenses and costs avoided are difficult to document and attribute directly to EMR implementation. For example, a value-added benefit such as increased patient satisfaction is not easily translated into financial gain. .
Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. 
Evaluation of Low Value Services
Although implementation of electronic health records can increase income through billing of ancillary procedures, EHRs can also be used to identify low value services and consequently decrease cost and maximize value. In a study published in the Journal of the American Medical Informatics Association, the authors found that "secondary analysis of EHR data can accurately measure the use of low-value services such as Pap testing performed sooner than recommended in women at low risk of cervical cancer." Although this study was limited to a specific screening exam, the authors concluded that "similar application of our methodology could facilitate efforts to simultaneously improve quality and decrease costs, maximizing value in the US healthcare system."
The adoption of EMRs is largely beneficial to healthcare providers as financial incentives are provided for use. In 2009, the HITECH Act was passed to “promote the use of electronic health records by providing over $27 billion in financial incentives for eligible health care providers who become ‘meaningful users’ of them”  . The main goal behind increasing the meaningful users of electronic health records (EHR) was to enable greater efficiency of a patient-centered health care system, thereby reducing administrative costs of healthcare providers and improving coordination of care between multiple providers, while increasing the patient’s participation in being an active part of their own care process .
The meaningful use of certified EHR systems is the central focus of healthcare providers as this is the method toward attaining governmental funding and incentives. Starting in 2011, the HITECH provisions of the American Recovery and Reinvestment Act of 2009 (ARRA) allows incentive payments from the Centers for Medicare & Medicaid Services (CMS) to be furnished to eligible providers that demonstrate meaningful use of certified EHR technology 
The American Reinvestment and Recovery Act law creates two key concepts to determine whether providers qualify for the health IT incentives: they must make "meaningful use" of IT and use a "qualified or certified EHR" (electronic health record). Besides incentives to providers and hospitals, the law also creates $2 billion in health IT funding administered by the Office of the National Coordinator for Health Information Technology (ONC). A significant amount of this $2 billion should lay important groundwork to help providers use health IT meaningfully toward the goals of improving the nation's health. (14)
In recent years, many providers have factored government incentive payments into the cost analysis and final decision to purchase an EHR. The Medicare EHR Incentive Program provides incentive payments of $44,000 over five years to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HPSA). Medicare eligible professionals who predominantly furnish services in an area designated as a Health Professional Shortage Area (HPSA) will receive a 10% increase in their annual EHR incentive payments.(29)
The Medicaid EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. (11)
Beginning in 2015, Medicare eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%.(29)
Certified EMRs significantly aid healthcare professionals and hospitals in achieving Meaningful Use measures by means including:
- Pop up alerts to providers reminding them to ask the patient for smoking status, medical history, ect.
- Allowing providers to proactively see how they are doing and compare themselves to their peers
Several EMRs also dramatically increase the chance of hospitals and physicians collecting Meaningful Use money by providing reports to submit proof that those measures were met. When Meaningful Use measures are met and submitted, a Physician can earn up to $44,000 a year for 5 years and avoid paying penalties for not meeting the requirements 
National and international effects
Growth, Job creation, and enhancement in the Commercial Clinical IT sector
The commercial marketplace for clinical IT products has evolved dramatically in recent years through corporate mergers, acquisitions, and other challenges to fledgling startup companies. Cerner Corporation and Eclipsys Corporation, two vendors of clinical IT solutions, have acquired the greatest share of the market. Other major participants include Epic Systems Corporation (Madison, WI), IDX (Burlington, VT), McKesson (San Francisco, CA), Siemens Medical Solutions (Erlangen, Germany), and Meditech (Westwood, MA).2,3 Industry analysts estimate that only 5% of the health care IT market has been penetrated, and this estimate has led to optimistic growth forecasts for vendors of clinically focused IT products as the market continues to mature.
Adapt to governmental regulatory changes and requirements
HIPAA and other legislative bodies often require specific requirements. Compiling information from thousands of documents could be needed to complete the government’s requirements, a feat that would be inefficiently labor and time intensive if done with paper records. Digital patient records helps administration and upper management to meet requirements and regulatory changes to satisfy legislative demands. With digital records, auditors can quickly see if physicians and hospital systems are government compliant and can easily point out if they are not, allowing the non-compliant party to correct their inadequacy. 
Add in later elsewhere
These offer substantial benefits to the organization, but at some future date. E.g. investments in networking and telecommunications offer significant future strategic benefits, positioning organizations to utilize enterprise-wide patient indexing and EMR or distributed case management technologies as they emerge.
If EMR is fully implemented and functional, the benefits they offer are substantially than a paper records. Some of these benefits are:
- Improvement in quality of patient care
- An increase patient participation in their care (making appoints, refill of prescriptions, limited access to their records.
- There will be an improvement in the accuracy of diagnoses and health outcomes-decrease of some types of medical errors
- Improve care coordination
- Increase practice efficiencies and cost savings 
Sources of Funding
- Organizational Reserves – provider organization make investments in affiliated organizations
- Bank and other financial service – short term loans
- Capital leases – used for large equipment acquisitions but can be negotiated for a major IT investment
- Vendor discounts and incentives – requires something in return
- Joint venture or partnership – tighter relationship
- Health plans and plan sponsors – contractual arrangement
- Private philanthropy – fellowships or university chairs
- Pharmaceutical companies – willing to conduct clinical trials
- Public grants – government initiatives
- State legislative initiatives – local and state initiatives
60. Interviews with John Kansky, Laura Adams (2014, 8) by Mark Braunstein, GA Tech. 61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf
Although it is assumed that EHR adoption have various benefits, in reality, it is not always the case. Example reviews include:
- O'Neill, T. (2015, August). Are Electronic Medical Records Worth the Cost of Implementation.
- Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study. Sameer Kumar, Krista Aldrich. http://jhi.sagepub.com/content/16/4/306.full.pdf+html
- Matthias Turina, MD, PhD1 and Ravi P. Kiran, MBBS, MS1 Electronic Medical Records in Colorectal Surgery http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3699143
- EHR financial benefits http://www.medscape.com/viewarticle/731134
- Benefits of EHR-Cost savings. http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
- Medical Practice Efficiencies and Cost Savings http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings
- Administrative Cost Advantages of Electronic Medical Records. http://www.medicalrecords.com/physicians/advantages-of-electronic-medical-records
- Electronic health records may lower malpractice settlements. Nov 2008. http://www.eurekalert.org/pub_releases/2008-11/hms-ehr112508.php
- Cannon, J & Lucci, S. Transcription and EHRs: Benefits of a Blended Approach. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046429.hcsp?dDocName=bok1_046429
- The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp
- Wang, S. J., Middleton, B., A. Prosser, L., G. Bardon, C., D. Spurr, C., J. Carchidi, P. A cost-benefit analysis of electronic medical records in primary care. http://www.ncbi.nlm.nih.gov/pubmed/12714130
- Chen, P. A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. http://www.ncbi.nlm.nih.gov/pubmed/12645347
- Kaushal at al, 2006. Return on Investment for a Computerized Physician Order Entry System. http://jamia.oxfordjournals.org/content/13/3/261.long
- Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56.
- Cook-Moine, Colleen. (2005, April). Financial Savings From an Electronic Medical Record in a Small Group Practice. http://www.himssehra.org/docs/caseStudies/CHARTCARE_Eden%20Park%20ROI.pdf
- Wang, Tiankai; Biedermann, Sue. "Running the Numbers on an EHR: Applying Cost-Benefit Analysis in EHR Adoption." Journal of AHIMA 81, no.8 (August 2010): 32-36. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047866.hcsp?dDocName=bok1_047866
- Hoffman, S. & Podgurski, A. Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems.http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1122426
- Shekelle P, Morton SC, Keeler EB. Costs and Benefits of Health Information Technology.http://www.ncbi.nlm.nih.gov/books/NBK37984/#A210194
- McGregor JC, Weekes E, Forrest GN, et al. Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513678/
- Kuperman, G. J., & Gibson, R. F. (2003). Computer Physician Order Entry: Benefits, Costs and Issues. Annals of Internal Medicine, 139, 31-39. Retrieved from http://annals.org/article.aspx?articleid=716518
- Pruszydlo, M. G., Walk-Fritz, S. U., Hoppe-Tichy, T., Kaltschmidt, J., & Haefeli, W. E. (2012). Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care. BMC Med Inform Decis Mak, 12, 137. doi: 10.1186/1472-6947-12-137
- 5 simple ways to realize ROI from your EHR.http://www.healthcareitnews.com/news/5-simple-ways-realize-roi-your-ehr/
- Quattlebaum TG1, Darden PM, Sperry JB.Effectiveness of computer-generated appointment reminders.http://www.ncbi.nlm.nih.gov/pubmed/1910162
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