http://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&feed=atom&action=historyEMR Benefits: Financial - Revision history2024-03-29T06:51:30ZRevision history for this page on the wikiMediaWiki 1.22.4http://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=25404&oldid=prevPtong: /* Alternative View */2015-09-28T18:13:55Z<p><span dir="auto"><span class="autocomment">Alternative View</span></span></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Although it is assumed that EHR adoption have various benefits, in reality, it is not always the case. Example reviews include:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>Although it is assumed that EHR adoption have various benefits, in reality, it is not always the case. Example reviews include:</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[[Does electronic health record use improve hospital financial performance|Does electronic health record use improve hospital financial performance]]</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[[Does electronic health record use improve hospital financial performance|Does electronic health record use improve hospital financial performance]]</div></td></tr>
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</table>Ptonghttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=25403&oldid=prevPtong: /* Sources of Funding */2015-09-28T18:13:35Z<p><span dir="auto"><span class="autocomment">Sources of Funding</span></span></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>  61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>  61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf</div></td></tr>
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<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">== Alternative View ==</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">Although it is assumed that EHR adoption have various benefits, in reality, it is not always the case. Example reviews include:</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">[[Does electronic health record use improve hospital financial performance|Does electronic health record use improve hospital financial performance]]</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== References ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== References ==</div></td></tr>
</table>Ptonghttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24799&oldid=prevSjalex: fixed a mess around transcription. still not ideal but better.2015-09-17T04:10:27Z<p>fixed a mess around transcription. still not ideal but better.</p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.[36]</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.[36]</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">One of the most widely touted financial benefits for physician offices is elimination of transcription services, which can save several thousand dollars per physician, per year. A 2010 article published by the American Health Information Management Association urges </del>practices to <del class="diffchange diffchange-inline">realistically gauge their probability of eliminating </del>transcription <del class="diffchange diffchange-inline">altogether</del>. <del class="diffchange diffchange-inline"> Many </del>practices <del class="diffchange diffchange-inline">instead opt </del>to <del class="diffchange diffchange-inline">retain some transcription</del>, or <del class="diffchange diffchange-inline">implement </del>voice recognition software in its place, <del class="diffchange diffchange-inline">mitigating the effect </del>of <del class="diffchange diffchange-inline">this factor on actual vs expected ROI (10)</del>. 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<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">Cannon & Lucci note that suggest that many </ins>practices <ins class="diffchange diffchange-inline">may be unable </ins>to <ins class="diffchange diffchange-inline">completely eliminate </ins>transcription <ins class="diffchange diffchange-inline">and its associated costs by switching to structured templates for clinical documentation</ins>. <ins class="diffchange diffchange-inline">A number of </ins>practices <ins class="diffchange diffchange-inline">have opted </ins>to <ins class="diffchange diffchange-inline">take a blended approach</ins>, <ins class="diffchange diffchange-inline">implementing templates but retaining transcription </ins>or <ins class="diffchange diffchange-inline">implementing </ins>voice recognition software in its place<ins class="diffchange diffchange-inline"><ref name="Cannon Lucci 2010">Cannon</ins>, <ins class="diffchange diffchange-inline">J & Lucci, S. Transcription and EHRs: Benefits </ins>of <ins class="diffchange diffchange-inline">a Blended Approach. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046429.hcsp?dDocName=bok1_046429</ref></ins>.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>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<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref>.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td></tr>
</table>Sjalexhttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24795&oldid=prevTeddisque: /* Reducing cost */2015-09-17T04:01:29Z<p><span dir="auto"><span class="autocomment">Reducing cost</span></span></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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 [38]. The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study<ref name="wang 2003">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 </ref>.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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 [38]. The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study<ref name="wang 2003">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 </ref>.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">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. <ref name = "Chen, P.">Chen, P. A computer-based intervention for improving the appropriateness of antiepileptic drug level monitoring. http://www.ncbi.nlm.nih.gov/pubmed/12645347 </ref></ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td></tr>
</table>Teddisquehttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24793&oldid=prevJcibekwe85: /* Incentive Programs */2015-09-17T03:55:42Z<p><span dir="auto"><span class="autocomment">Incentive Programs</span></span></p>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Incentive Programs ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Incentive Programs ==</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">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” <ref name="Galbraith 2013">Galbraith, K. L. (2013). What's So Meaningful about Meaningful Use?. Hastings Center Report, 43(2), 15-17. doi:10.1002/hast.154</ref></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">. 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 <ref name="Galbraith 2013">Galbraith, K. L. (2013). What's So Meaningful about Meaningful Use?. Hastings Center Report, 43(2), 15-17. doi:10.1002/hast.154</ref>. </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">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 <ref name="Fortin 2010">Fortin, J., & Zywiak, W. (2010). Beyond meaningful use: getting meaningful value from IT. Hfm (Healthcare Financial Management), 64(2), 54-59.</ref></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;"></ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">The [[ARRA|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 [[Office of the National Coordinator for Health Information Technology (ONC)|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)</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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)</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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)</div></td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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)</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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)</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">The [[ARRA|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 [[Office of the National Coordinator for Health Information Technology (ONC)|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)</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Meaningful Use ===  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Meaningful Use ===  </div></td></tr>
</table>Jcibekwe85http://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24788&oldid=prevSjalex: fixing wang_2003 reference2015-09-17T03:42:46Z<p>fixing wang_2003 reference</p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 03:42, 17 September 2015</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>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 [38]. The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study<del class="diffchange diffchange-inline">. </del><ref name="wang 2003"></ref></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>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 [38]. The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study<ref name="wang 2003"><ins class="diffchange diffchange-inline">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 </ins></ref><ins class="diffchange diffchange-inline">.</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td></tr>
</table>Sjalexhttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24786&oldid=prevSjalex: /* Efficiency of transactions */2015-09-17T03:41:54Z<p><span dir="auto"><span class="autocomment">Efficiency of transactions</span></span></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 03:41, 17 September 2015</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.[36]</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.[36]</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>One of the most widely touted financial benefits for physician offices is elimination of transcription services, which can save several thousand dollars per physician, per year. A 2010 article published by the American Health Information Management Association urges practices to realistically gauge their probability of eliminating transcription altogether.  Many practices instead opt to retain some transcription, or implement voice recognition software in its place, mitigating the effect of this factor on actual vs expected ROI (10). 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<del class="diffchange diffchange-inline">. </del><ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>One of the most widely touted financial benefits for physician offices is elimination of transcription services, which can save several thousand dollars per physician, per year. A 2010 article published by the American Health Information Management Association urges practices to realistically gauge their probability of eliminating transcription altogether.  Many practices instead opt to retain some transcription, or implement voice recognition software in its place, mitigating the effect of this factor on actual vs expected ROI (10). 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<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref>.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">The net benefit from using an EHR for a 5 year period was $86,400 per provider</del>. <del class="diffchange diffchange-inline"><ref name="wang 2003">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 </ref></del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Reducing cost ===</div></td></tr>
</table>Sjalexhttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24780&oldid=prevSjalex: /* Reducing cost */ fixed some facts, clarified some language, fixed and updated references2015-09-17T03:38:53Z<p><span dir="auto"><span class="autocomment">Reducing cost: </span> fixed some facts, clarified some language, fixed and updated references</span></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 03:38, 17 September 2015</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">In addition to reducing medication errors, EMR can help hospital savings on total drug costs annually by 15% just by recommending alternative drugs in the EMR reminders.<ref name="wang 2003"></ref>  </del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">Clinical support alerts and reminders can also assist with offering alternatives </del>to <del class="diffchange diffchange-inline">expensive medications and updates </del>on drug <del class="diffchange diffchange-inline">dosage recommendations. A </del>clinical decision <del class="diffchange diffchange-inline">to utilize a generic drug substitution </del>or <del class="diffchange diffchange-inline">decrease a drug dosage frequency from twice a day to once a day </del>can <del class="diffchange diffchange-inline">offer additional savings to a healthcare institution, </del>estimated <del class="diffchange diffchange-inline">at </del>$16,400 annually per provider <ref name="wang 2003"></ref><del class="diffchange diffchange-inline">Interventions </del>to switch <del class="diffchange diffchange-inline">the </del>twice-daily dosing of ceftriaxone to once-<del class="diffchange diffchange-inline">d</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">In addition </ins>to <ins class="diffchange diffchange-inline">reducing medication errors, EMRs may drive hospital savings </ins>on <ins class="diffchange diffchange-inline">total </ins>drug <ins class="diffchange diffchange-inline">costs up to 15% annually by means of </ins>clinical decision <ins class="diffchange diffchange-inline">support recommending alternative drugs </ins>or <ins class="diffchange diffchange-inline">alternative dosing regimens.<ref name="wang 2003"></ref>. Wang et al's analysis suggests that EMR implementation </ins>can <ins class="diffchange diffchange-inline">result in an </ins>estimated <ins class="diffchange diffchange-inline">drug savings of </ins>$16,400 annually per provider<ref name="wang 2003"></ref><ins class="diffchange diffchange-inline">. Kaushal et al showed that interventions </ins>to switch twice-daily dosing of ceftriaxone to once-<ins class="diffchange diffchange-inline">daily </ins>dosing at Brigham and Women's Hospital resulted in $<ins class="diffchange diffchange-inline">175</ins>,<ins class="diffchange diffchange-inline">094 </ins>in annual cost savings<ins class="diffchange diffchange-inline"><ref name="kaushal 2006"></ins>Kaushal at al, 2006<ins class="diffchange diffchange-inline">. Return on Investment for a Computerized Physician Order Entry System. http://jamia.oxfordjournals.org/content/13/3/261.long</ref></ins>.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">*Provide users with real time knowledge</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">*Reduce non-clinical time</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">*Increase patient doctor time</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">*Investment Motivationaily </del>dosing at Brigham and Women's Hospital <del class="diffchange diffchange-inline">(BWH)</del>resulted in $<del class="diffchange diffchange-inline">320</del>,<del class="diffchange diffchange-inline">000 </del>in annual cost savings <del class="diffchange diffchange-inline">(</del>Kaushal at al, 2006<del class="diffchange diffchange-inline">)</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. <ref>Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56.</ref></div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. <ref>Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56.</ref></div></td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. <ref name="Cook-Moine"> 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 </ref></div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. <ref name="Cook-Moine"> 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 </ref></div></td></tr>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Investment Flexibility ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Investment Flexibility ===</div></td></tr>
</table>Sjalexhttp://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24768&oldid=prevJstewart12: /* An EMR Cost Benefit Analysis */2015-09-17T03:20:24Z<p><span dir="auto"><span class="autocomment">An EMR Cost Benefit Analysis</span></span></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 03:20, 17 September 2015</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. [48]</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>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. [48]</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">=== An EMR Cost Benefit Analysis ===</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">Samsung Medical Center (SMC) performed a cost benefit analysis (CBA) on the cost benefits of implementing an electronic medical record (EMR) system.  Costs of implementing the EMR system involved both '''direct costs''' to build the system infrastructure and '''induced costs''' to make a smooth transition to the new system.  Benefits of implementing the EMR system include both cost reductions and increased revenue.  Five types of cost reductions, mentioned by the authors, include:</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"># Reduction of supplies for paper charts</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"># Disposal of storage facilities used for paper chart storage</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"># Reduction of full-time equivalent (FTE) employees for the paper chart management</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"># Reduction in staff for outpatient clinics</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"># Decreased supplies for medical devices</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">The FTE's responsible for paper management were greatly reduced from 28 FTE's (2007) to 1 FTE (2009).</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">This CBA was based on an eight year period post EMR implementation.  SMC determined the EMR system became cost effective shortly after 6 years.  The outcomes of the CBA were calculated using the following formulas:</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">* The primary outcome is the Net Present Value (NPV)</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">** '''NPV = Present Value (PV) of benefit for the eight year period - PV of cost'''</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">* The second outcome is the Benefit Cost Ratio (BCR)</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">** '''BCR = PV of the benefit / PV of the cost'''</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">* The third outcome is the Discounted Payback Period (DPP).  </del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">**'''This is the time to reach the breakeven point'''.</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;"></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/</ref></del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Evaluation of Low Value Services ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Evaluation of Low Value Services ==</div></td></tr>
</table>Jstewart12http://www.clinfowiki.org/wiki/index.php?title=EMR_Benefits:_Financial&diff=24760&oldid=prevJstewart12: /* An EMR Cost Benefit Analysis */2015-09-17T02:56:23Z<p><span dir="auto"><span class="autocomment">An EMR Cost Benefit Analysis</span></span></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 02:56, 17 September 2015</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>**'''This is the time to reach the breakeven point'''.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>**'''This is the time to reach the breakeven point'''.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>This CBA does not include clinical benefits of the EMR implementation such as decreased medication errors, improved workflow, and reduced length of stay.<ref name="Choi 2013">Choi, J., Lee, W., Rhee, P. (2013). Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital, Health Informatics Research;19(3):205-214. http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3810528/<ins class="diffchange diffchange-inline"></ref></ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Evaluation of Low Value Services ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Evaluation of Low Value Services ==</div></td></tr>
</table>Jstewart12