Hospital computing and the costs and quality of care: a national study.
BACKGROUND
Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals.


METHODS
We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others.


RESULTS
More computerized hospitals had higher total costs in bivariate analyses (r=0.06, P=.001) but not multivariate analyses (P=.69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P=.0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r=0.07, P=.003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analyses, more computerized hospitals had slightly better quality. Hospitals on the "Most Wired" list performed no better than others on quality, costs, or administrative costs.


CONCLUSIONS
As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.
Himmelstein
David U
DU
Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, MA 02139, USA. Dhimmelstein@challiance.org
Wright
Adam
A
Woolhandler
Steffie
S
D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D057286:Electronic Health Records / Q000191:economics; D005260:Female; D019538:Health Care Surveys; D006739:Hospital Administration / Q000191:economics* / Q000592:standards; D017721:Hospital Costs; D006751:Hospital Information Systems / Q000191:economics*; D006801:Humans; D016014:Linear Models; D008297:Male; D008484:Medicaid / Q000191:economics; D016347:Medical Records Systems, Computerized / Q000191:economics* / Q000592:standards; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D011787:Quality of Health Care / Q000191:economics* / Q000458:organization & administration* / Q000592:standards; D012107:Research Design; D014481:United States