title: Which components of health information technology will drive financial value?
abstract: The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most likely to drive financial savings in the ambulatory, inpatient, and emergency department settings.
  
  
  
  Framework development and a national expert panel.
  
  
  
  We searched the literature to identify functionalities enabled by EHRs and HIE across the 3 healthcare settings. We rated each of 233 functionality-setting combinations on their likelihood of having a positive financial effect. We validated the top-scoring functionalities with a panel of 28 national experts, and we compared the high-scoring functionalities with Stage 1 meaningful use criteria.
  
  
  
  We identified 54 high-scoring functionality- setting combinations, 27 for EHRs and 27 for HIE. Examples of high-scoring functionalities included providing alerts for expensive medications, providing alerts for redundant lab orders, sending and receiving imaging reports, and enabling structured medication reconciliation. Of the 54 high-scoring functionalities, 25 (46%) are represented in Stage 1 meaningful use. Many of the functionalities not yet represented in meaningful use correspond with functionalities that focus directly on healthcare utilization and costs rather than on healthcare quality per se.
  
  
  
  This work can inform the development and selection of future meaningful use measures; inform implementation efforts, as clinicians and hospitals choose from among a "menu" of measures for meaningful use; and inform evaluation efforts, as investigators seek to measure the actual financial impact of EHRs and HIE.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York, NY 10065, USA. lmk2003@med.cornell.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.forename: Adam
authors.initials: A
authors.lastname: Wilcox
authors.forename: Jason
authors.initials: J
authors.lastname: Shapiro
authors.forename: Rina V
authors.initials: RV
authors.lastname: Dhopeshwarkar
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D017046:Cost Savings; D057286:Electronic Health Records / Q000191:economics*; D063005:Health Information Systems / Q000191:economics*; D062527:Meaningful Use; D008490:Medical Informatics / Q000191:economics*; D008498:Medical Record Linkage; D014481:United States