title: Modeling return on investment for an electronic medical record system in Lilongwe, Malawi.
abstract: OBJECTIVE
  To model the financial effects of implementing a hospital-wide electronic medical record (EMR) system in a tertiary facility in Malawi.
  
  
  METHODS
  We evaluated three areas of impact: length of stay, transcription time, and laboratory use. We collected data on expenditures in these categories under the paper-based (pre-EMR) system, and then estimated reductions in each category based on findings from EMR systems in the USA and backed by ambulatory data from low-income settings. We compared these potential savings accrued over a period of 5 years with the costs of implementing the touchscreen point-of-care EMR system at that site.
  
  
  RESULTS
  Estimated cost savings in length of stay, transcription time, and laboratory use totaled US$284 395 annually. When compared with the costs of installing and sustaining the EMR system, there is a net financial gain by the third year of operation. Over 5 years the estimated net benefit was US$613 681.
  
  
  CONCLUSIONS
  Despite considering only three categories of savings, this analysis demonstrates the potential financial benefits of EMR systems in low-income settings. The results are robust to higher discount rates, and a net benefit is realized even under more conservative assumptions.
  
  
  CONCLUSIONS
  This model demonstrates that financial benefits could be realized with an EMR system in a low-income setting. Further studies will examine these and other categories in greater detail, study the financial effects at different levels of organization, and benefit from post-implementation data. This model will be further improved by substituting its assumptions for evidence as we conduct more detailed studies.
authors.affiliation: Department of Health Policy & Management, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. driessen@pitt.edu
authors.forename: Julia
authors.initials: J
authors.lastname: Driessen
authors.forename: Marco
authors.initials: M
authors.lastname: Cioffi
authors.forename: Noor
authors.initials: N
authors.lastname: Alide
authors.forename: Zach
authors.initials: Z
authors.lastname: Landis-Lewis
authors.forename: Gervase
authors.initials: G
authors.lastname: Gamadzi
authors.forename: Oliver Jintha
authors.initials: OJ
authors.lastname: Gadabu
authors.forename: Gerald
authors.initials: G
authors.lastname: Douglas
mesh_terms: D017046:Cost Savings; D003906:Developing Countries; D004469:Economics, Hospital; D006739:Hospital Administration / Q000191:economics; D006801:Humans; D007449:Investments; D007902:Length of Stay / Q000191:economics; D008295:Malawi; D016347:Medical Records Systems, Computerized / Q000191:economics*; D018803:Models, Economic
keywords: Cost Savings; Economics; Electronic Medical Records; Low-Income Population; Malawi