title: Effect of electronic health records on health care costs: longitudinal comparative evidence from community practices.
abstract: BACKGROUND
  The United States is aiming to achieve nationwide adoption of electronic health records (EHRs) but lacks robust empirical evidence to anticipate the effect on health care costs.
  
  
  OBJECTIVE
  To assess short-term cost savings from community-wide adoption of ambulatory EHRs.
  
  
  METHODS
  Longitudinal trial with parallel control group.
  
  
  METHODS
  Natural experiment in which 806 ambulatory clinicians across 3 Massachusetts communities adopted subsidized EHRs. Six matched control communities applied but were not selected to participate.
  
  
  METHODS
  47,979 intervention patients and 130,603 control patients.
  
  
  METHODS
  Monthly standardized health care costs from commercial claims data from January 2005 to June 2009, including total cost, inpatient cost, and ambulatory cost and its subtypes (pharmacy, laboratory, and radiology). Projected savings per member per month (PMPM), excluding EHR adoption costs.
  
  
  RESULTS
  Ambulatory EHR adoption did not impact total cost (pre- to postimplementation difference in monthly trend change, -0.30 percentage point; P = 0.135), but the results favored savings (95% CI, $21.95 PMPM in savings to $1.53 PMPM in higher costs). It slowed ambulatory cost growth (difference in monthly trend change, -0.35 percentage point; P = 0.012); projected ambulatory savings were $4.69 PMPM (CI, $8.45 to $1.09 PMPM) (3.10% of total PMPM cost). Ambulatory radiology costs decreased (difference in monthly trend change, -1.61 percentage points; P < 0.001), with projected savings of $1.61 PMPM (1.07% of total PMPM cost).
  
  
  CONCLUSIONS
  Intervention communities were not randomly selected and received implementation support, suggesting that results may represent a best-case scenario. Confounding is possible.
  
  
  CONCLUSIONS
  Using commercially available EHRs in community practices seems to modestly slow ambulatory cost growth. Broader changes in the organization and payment of care may prompt clinicians to use EHRs in ways that result in more substantial savings.
authors.affiliation: University of Michigan, School of Information, 4376 North Quad, 105 South State Street, Ann Arbor, MI 48109, USA. juliaam@umich.edu
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
authors.forename: Claudia
authors.initials: C
authors.lastname: Salzberg
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Newhouse
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D017046:Cost Savings; D017598:Efficiency, Organizational; D057286:Electronic Health Records / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D008404:Massachusetts; D016555:Matched-Pair Analysis; D010865:Pilot Projects