title: Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.
abstract: BACKGROUND
  In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts.
  
  
  METHODS
  Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE.
  
  
  RESULTS
  Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%.
  
  
  CONCLUSIONS
  Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA. ezimlichman@partners.org
authors.forename: Eyal
authors.initials: E
authors.lastname: Zimlichman
authors.forename: Carol
authors.initials: C
authors.lastname: Keohane
authors.forename: Calvin
authors.initials: C
authors.lastname: Franz
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Everett
authors.forename: Diane L
authors.initials: DL
authors.lastname: Seger
authors.forename: Catherine
authors.initials: C
authors.lastname: Yoon
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Leung
authors.forename: Bismarck
authors.initials: B
authors.lastname: Cadet
authors.forename: Michael
authors.initials: M
authors.lastname: Coffey
authors.forename: Nathan E
authors.initials: NE
authors.lastname: Kaufman
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D017046:Cost Savings; D020000:Decision Support Systems, Clinical / Q000191:economics*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics* / Q000517:prevention & control*; D006764:Hospitals, Community / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008404:Massachusetts; D050316:Medical Order Entry Systems / Q000191:economics*; D008508:Medication Errors / Q000517:prevention & control