title: The long-term financial impact of electronic health record implementation.
abstract: OBJECTIVE
  To examine the financial impact of electronic health record (EHR) implementation on ambulatory practices.
  
  
  METHODS
  We tracked the practice productivity (ie, number of patient visits) and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared each practice to their pre-EHR implementation baseline.
  
  
  RESULTS
  Reimbursements significantly increased after EHR implementation even though practice productivity (ie, the number of patient visits) decreased over the 2-year observation period. We saw no evidence of upcoding or increased reimbursement rates to explain the increased revenues. Instead, they were associated with an increase in ancillary office procedures (eg, drawing blood, immunizations, wound care, ultrasounds).
  
  
  CONCLUSIONS
  The bottom line result-that EHR implementation is associated with increased revenues-is reassuring and offers a basis for further EHR investment. While the productivity losses are consistent with field reports, they also reflect a type of efficiency-the practices are receiving more reimbursement for fewer seeing patients. For the practices still seeing fewer patients after 2 years, the solution likely involves advancing their EHR functionality to include analytics. Although they may still see fewer patients, with EHR analytics, they can focus on seeing the right patients.
  
  
  CONCLUSIONS
  Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context.
authors.affiliation: LeBow College of Business, Drexel University, Philadelphia, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Howley
authors.affiliation: Department of Internal Medicine and Clinical Informatics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Edgar Y
authors.initials: EY
authors.lastname: Chou
authors.affiliation: Department of Clinical Informatics, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Hansen
authors.affiliation: AHIP, College of Information Science and Technology, Drexel University, Philadelphia, Pennsylvania, USA.
authors.forename: Prudence W
authors.initials: PW
authors.lastname: Dalrymple
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000458:organization & administration; D059019:Clinical Coding; D017598:Efficiency, Organizational / Q000191:economics*; D057286:Electronic Health Records / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D009936:Organizational Innovation; D014481:United States
keywords: Electronic Health Record; Financial Impact; Provider Productivity; Provider Reimbursement