Early cost and safety benefits of an inpatient electronic health record

Abstract

There is controversy over the impact of electronic health record (EHR) systems on cost of care and safety. The authors studied the effects of an inpatient EHR system with computerized provider order entry on selected measures of cost of care and safety. Laboratory tests per week per hospitalization decreased from 13.9 to 11.4 (18%; p < 0.001). Radiology examinations per hospitalization decreased from 2.06 to 1.93 (6.3%; p < 0.009). Monthly transcription costs declined from $74,596 to $18,938 (74.6%; p < 0.001). Reams of copy paper ordered per month decreased from 1668 to 1224 (26.6%; p < 0.001). Medication errors per 1000 hospital days decreased from 17.9 to 15.4 (14.0%; p < 0.030), while near misses per 1000 hospital days increased from 9.0 to 12.5 (38.9%; p < 0.037), and the percentage of medication events that were medication errors decreased from 66.5% to 55.2% (p < 0.007). In this manuscript, we demonstrate that the implementation of an inpatient EHR with computerized provider order entry can result in rapid improvement in measures of cost of care and safety.

Figure 1

Mean number of laboratory tests per week per hospitalization in the year before electronic health record (EHR) implementation, the first 3 months after EHR implementation without computerized provider order entry (CPOE), and the 9 months after CPOE implementation.

Figure 2

Mean number of radiology examinations completed per hospitalization in the year before health record (EHR) implementation, the first 3 months after EHR implementation without computerized provider order entry (CPOE), and the 9 months after CPOE implementation.

Figure 3

Medication events per 1000 hospital days and percentage of medication errors compared with near misses in the year before electronic health record (EHR) implementation, the first 3 months after EHR implementation without computerized provider order entry (CPOE), and the 9 months after CPOE implementation.