Clinical research studyHospital Computing and the Costs and Quality of Care: A National Study
Section snippets
Data Sources
We analyzed data from 3 sources: the Healthcare Information and Management Systems Society (HIMSS) Analytics annual survey of hospitals' computerization; the Medicare Cost Reports submitted to the Centers for Medicare and Medicaid Services; and the 2008 Dartmouth Health Atlas, which compiles Centers for Medicare and Medicaid Services data on the costs and quality of care that hospitals deliver to Medicare patients.
We used HIMSS surveys for the years 2003 to 2007 to assess the degree of hospital
Results
Hospital computerization increased between 2003 and 2004 and from 2005 to 2007. Data discontinuity precluded analysis of changes between 2004 and 2005. By 2007, the average hospital in the HIMSS survey had implemented 64% of the 24 surveyed computer applications, although only 23% had implemented computerized physician order entry. Larger urban and teaching hospitals were more computerized, whereas public hospitals were less computerized. As expected, hospitals on the “Most Wired” lists
Discussion
We found no evidence that computerization has lowered costs or streamlined administration. Although bivariate analyses found higher costs at more computerized hospitals, multivariate analyses found no association. For administrative costs, neither bivariate nor multivariate analyses showed a consistent relationship to computerization. Although computerized physician order entry was associated with lower administrative costs in some years on bivariate analysis, no such association remained after
Conclusions
Whatever the explanation, as currently implemented, health information technology has a modest impact on process measures of quality, but no impact on administrative efficiency or overall costs. Predictions of cost-savings and efficiency improvements from the widespread adoption of computers are premature at best.
Acknowledgment
HIMSS Analytics provided data free of charge but played no role in the analysis or interpretation of the data.
References (37)
- et al.
The extent and importance of unintended consequences related to computerized provider order entry
J Am Med Inform Assoc
(2007) - et al.
Final Report on the Evaluation of the Implementation of a Medical Information System in a General Community Hospital
(1975) The Computer-Based Patient Record
(1991)Toward a National Health Information InfrastructureReport of the Work Group on Computerization of Patient Records to the Secretary of the US Department of Health and Human Services
(April 1993)Huge savings expected from new EDI standards
Mod Healthc
(1996)- et al.
The value of health care information exchange and interoperabilityHealth Affairs, Web Exclusive January 19, 2005
- et al.
Can electronic medical record systems transform health care?Potential health benefits, savings, and costs
Health Aff (Millwood)
(2005) HHH.gov: Health Information Technology
Evidence report/technology assessment number 132: Costs and benefits of health information technology. AHRQ Publication No. 06-E006, April 2006
Systematic review: impact of health information technology on quality, efficiency, and costs of medical care
Ann Intern Med
Evidence on the costs and benefits of health information technology. Publication number 2976. Washington: Congressional Budget Office, May, 2008
Key issues in analyzing major health insurance proposals. Publication number 3102. Washington: Congressional Budget Office, December, 2008
Administration costs in US hospitals
N Engl J Med
Costs of care and administration at for-profit and other hospitals in the United States
N Engl J Med
The 2008 Dartmouth Atlas of Health Care
Quality Measures: What are the hospital process of care measures?
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Funding: None.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.