School of Information, University of Michigan, Ann Arbor, USA.
Health Aff (Millwood). 2013 Mar;32(3):562-70. doi: 10.1377/hlthaff.2012.0306.
Health care providers remain uncertain about how they will fare financially if they adopt electronic health record (EHR) systems. We used survey data from forty-nine community practices in a large EHR pilot, the Massachusetts eHealth Collaborative, to project five-year returns on investment. We found that the average physician would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful-use incentive. The largest difference between practices with a positive return on investment and those with a negative return was the extent to which they used their EHRs to increase revenue, primarily by seeing more patients per day or by improved billing that resulted in fewer rejected claims and more accurate coding. Almost half of the practices did not realize savings in paper medical records because they continued to keep records on paper. We conclude that current meaningful use incentives alone may not ensure that most practices, particularly smaller ones, achieve a positive return on investment from EHR adoption. Policies that provide additional support, such as expanding the regional extension center program, could help ensure that practices make the changes required to realize a positive return on investment from EHRs.
医疗机构对于采用电子健康记录（EHR）系统后在财务方面的表现仍存在不确定性。我们使用了来自大型 EHR 试点项目——马萨诸塞州电子健康合作组织（Massachusetts eHealth Collaborative）中的 49 家社区医疗机构的调查数据，对投资回报进行了五年预测。我们发现，一般来说，医生在五年内会损失 43743 美元；只有 27%的医疗机构能够获得投资回报；如果他们获得了 44000 美元的联邦“有意义使用”激励，那么只有另外 14%的医疗机构能够获得收益。投资回报为正的医疗机构和投资回报为负的医疗机构之间最大的区别在于他们利用 EHR 增加收入的程度，主要是通过每天看更多的病人，或者通过改进计费，减少拒付索赔和更准确的编码，从而获得更多的收入。近一半的医疗机构没有在纸质病历上节省成本，因为他们仍在使用纸质记录。我们的结论是，仅目前的“有意义使用”激励措施可能无法确保大多数医疗机构（特别是规模较小的医疗机构）从采用 EHR 中获得投资回报。提供额外支持的政策，如扩大区域扩展中心计划，可能有助于确保医疗机构做出必要的改变，从 EHR 中获得投资回报。
