University of Michigan, School of Information, 4376 North Quad, 105 South State Street, Ann Arbor, MI 48109, USA.
Ann Intern Med. 2013 Jul 16;159(2):97-104. doi: 10.7326/0003-4819-159-2-201307160-00004.
The United States is aiming to achieve nationwide adoption of electronic health records (EHRs) but lacks robust empirical evidence to anticipate the effect on health care costs.
To assess short-term cost savings from community-wide adoption of ambulatory EHRs.
Longitudinal trial with parallel control group.
Natural experiment in which 806 ambulatory clinicians across 3 Massachusetts communities adopted subsidized EHRs. Six matched control communities applied but were not selected to participate.
47,979 intervention patients and 130,603 control patients.
Monthly standardized health care costs from commercial claims data from January 2005 to June 2009, including total cost, inpatient cost, and ambulatory cost and its subtypes (pharmacy, laboratory, and radiology). Projected savings per member per month (PMPM), excluding EHR adoption costs.
Ambulatory EHR adoption did not impact total cost (pre- to postimplementation difference in monthly trend change, -0.30 percentage point; P = 0.135), but the results favored savings (95% CI, $21.95 PMPM in savings to $1.53 PMPM in higher costs). It slowed ambulatory cost growth (difference in monthly trend change, -0.35 percentage point; P = 0.012); projected ambulatory savings were $4.69 PMPM (CI, $8.45 to $1.09 PMPM) (3.10% of total PMPM cost). Ambulatory radiology costs decreased (difference in monthly trend change, -1.61 percentage points; P < 0.001), with projected savings of $1.61 PMPM (1.07% of total PMPM cost).
Intervention communities were not randomly selected and received implementation support, suggesting that results may represent a best-case scenario. Confounding is possible.
Using commercially available EHRs in community practices seems to modestly slow ambulatory cost growth. Broader changes in the organization and payment of care may prompt clinicians to use EHRs in ways that result in more substantial savings.
美国正致力于在全国范围内采用电子健康记录（EHRs），但缺乏有力的实证证据来预测这对医疗成本的影响。
评估社区范围内采用门诊 EHR 带来的短期成本节约。
具有平行对照组的纵向试验。
在马萨诸塞州的 3 个社区，806 名门诊临床医生采用补贴的 EHR 进行了自然实验。另外 6 个匹配的对照组申请但未被选中参与。
47979 名干预患者和 130603 名对照患者。
从 2005 年 1 月至 2009 年 6 月的商业索赔数据中每月标准化的医疗保健费用，包括总成本、住院成本和门诊成本及其亚型（药房、实验室和放射科）。每位成员每月的预计节约额（PMPM），不包括 EHR 采用成本。
门诊 EHR 的采用并未影响总费用（每月趋势变化的实施前后差异，-0.30 个百分点；P = 0.135），但结果有利于节约（95%CI，节省 21.95 PMPM 至增加成本 1.53 PMPM）。它减缓了门诊成本的增长（每月趋势变化的差异，-0.35 个百分点；P = 0.012）；预计门诊节约额为 4.69 PMPM（CI，8.45 至 1.09 PMPM）（占总 PMPM 成本的 3.10%）。门诊放射科费用减少（每月趋势变化的差异，-1.61 个百分点；P < 0.001），预计节约额为 1.61 PMPM（占总 PMPM 成本的 1.07%）。
干预社区并非随机选择，且获得了实施支持，这表明结果可能代表了最佳情况。可能存在混杂因素。
在社区实践中使用商业上可用的 EHR 似乎可以适度减缓门诊成本的增长。医疗保健的组织和支付方式的更广泛变化可能会促使临床医生以更节省的方式使用 EHR。
