What is the value of Electronic Medical Records?
There are a pair of very interesting studies that I’ve seen recently that speak to different sides of this discussion. The first is a paper from Carnegie Mellon that looks at patient safety events in Pennsylvania and determines that electronic medical records are a major player in increasing safety:
We nd that the hospitals’ adoption of advanced EMRs has a benecial impact on patient safety, as reported events decline by 27 percent. This overall decline is driven by declines in several important subcategories, 30 percent decline in events due to medication errors and 25 percent decline in events due to complications….
The study seems to have validated its results against common objections so the BS check is fairly strong. They were not looking for strong mortality impacts, but the impacts they found were notable but not statistically significant. But EMRs seem to improve safety and quality after adaption.
The Incidental Economist is passing along a study about the effectiveness of the HITECH Act of 2009 that looks at the impact of the Act which gave all providers incentives to implement EHR.
As of 2008, about 48 percent of independent hospitals and 55 percent of system hospitals had adopted at least one of two advanced EMR technologies, physician documentation (PD) and computerized practitioner order entry (CPOE). By 2011, these adoption rates for both independent and system members had risen to 77 percent. […]
Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent. Thus, HITECH promoted adoption among independent hospitals by an additional 10 percentage points. While this may seem like a substantial effect, when we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million, which is more than enough to cover the cost of a generous EMR system. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.
Now this raises a really interesting question — does $48 million dollars for an additional two years of EHR make sense? If the first study or studies like it can show that EHRs can gain between 100 to 480 Quality Adjusted Life Years in a two year period, then the HITECH Act was a great investment of social resources as the benefits would exceed the costs. The reason why the spread is so large is that there is a good deal of debate on what the US willingness to pay for a QALY is worth. Another way of looking at it is that most federal regulations assume a $6 million dollar cost in regulatory burden is a reasonable cost if it prevents one average death. With that view, if EMRs can prevent a few average deaths per year for the two years of accelerated adaption, then HITECH was a good deal.