Jan. 6—A new model aims to help hospitals determine the ROI of their electronic health record (EHR) systems and best configure these systems to achieve optimal value.

The model, which was developed by participants in the Institute of Medicine's (IOM's) Digital Learning Collaborative and members of HFMA, includes a standard approach for calculating the financial costs, benefits, and implications of implementing and optimizing EHRs and related technologies.

The model comes several years into the federal meaningful use program, which sought to provide about $27 billion in incentive payments to providers that adopt and implement qualifying EHRs. The model will help hospitals at various stages of implementation assess their financial benefits to-date and to adjust the ongoing implementation and use accordingly.

"It’s a standard framework of the ways that organizations are thinking about the return from their EHR investments," said Chad Mulvany, director of healthcare finance policy, strategy, and development for HFMA. "The first part is to measure where we are with EHRs, and if we are not seeing the returns we thought we should see at this point, then it supports looking for the most leveraged places where we could possibly improve it."

The tool also will enable interorganizational comparisons and identification of best-in-class implementation approaches.

Overcoming EHR Obstacles

The development of the new model followed reports that providers have struggled to clearly identify the costs and benefits from EHRs, which can vary widely. Common logistical and conceptual challenges have hindered the adoption and implementation of EHRs, according to the authors of a discussion paper on the model, Return on Information: A Standard Model for Assessing Institutional Return on Electronic Health Record, released on Jan. 6. (Read the report and download the tool.)

The model includes a catalog of categorized benefits, expenses, and potential revenue impacts and identifies the areas where each may exist. Also included is an alignment of benefits with the stated goals of the Office of the National Coordinator for Health IT’s meaningful use standards, assessments of whether benefits are expected to accrue to the provider based on various payment methods, and designation of whether revenue impacts are expected to be negative or positive. Both benefits and revenue impacts are prioritized by their ability to quantify financial impact and the relative scale of financial impact.

"A standard model would provide credibility in discussion with other executives, board members, and even in negotiations with EHR vendors," Jonathan Perlin, MD, chief medical officer, HCA, Inc., and co-chair of IOM's Digital Learning Collaborative, wrote in a Health Affairs blog post. "Second, the comparability the model provides would help identify more efficient approaches to implementation, based on differences in experiences between provider sites, and would accelerate learning about best practices."

Previous research has identified net EHR financial benefits for provider organizations. However, much of the data came from highly capitated systems, the experiences of which may not clearly translate to most other types of hospitals and health systems, according to healthcare finance experts.

The IOM panel agreed that it is difficult to compare studies and determine which differences arise because of the technology itself and the manner of its deployment and which differences are related to the methods used to assess costs and benefits. 

The hope is that the model will "[accelerate] improving the business case for EHR implantation and advanced information technologies that improve the safety, quality and efficiency of health care and foster a learning health system," the report's authors wrote.

Publication Date: Monday, January 06, 2014