The financial costs of implementing electronic health records in hospitals

Sarah P. Slight, Casey Quinn, Anthony J. Avery, David W. Bates, Aziz Sheikh

Research output: Contribution to journalMeeting abstractpeer-review


BACKGROUND: Electronic health record (EHR) systems hold the promise of
improving the safety, quality and efficiency of health care.(1) Despite this promise, U.K. hospitals have been slow to implement and adopt such systems.(2) This is due, in part, to the inhibitory cost of EHRs and the uncertainty in relation to whether they can achieve a return on investment. With more and more health care institutions considering implementation of EHR systems worldwide, this study aimed to categorize the costs associated with implementation and the factors that can influence these costs.
METHODS: We conducted a qualitative study to explore the views and perspectives of a diverse range of relevant staff and members of the implementation team at 12 hospitals planning to implement three centrally procured applications i.e., iSOFT’s Lorenzo Regional Care, Cerner’s Millennium, and CSE’s RiO. After obtaining ethical approval, we conducted 41 semi-structured interviews between February 2009 and January 2011. A workable list of main- and sub-themes was developed inductively
and applied systematically to these data with the aid of the computerized qualitative data analysis software QSR N-Vivo.
RESULTS: We identified four overarching cost categories associated with
implementing EHR systems, namely: infrastructure (e.g., hardware and software),
personnel (e.g., project management and training teams), estates or facilities (e.g., furniture and fittings), and other (e.g., consumables and training materials). Many factors were felt to impact on these costs, with different hospitals choosing varying amounts and types of infrastructure. This infrastructure was dependent on the stage of hardware maturity within the hospital; the requirements of the software application being implemented; the products currently available on the market; the budget (if predetermined); and the physical requirements of the wards or office rooms. The amount of resource spent on training clinicians and administrative staff to use the new EHR system depended on the number of users at each site; the training methods
employed; the decision to backfill staff; and the level of support provided to clinical users.
CONCLUSIONS: We found that organizations faced hard compromises relating
to cost, e.g., the infrastructure implemented may not satisfy the demands of
ward staff at peak times, and should therefore consider devoting specific
attention to these areas in the planning phase. With cost considered one of the
most significant barriers to EHR adoption, it is important for hospitals and
governments to be clear from the outset as to the categories of costs involved
and the factors that may impact on these costs. References: 1. UK Clinical
Research Collaboration Select Committee on Health. 2007. 2. Crosson JC,
Ohman-Strickland PA, Cohen DJ, Clark EC, Crabtree BF. Typical electronic
health record use in primary care practices and the quality of diabetes care. Ann
Fam Med. 2012;10(3):221–7.
Original languageEnglish
Pages (from-to)S224-S224
Number of pages1
JournalJournal of General Internal Medicine
Issue number1 Supplement
Publication statusPublished - Apr 2014
Event37th Annual Meeting of the Society-General-Internal-Medicine - San Diego, Canada
Duration: 23 Apr 201426 Apr 2014

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