The American Journal of Medicine
Volume 123, Issue 1 , Pages 40-46 , January 2010

Hospital Computing and the Costs and Quality of Care: A National Study

  • David U. Himmelstein, MD

      Affiliations

    • Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass
    • Corresponding Author InformationReprint requests should be addressed to David U. Himmelstein, MD, Department of Medicine, Cambridge Hospital/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA 02139
  • ,
  • Adam Wright, PhD

      Affiliations

    • Clinical Informatics Research and Development, Partners Healthcare System, Boston, Mass
  • ,
  • Steffie Woolhandler, MD, MPH

      Affiliations

    • Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass

References 

  1. IBM film. http://www.youtube.com/watch?v=t-aiKlIc6uk&eurl=http%3A%2F%2Fvideo%2Egoogle%2Ecom%2Fvideosearch%3Fq%3D1961%2Belectronic%2Bmedical%2Brecords%26hl%3Den%26emb%3D0%26aq%3Df&feature=player_embeddedAccessed June 29, 2009
  2. Barrett JP, Barnum RA, Gordon BB, Pesut RN. Final Report on the Evaluation of the Implementation of a Medical Information System in a General Community Hospital. Pub. no. NTIS PB248340 Columbus, OH: Battelle Columbus Labs; 1975;
  3. Committee on Improving the Patient Record: Institute of Medicine. The Computer-Based Patient Record. Washington, DC: National Academy Press; 1991;
  4. Toward a National Health Information Infrastructure (Report of the Work Group on Computerization of Patient Records to the Secretary of the US Department of Health and Human Services). Washington, DC: US Department of Health and Human Services; April 1993;
  5. Moore JD. Huge savings expected from new EDI standards. Mod Healthc. 1996;26:18–19
  6. Workgroup for Electronic Data Interchange. 1993 Report. http://www.wedi.org/public/articles/full1993report.docAccessed January 15, 2009
  7. Walker J, Pan E, Johnston D, et al. The value of health care information exchange and interoperability (Health Affairs, Web Exclusive January 19, 2005). http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.10v1Accessed January 30, 2009
  8. Hillestad R, Bigelow J, Bower A, et al. Can electronic medical record systems transform health care? (Potential health benefits, savings, and costs). Health Aff (Millwood). 2005;24:1103–1117
  9. HHH.gov: Health Information Technology. http://www.hhs.gov/healthit/Accessed December 20, 2008
  10. Southern California Evidence-based Practice Center. Evidence report/technology assessment number 132: Costs and benefits of health information technology. AHRQ Publication No. 06-E006, April 2006. http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/hitsys.pdfAccessed December 30, 2008
  11. Chaudhry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med. 2006;144:742–752
  12. Congressional Budget Office. Evidence on the costs and benefits of health information technology. Publication number 2976. Washington: Congressional Budget Office, May, 2008. http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdfAccessed December 30, 2008
  13. Congressional Budget Office. Key issues in analyzing major health insurance proposals. Publication number 3102. Washington: Congressional Budget Office, December, 2008. http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdfAccessed December 30, 2008
  14. Woolhandler S, Himmelstein DU, Lewontin JP. Administration costs in US hospitals. N Engl J Med. 1993;329:400–403
  15. Woolhandler S, Himmelstein DU. Costs of care and administration at for-profit and other hospitals in the United States. N Engl J Med. 1997;336:769–774
  16. The Dartmouth Institute. The 2008 Dartmouth Atlas of Health Care. http://www.dartmouthatlas.orgAccessed January 4, 2009
  17. Anonymous. Quality Measures: What are the hospital process of care measures?. http://www.hospitalcompare.hhs.gov/Hospital/Static/About-HospQuality.asp?dest=NAV%7CHome%7CAbout%7CQualityMeasuresAccessed January 19, 2009
  18. Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional variations in Medicare spending (part 1: the content, quality, and accessibility of care). Ann Intern Med. 2003;138:273–287
  19. Anonymous. Most wired winners, 2005 (Hospitals and Health Networks 2005). http://www.hhnmag.com/hhnmag_app/hospitalconnect/search/article.jsp?dcrpath=HHNMAG/PubsNewsArticle/data/backup/0507HHN_CoverStory_WinnersList&domain=HHNMAGAccessed January 6, 2009
  20. Anonymous. The 100 most wired hospitals and health systems. http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2007/0707HHN_CoverStory_07Winners&domain=HHNMAGAccessed January 6, 2009
  21. Garg A, Adhikari NKJ, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–1238
  22. Amarasingham R, Plantinga L, Diener-West M, et al. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009;169:108–114
  23. Chen C, Garrido T, Chock D, et al. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Milwood). 2009;28:323–333
  24. Ash J, Sittig DF, Poon EG, et al. The extent and importance of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc. 2007;14:415–423
  25. Linder JA, Ma J, Bates DW, et al. Electronic health record use and the quality of ambulatory care in the United States. Arch Intern Med. 2007;167:1400–1405
  26. Gandhi TK, Weingart SN, Seger AC, et al. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med. 2005;20:837–841
  27. Nebecker JR, Hoffman JM, Weir CR, et al. High rates of adverse drug events in a highly computerized hospital. Arch Intern Med. 2005;165:1111–1116
  28. Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005;293:1197–1203
  29. Han YY, Carcille JA, Venkataraman ST, et al. Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system. Pediatrics. 2005;116:1506–1512
  30. Del Beccaro MA, Jeffries HE, Eisenberg MA, Harry ED. Computerized provider order entry implementation: no association with increased mortality rates in an intensive care unit. Pediatrics. 2006;118:290–295
  31. Parente S, Dunbar JL. Is health information technology investment related to the financial performance of US hospitals?. Int J Healthc Technol Manag. 2001;3:48–58
  32. Menachemic N, Burkhardt J, Shewchuk R, et al. Hospital information technology and positive financial performance: a different approach to finding an ROI. J Healthc Management. 2006;51:40–58
  33. Sidorov J. It ain't necessarily so: the electronic health record and the unlikely prospect of reducing health care costs. Health Aff (Millwood). 2006;25:1079–1085
  34. Himmelstein DU, Lewontin JP, Woolhandler S. Who administers? Who cares? (Medical administrative and clinical employment in the United States and Canada). Am J Public Health. 1996;86:172–178
  35. Kahn JG, Kronick R, Kreger M, Gans DN. The cost of health insurance administration in California; Estimates for insurers, physicians, and hospitals. Health Aff (Millwood). 2005;24:1629–1639
  36. Jha AK, DesRoches CM, Campbell EG, et al. Use of electronic health records in US hospitals. N Engl J Med. 2009;360:1628–1638
  37. McKinsey Global Institute. US productivity growth 1995-2000, understanding the contribution of information technology relative to other factors. Washington, DC: 2001. http://www.mckinsey.com/mgi/reports/pdfs/productivity/Retailbanking.pdfAccessed January 18, 2009

 Funding: None.

 Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.

 Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(09)00816-X

doi: 10.1016/j.amjmed.2009.09.004

The American Journal of Medicine
Volume 123, Issue 1 , Pages 40-46 , January 2010