COST Hospital Electronic Medical Record Use and Cost of Inpatient Pediatric Care Ronald J. Teufel II, MD, MSCR; Abby Swanson Kazley, PhD; Myla D. Ebeling, BS; William T. Basco Jr., MD, MSCR From the Department of Pediatrics, Medical University of South Carolina (Dr Teufel), Charleston; Department of Health Professions, Health Administration, & Policy, College of Health Professions (Dr Kazley), and Department of Pediatrics (Ms Ebeling and Dr Basco), Medical University of South Carolina, Charleston Address correspondence to Ronald J. Teufel II, MD, MSCR, Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Avenue, PO Box 250561, Charleston, SC 29425 (e-mail: teufelr@musc.edu). Received for publication December 21, 2011; accepted June 12, 2012. ABSTRACT OBJECTIVE: Electronic medical record (EMR) systems are costly for hospitals to implement and maintain, and the effects of EMR on the cost of care for inpatient pediatrics remain unknown. Our objective was to determine whether delivering care with advanced-stage EMR was associated with a decreased cost per case in a national sample of hospitalized children. METHODS: The Healthcare Cost and Utilization Project Kids Inpatient Dataset 2009 identified pediatric discharges. The Healthcare Information and Management Systems Society 2009 database identified hospitals’ EMR use. EMR was classi- fied into 3 stages, with advanced-stage 3 EMR including auto- mation of ancillary services, automation of nursing workflow, computerized provider order entry, and clinical decision support. Multivariable linear regression was used to determine the independent effect of advanced-stage EMR on cost per case. Propensity score adjustment was included to control for nonrandom assignment of EMR use. RESULTS: This analysis included 4,605,454 weighted discharges. EMR use by hospitals that care for children was common: 24% for stage 1, 23% stage 2, and 32% advanced stage 3. The multivariable model demonstrated that advanced stage EMR was associated with an average 7% greater cost per case ($146 per discharge). CONCLUSIONS: The care of children across the United States with EMRs may create a safer health care system but is not asso- ciated with inpatient cost savings. In fact our primary analysis shows a 7% additional cost per case. This finding is contrary to predicted savings and may represent an added barrier in the adoption of EMR for inpatient pediatrics. KEYWORDS: Health Information Technology; electronic medical records; cost; efficiency; hospital ACADEMIC PEDIATRICS 2012;12:429–435 WHAT’S NEW Electronic medical records (EMR) are costly for hospi- tals. We demonstrate EMR use is not associated with inpatient cost savings and may be associated with a 7% additional cost. This finding is contrary to pre- dicted savings and may represent an added barrier in adoption of EMR for hospitals that care for children. INTRODUCTION ELECTRONIC MEDICAL RECORD (EMR) systems have been promoted as a mechanism to improve the overall safety and cost of the U.S. health care system. 1–3 These cost savings are predicted to be $81 billion annually not only because of improvements in safety but also efficiency of care. 2 For hospi- tals, EMR systems are expensive to purchase, implement, and maintain, 2,4 but this investment may well be worth the predicted improvements in safety and cost of care on the hospital level. While early studies suggested that the effectiveness of EMR to improve safety for pediatric patients is dependent on the method of implementation 5–6 and that unintended consequences during implementations may occur, 7–8 the majority of studies demonstrate the potential to improve the safety of care by decreasing medication errors 9–10 or adverse drug events (ADEs). 11-12 These improvements in safety added to improvements in efficiency of inpatient care were used to build the case for the $81 billion in savings. 2 Limited studies within adult pop- ulations have demonstrated inpatient cost savings, but these savings have not been evaluated in children. 13–15 Children’s hospitals have noted the challenge of finding information technology that meets hospital and/or end user satisfaction, 16 and implementation of commercial products within children’s health care has been associated with nega- tive outcomes if not implemented correctly. 6 Caring for chil- dren has unique challenges in regard to medication dosing and medication errors, including off-label use prescribing and weight-based dosing. 17 Given the complexity of pedi- atric medication dosing alone, it is quite possible that use ACADEMIC PEDIATRICS Volume 12, Number 5 Copyright ª 2012 by Academic Pediatric Association 429 September–October 2012