VOL. 20, NO. 6 n THE AMERICAN JOURNAL OF MANAGED CARE n e183 MANAGERIAL © Managed Care & Healthcare Communications, LLC E lectronic health records (EHRs) have been suggest- ed as a tool for improving the overall quality and cost of care in the United States. 1 Proponents and policy makers have created incentives through the Health Information Technology for Clinical and Economic Health (HITECH) Act to ofset the cost of purchase in order to en- courage the adoption and use of advanced EHR systems in a “meaningful” way. 2 Such criteria for use are based on previ- ous studies that report improvements in quality. 3 To qualify as a meaningful user and beneft from the related incentives, EHR systems must include electronic prescribing, health in- formation exchange with other providers, automated report- ing of quality data, electronic recording of patients’ history (demographics, vital signs, medication and diagnosis lists, and smoking status), created care summary documents, and at least 1 clinical decision support tool. 4-6 Such meaningful use requirements are believed to improve the legibility of rec- ords, reduce prescription errors, improve adherence to best clinical practice guidelines, improve patient and clinician ac- cess to records, and allow exchange of health information. 4 In addition to gains in quality, EHRs have been predicted to save $81 billion annually through safety improvement and increased efciency of care, 7 yet little is known about their impact on hospital cost, and no previous studies have exam- ined the relationship between cost per admission and EHR use in a national sample of acute care hospitals for adults. Cost savings associated with EHRs are expected to come through better coordination of care, reduction of medical errors and adverse drug events (ADEs), and increased ef- ciency and reduction of duplicate testing; previous studies have demonstrated the potential. Silow-Carroll and col- leagues found that at 9 hospitals with comprehensive EHR use, “Faster, more accurate communication and streamlined processes have led to improved patient fow, fewer duplica- tive tests, faster responses to patient inquiries, redeployment of transcription and claims staf, more complete capture of charges, and federal incentive payments,” which lead to cost Association of Electronic Health Records With Cost Savings in a National Sample Abby Swanson Kazley, PhD; Annie N. Simpson, PhD; Kit N. Simpson, DPH; and Ron Teufel, MD ABSTRACT Objectives To determine whether advanced electronic health record (EHR) use in hospitals is associated with lower cost of providing inpa- tient care. Study Design National Inpatient Sample (NIS) and the Health Information Man- agement Systems Society (HIMSS) Annual Survey are combined in the restrospective, cross-sectional analysis. We study patients who are 18 years or older and discharged from a general acute care hospital. Methods Using 2009 data and a cross-sectional design with a gamma distributed generalized linear model, a patient-level analysis is conducted with propensity scores to control for selection bias. Patient- and organizational-level variables are included as controls. The main outcome measure is total cost per patient admission and represents the amount that it costs the hospital to provide services based on the adjusted charges for an admission. Results We include 5,047,089 individuals treated at 550 hospitals in the United States and represent a population-based sample. There are 104 (18.9%) hospitals included that use advanced EHRs. Patients treated in hospitals with advanced EHRs cost, on aver- age, $731, or 9.66%, less than patients admitted to hospitals without advanced EHRs, after controlling for patient and hospital characteristics. Conclusions Hospitals that use advanced EHRs have lower cost per patient admission than comparable hospitals with similar case mix. Am J Manag Care. 2014;20(6):e183-e190