Because of an increase in healthcare demand and a decline in available resources, the pressure on healthcare costs has increased throughout the years. This increased pressure of costs forces hospitals to deliver care in an efficient and cost-effective way. Electronic Medical Records (EMR) are often seen as a tool to realize the required cost reduction and efficiency improvements, even though recent research at the Harvard School of Public Health suggests otherwise. What types of benefits can be realized through EMR implementations? Are these benefits applicable to Dutch hospitals? To address these questions, we supported an MSc research project on this particular subject.

To identify existing evidence, literature was studied on realized benefits by EMR implementations. The results were used to create a general EMR benefits model, describing the benefits, linked to specific EMR functions. Next, a case study was set up to see whether the benefits found in the literature were also applicable to Dutch hospitals. Interviews were held at ten Dutch hospitals in different phases of their EMR implementation.
The literature study showed benefits for the two main functions of EMR systems, the Clinical Data Repository (CDR) and Computerized Provider Order Entry (CPOE). Within these main functions, several benefit categories could be identified:

• CDR
  • Chart related savings
  • Reduced transcription
  • Improved billing capabilities
• CPOE
  • Reduction of order time
  • Prevention of orders
  • Prevention of errors
  • Reduced trascription

The reported benefits in the case study could easily be classified to the benefit categories described above. Several benefits were mentioned in all categories, except for improved billing, where only one hospital expected to find benefits. Nevertheless, the resulting benefits model provides a clear and understandable view of the realizable benefits and can therefore be used for the development of EMR business cases in Dutch hospitals.
Only a small majority of the interviewed hospitals have created a business case, and even then this business case is hardly ever used beyond initial investment decisions. Just two of the ten hospitals interviewed use the business case during the subsequent phases of the EMR implementation project. Furthermore, the main reason to implement an EMR is the improvement of quality of care, and patient safety. Perhaps the need to realize financial benefits is not (yet) high enough? This is likely to change drastically in years to come.
The prediction of EMR benefits within a business case is only the first step in their realization. If a hospital wants to achieve the intended effect, these benefits should be monitored throughout the whole implementation project. By monitoring and managing the intended outcome measures, the chances of successfully realizing the projected benefits improve significantly. Business cases are a great tool to facilitate this continuous monitoring and deserve to be used for this purpose as well.