ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Implementation of Electronic Dental Records’ Effects on Cost Savings for a Private Dental Practitioner are Unclear Due to Lack of Research
Clinical Question For a private dental practitioner, are electronic records more cost effective than paper dental records?
Clinical Bottom Line Research in the medical field has shown that electronic records are less expensive than paper records, but at this time there has been no published research in the dental community showing that the cost of electronic records is less expensive than paper records.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 16162555Miller/200514 solo or small-group medical primary care practicesCase Series
Key resultsThe case series found that the average FTE (Full-Time Equivalent) provider would spend $43,826 on initial costs for the implementation/installation of electronic health records with an ongoing costs per year of $8,412. However, the total benefits per FTE provider came out to an average of $32,737 with a maximum of $56,161 and a minimum of $6,600. Thus, it was concluded that the ““average practice paid for its initial and cumulative ongoing EHR costs within two and a half years”” (pg. 6). The sources of benefits due to efficiency savings ($13,144) came from decreases in compensation for medical records and other support staff FTE positions and overtime, and decreases in transcription and paper supply costs. Other financial benefits came from increased coding levels ($16,929) and efficiency revenue gains from increased visits ($2,664).
#2) 12714130Wang/2003Primary care physicians in an ambulatory-care settingCase Report/Case Series
Key resultsThe case report/case series found that the implementation costs would be $24,300. This cost included the software, implementation, support and maintenance, hardware, and temporary productivity loss. The results were acquired using a 5-year-cost-benefit model and found that the net benefit of the implementation of a full electronic medical record system was about $86,400 per provider. The main areas of benefit came from “reductions in drug expenditures, improved utilization of radiology tests, improvements in charge capture, and decreased billing errors”(pg. 7).
Evidence Search ("Cost-Benefit Analysis"[MeSH Terms]) AND "Medical Records Systems, Computerized/economics"[MAJR]
Comments on
The Evidence
Validity: Both studies were performed in medical practices and may not apply to dental studies. 16162555: The study by Miller is in the form of a case series is in the lower half of the Evidence Pyramid and is thus more prone to bias. The researchers performed a retrospective qualitative case study of 14 solo or small-group primary care practices in twelve different states. The selected practices had used EHRs for 1-3 years when first contacted, they had full practices before implementation, had stable complements of billing providers, and they could provide the needed data. The researchers acquired data by conducting semi-structured interviews, reviewing vendor contracts and practice reports, and observing providers’ use of EHRs (in eleven practices). Being a case series study, there is typically no comparison group nor evidence for cause-and-effect relationships; thus, this form of evidence is typically weaker than that of a cohort study or case-control study. Another weak point in the study is that the sample size was relatively small. The study practice might also not be representative of other practices use the same EHR products from different vendors. 12714130: The case report/case series is lower than case control studies on the Evidence Pyramid which means it is even more prone to bias. Like the first study, this type of research study typically offers no comparison group, nor evidence for cause-and-effect relationships, thus lowering the validity of the study. The researchers performed a cost-benefit analysis of electronic medical record usage by primary care physicians in an ambulatory-care setting. The data on the costs and benefits came from data collected from their own medical record system, other published studies, and from expert opinion. The study accounted for a temporary loss of productivity as a source of cost, but some providers may experience longer periods of reduced productivity. The study also claimed that the effectiveness of the interventions used has been “demonstrated in the inpatient setting, but the outpatient effectiveness is less certain” (pg. 6). Another fault lies in the fact that there may be other costs associated with implementing electronic medical records that weren’t take into consideration.
Applicability Electronic health records have the potential to improve care quality and the efficiency of a dental practice to better manage scheduling of operatories, resources, and people. More offices are moving towards EHR and away from paper records. According to the ADA, in 2006, “90% of dentists used some form of practice management software.” The medical community has shown that EHR does have the potential to increase financial gain; however, the dental community still faces the issue of whether or not the transition to EHR is more beneficial than the use of paper records. Thus, more research in the dental community is needed to determine the outcome.
Specialty/Discipline (General Dentistry)
Keywords Electronic health records, paper records, cost-benefit analysis
ID# 3086
Date of submission: 04/11/2016spacer
E-mail saldivaraa@livemail.uthscsa.edu
Author Abiel A. Saldivar
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Jeffery L. Hicks, DDS & John D. Rugh, PhD
Faculty mentor/Co-author e-mail HicksJ@uthscsa.edu; Rugh@uthscsa.edu
Basic Science Rationale
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