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Jim,
Interesting post. I'm absolutely sure that turning on an EMR assures nothing. Per John Glasser's quip "you dont buy ROI, you manage to it."

Purchasing and installing an EMR gets you a capability. Similar to buying a book. If you don't read it and apply what you read, then you just have a book.

I would be interested in your take on the Premier / CMS HQID work here:

http://www.premierinc.com/about/news/08-jan/performance-pays-2.jsp

Unless they completely fabricated the data (I dont think so), then the results (quality and cost improvements) are true of something. Several of the hospitals they featured are known to have very successful EMR implementations that contributed to the result.

As support for your argument, I would just mention my post "Obama Asks Bloggers For Help With Health Care System Overhaul." The gist is, using Dr David Eddy's Archimedes work (Kaiser, CDC, and employer clients), Eddy shows that closing the inferential gap (Evidence-based Medicine term) does not guarantee lower population costs over time. Cholesterol management in some patients absolutely does / Hypertension management not so much. This suggests that an EMR is a kin to a 2 edged sword that can cut for good or ill.

You started off with "financial efficiencies." I hope I didn't take you off track to a related but different topic.

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