Aims and objectives: Computer-based patient records (CPRs) offer many benefits, but have yet to gain widespread acceptance. In the United States, the expense of introducing a comprehensive CPR into an existing practice has been estimated at US$20,000 per provider for the first year and US$5,000 per provider for subsequent years. The substantial investment required is often cited as a major reason for deferring automation. Although it is generally agreed that CPRs have the potential to improve the quality of care, data regarding their financial benefits are generally lacking. To assess properly the value of a CPR, its costs must be weighed against the sum of its benefits. One of the benefits of a CPR is the ability to implement a computer-based reminder system (CRS), which, unlike a manual reminder system, can be adapted to multiple uses with minimal marginal cost for each new application. CRSs have been shown to increase compliance with preventive-care standards. In this analysis, we present a methodology for evaluating the cost-effectiveness of CPRs using the sum of the benefits offered by the CPR, with the example of colon-cancer screening (i.e., fecal occult blood testing, rectal examination and sigmoidoscopy). Methods: A recent meta-analysis reported that CRSs improved compliance with colon-cancer screening guidelines (odds-ratio 2.25 vs. no reminder). Using techniques from decision analysis, our work combines this effect of CRSs with published economic analyses of colon-cancer screening. Findings: From a risk-neutral societal perspective and under appropriate assumptions regarding the cost-effectiveness of colon-cancer screening itself, the cost of the CPR can be partially justified by improved colon- cancer screening. To support this argument, we performed sensitivity analyses on cost-effectiveness of colon-cancer screening and on the odds-ratio of being screened given the availability of a CRS. Conclusions: Although CPRs are expensive, they can measurably improve care. We suggest that the cost of the CPR be weighed against the sum of benefits, many of which reduce overall costs while improving quality of care. Some of the benefits are administrative (e.g., reduced transcription costs, improved billing) but others are medical (e.g., improved screening for colon cancer). When this argument is extended to include other applications with low marginal cost of introduction to the CPR, the overall cost-justification for investment in a CPR becomes clear.
