Reducing the Costs of U.S. Health Care: The Role of Electronic Health Records

the federal meaningful use program (1). This is one of the largest public infrastructural investments made by the fed-eral government in health care or any other industry (2). It is widely believed that wiring the health care system will improve the quality, safety, and efficiency of health care. The evidence behind improvements in quality and safety is solid and growing (3). However, we have little empirical evidence that the costs of health care can be reduced through the use of EHRs. Much of the financial work on EHRs has focused on extensively customized home-grown systems in the inpa-tient setting or specific elements of EHRs (such as com-puterized physician order entry) or has lacked rigorous study designs, often relying on expert estimates (4). Rela-tively little work has addressed the effects of EHRs or othe