Barack Obama is certain that electronic health records (EHRs) can improve the quality of care and the efficiency with which it is delivered. How certain? Certain enough to have bet billions on a program that pays providers to adopt and meaningfully use EHRs.

Of course there are many ways to improve quality and efficiency. The Pennsylvania Health Care Cost Containment Council (PHC4) for example, publishes outcomes data for the states’ 172 hospitals. Its reports have driven countless hospital-based efforts to improve quality.

But Obama didn’t bet on that. Nor did he bet on process improvement strategies like TQM or beefed-up peer-review and continuing medical education programs, or recertification programs for physicians.

So, did he bet wisely?

The answer depends on 2 variables: the extent to which EHRs actually do improve quality and efficiency, and the size of his bet.

EHR Bloggers has reviewed numerous studies showing that EHRs do improve care. For example, EHR data has been shown to predict domestic abuse, diabetes and cardiovascular disease and early warning systems like this allow providers to initiate prevention programs that save money and lives down the road.

And EHRs actually outperformed other quality improvement strategies in a recent head-to-head comparison.

So what about the size of the bet? Unfortunately, this is where things get murky, as Fred Schulte of the Huffington Post Investigative Fund recently revealed.

Many folks say Obama bet $19 billion. That number appears in a Health and Human Services press release from last March which introduced David Blumenthal as Obama’s National Coordinator of Health Information Technology.

The release notes that the American Recovery and Reinvestment Act “includes a $19.5 billion investment” in systems which “will save money, improve quality of care for patients and make our health care system far more efficient.”

The $19 billion figure subsequently worked its way into the national lexicon via many articles and blogs. Just last month in fact, Aneesh Chopra, our national CTO cited the figure twice in a podcast from the White House.

It turns out that things aren’t that simple. Two months before HHS went public with the $19 billion figure, federal forecasters estimated they’d pay out $31 billion between 2011 and 2016 via the HITECH “meaningful use” incentive program. From that number, they subtracted $12 billion based on an estimate by the Congressional Budget Office for savings in Medicare and Medicaid spending over the ensuing decade if EHRs made health care delivery more efficient.

Sometime after that and with very little fanfare, the HHS budget was released and the line-item representing anticipated Federal outlays was bumped up $47 billion.

When asked about the triple-step, HHS spokesperson Nicholas Papas said the higher figure is “undergoing revision and we anticipate it will decrease.” He told Schulte that his agency expects to have a “firmer figure” by year-end.

Papas denied any attempt to lowball the number for public consumption, but Steve Ellis, a VP of Taxpayers for Common Sense was quick to call out the Feds for “fuzzy math.”

“This is an effort to make the numbers look better,” he said. “It is always a concern when the costs are tangible and the offsets are squishy.”

Steve Findlay, a health policy analyst with the Consumers Union who advises the Feds on EHRs, agreed: “Nobody knows” whether savings will be realized, he said. “I think that everybody ought to stop guessing at how much money we will save. There’s no way to know.”

For their part, officials at the Cleveland Clinic seemed to concur. The prestigious hospital has spent $100 million on its EHR, and the EHR “drives the quality of care we offer, but is not a cost-saving measure,” said spokeswoman Eileen Sheil. “We don’t tout cost savings.”

Glenn Laffel is Sr. VP, Clinical Affairs at Practice Fusion.

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