Return on investment (ROI) analysis is often used to build the business case for implementation.  Decision-makers use ROI to evaluate the investment by comparing the magnitude and timing of expected gains to the cost of the investment.  Calculation of return on investments for clinical systems can often be a complicated undertaking.  ROI in terms of health IT involves a comparison of the cost of investment to not only direct revenue gains, but also to savings from aversion of medical errors and operating efficiencies (e.g., improved communication).  Thus, the estimation of ROI for health IT systems may include "hard" benefits (e.g., decrease in length of stay) or "soft" benefits (e.g., improvement in patient safety and quality from misinterpretation of handwriting).  While some hard benefits may be measured in terms of revenue, most soft benefits can be difficult to quantify.

For health IT efforts, especially in the inpatient setting, higher patient volume can increase ROI.  Therefore, smaller hospitals, including CAHs and rural hospitals with less than 50 beds, attempting to implement a health IT system often face relatively larger costs per patient and will require longer time periods to recoup revenue gains.  However, certain benefits, including enhanced patient safety, can be realized sooner.

Resources on understanding what constitutes a ROI:

• HIMSS ROI for the Ambulatory EMR (PDF - 516KB)
• EMR Costs  - EMR Experts
• EMR Pricing Models (PDF - 116KB) 
• EMR Cost-Benefit Analysis: Managing ROI into Reality (PDF - 68KB)  
• Small Practice Economics (PDF - 520KB)
• EHR and the Return on Investment (PDF - 77KB)  
• The ROI of EMR-EHR (PDF - 251KB) - HIMSS
• Michigan State University/ Centricity: EMR Cost-Benefit Analysis: Managing ROI into Reality (PDF - 1.07MB)  - HIMSS
• Cost-Benefit Analysis - MetaStar

Additional Resources for ROI tools:

• EMR ROI Calculator  - Developed by the Health Information Management and Systems Society (HIMSS)