Electronic medical records are being implemented throughout the US health care system. Incentives for implementation are being partially paid for by the US taxpayer. To receive implementation incentives, clinicians must demonstrate meaningful use—that is, the electronic medical record must be used to improve quality and must satisfy certain indicators.1 What is missing from the definition of meaningful use is any direct measure of either value or cost. It is likely that introducing electronic medical records will improve quality on such dimensions as whether a vaccine is administered, measurement of blood pressure is taken, diabetes is better controlled, and admissions for poorly controlled diabetes are reduced.2 However, in most systems there are no measures built into electronic medical records to help physicians control cost or even to know the cost of the care that they are providing.
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