The discussion paper begins with the statement “Although it may seem obvious that both the demands for higher reliability and higher-value health care require robust electronic health records (EHRs), information exchange, and deep analytic capabilities, it remains difficult to measure the return on investment (ROI) in information systems.” In my experience EMR cost justification studies in hospitals occur rarely and do not typically drive the purchase decision. Part of the reason for this certainly stems from the difficulty in accurately measuring quantitative benefits. For example, did the EHR cause the process to change or was it simply that the process was reassessed coincident with the implementation. The IOM model presents 28 types of expenses, 32 benefit areas and 14 potential revenue impacts. This model certainly suggests areas to look when considering the costs and benefits, both qualitative and quantitative. It does not however make them any easier to measure.  2014-IOM-Return-on-Investment