Given the design and performance assessments that you made with the Program Design Tool, the last key question is what level of investment in a new program to recommend. Is the elaborate version the best level of investment or is it too expensive given the benefits it will deliver? What about a moderate or only a modest investment at first? It may be that the cost and performance assessments support taking no action at all. But how would you know?

The Cost Estimation Tool assists in this phase. It identifies the cost categories associated with the design, its implementation and on going operation. This tool allows for the costs of the program to be specified for modest, moderate and elaborate designs. A comparison of the costs at each level to the benefits you identified earlier helps you choose the right level of investment for achieving your goals.

People often tend to underestimate the cost of developing and delivering effective electronic records access programs. This may be due to the fact that there are so many different kinds of expenses that it is easy to forget some. Often planners have less than perfect information and so avoid costing out the parts that are not fully understood. We find that it is critical to identify explicitly as many of the costs as possible, even when you cannot be absolutely exact or certain about every amount. To make these estimations as straightforward as possible for the three levels of service you have described, we have constructed a model cost worksheet. The cost worksheet can be a useful tool for planning the evolution of your service. A worksheet should be completed to represent the costs for various levels of aspiration: modest, moderate and elaborate. In this way, you can assess explicitly what the start-up and on going costs might be for these three different versions. Sometimes it makes a great deal of sense to undertake substantial one-time investments in aiming for an elaborate level of service objectives from the very beginning. In other situations, enormous first-year costs can be daunting, so more modest investments may be more feasible. The point here is to be able to compare the costs of at least three alternative plans as thoroughly and explicitly as possible.