Aim: The adoption and implementation of Electronic Health Records (EHR) have the potential to reduce cost of care. Empirical evidence on the relationship between EHR adoption and cost reduction in hospital inpatient care, especially in patient safety related services, has been sparse and inconclusive. This study examined the relationship between the level of electronic health records (EHRs) implementation and cost of care in related to patient safety indicators. Methods: Study was cross-sectional. Data were extracted from the 2009 National Inpatient Sample and the 2009 American Hospital Association (AHA) electronic health record implementation survey. Final sample was 2,626,743 discharges from acute care hospitals in the United States. The mixed model regression was used to analyze three levels of EHR implementation and costs related to eleven patient safety indicators. Results: Hospitals with a comprehensive EHR system had marginally significant lower cost per discharge for three patient safety indicators compared to hospitals with no EHR system. Compared to hospitals with no EHR, costs were $4,246 lower for Postoperative hemorrhage or hematoma, $4,205 lower for postoperative pulmonary embolism or deep vein thrombosis, and $4,971 for postoperative wound dehiscence among hospitals with a comprehensive EHR. Costs among hospitals with a basic EHR were not significantly different than those with no EHR. Conclusions: The high level of EHR implementation was moderately associated with low cost of care.