Electronic Health Records and Quality of Care

AbstractElectronic health records (EHRs) were implemented to improve quality of care and patient outcomes. This study assessed the relationship between EHR-adoption and patient outcomes.We performed an observational study using State Inpatient Databases linked to American Hospital Association survey, 2011. Surgical and medical patients from 6 large, diverse states were included. We performed univariate analyses and developed hierarchical regression models relating level of EHR utilization and mortality, readmission rates, and complications. We evaluated the effect of EHR adoption on outcomes in a difference-in-differences analysis, 2008 to 2011.Medical and surgical patients sought care at hospitals reporting no EHR (3.5%), partial EHR (55.2%), and full EHR systems (41.3%). In univariate analyses, patients at hospitals with full EHR had the lowest rates of inpatient mortality, readmissions, and Patient Safety Indicators followed by patients at hospitals with partial EHR and then patients at hospitals with no EHR (P < 0.05). However, these associations were not robust when accounting for other patient and hospital factors, and adoption of an EHR system was not associated with improved patient outcomes (P > 0.05).These results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system, after controlling for important confounders.To date, we have not yet seen the promised benefits of EHR systems on patient outcomes in the inpatient setting. EHRs may play a smaller role than expected in patient outcomes and overall quality of care.

[1]  Maria Lucia Specchia,et al.  The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. , 2016, European journal of public health.

[2]  J. Lynn,et al.  Value-Based Payments Require Valuing What Matters to Patients. , 2015, JAMA.

[3]  Jessica S. Ancker,et al.  Associations between healthcare quality and use of electronic health record functions in ambulatory care , 2015, J. Am. Medical Informatics Assoc..

[4]  John I. Allen.  Quality Measures for Colonoscopy: Where Should We Be in 2015? , 2015, Current Gastroenterology Reports.

[5]  A. Ryan,et al.  Methods for evaluating changes in health care policy: the difference-in-differences approach. , 2014, JAMA.

[6]  et al.,et al.  How is the electronic health record being used? Use of EHR data to assess physician-level variability in technology use , 2014, J. Am. Medical Informatics Assoc..

[7]  David L. Buckeridge,et al.  A novel method of adverse event detection can accurately identify venous thromboembolisms (VTEs) from narrative electronic health record data , 2014, J. Am. Medical Informatics Assoc..

[8]  Julia Adler-Milstein,et al.  More than half of US hospitals have at least a basic EHR, but stage 2 criteria remain challenging for most. , 2014, Health affairs.

[9]  Kenneth D. Mandl,et al.  Are Meaningful Use Stage 2 certified EHRs ready for interoperability? Findings from the SMART C-CDA Collaborative , 2014, J. Am. Medical Informatics Assoc..

[10]  Yohan Vetteth,et al.  Using electronic medical records to increase the efficiency of catheter-associated urinary tract infection surveillance for National Health and Safety Network reporting. , 2014, American journal of infection control.

[11]  Erika L. Abramson,et al.  Improving immunization data management: an editorial on the potential of electronic health records , 2014, Expert review of vaccines.

[12]  George Hripcsak,et al.  Caveats for the use of operational electronic health record data in comparative effectiveness research. , 2013, Medical care.

[13]  Henk Harkema,et al.  Applying a natural language processing tool to electronic health records to assess performance on colonoscopy quality measures. , 2012, Gastrointestinal endoscopy.

[14]  Jesse C. Crosson,et al.  Typical Electronic Health Record Use in Primary Care Practices and the Quality of Diabetes Care , 2012, The Annals of Family Medicine.

[15]  Wendy W. Chapman,et al.  Developing a natural language processing application for measuring the quality of colonoscopy procedures , 2011, J. Am. Medical Informatics Assoc..

[16]  D. Blumenthal,et al.  The benefits of health information technology: a review of the recent literature shows predominantly positive results. , 2011, Health affairs.

[17]  Spencer S Jones,et al.  Electronic health record adoption and quality improvement in US hospitals. , 2010, The American journal of managed care.

[18]  David W Bates,et al.  Can electronic clinical documentation help prevent diagnostic errors? , 2010, The New England journal of medicine.

[19]  Erika L. Abramson,et al.  Electronic Prescribing Improves Medication Safety in Community-Based Office Practices , 2010, Journal of General Internal Medicine.

[20]  William Hollingworth,et al.  Electronic prescribing at the point of care: a time-motion study in the primary care setting. , 2010, Health services research.

[21]  T. Dewitt,et al.  The Impact of the Electronic Health Record on an Academic Pediatric Primary Care Center , 2009, The Journal of ambulatory care management.

[22]  D. Bates,et al.  Improving safety with information technology. , 2003, The New England journal of medicine.

[23]  Sheryl M. Davies,et al.  Measures of Patient Safety Based on Hospital Administrative Data - The Patient Safety Indicators. Technical Review Number 5. AHRQ Publication No. 02-0038 , 2002 .

[24]  H. Hemilä.  Vitamin C intake and susceptibility to pneumonia. , 1997, The Pediatric infectious disease journal.

[25]  D. Blumenthal.  Launching HITECH. , 2010, The New England journal of medicine.